Transcript The Role of the Glidescope Videolaryngoscope in the DifficultAirway Michael Aziz, M.D., David Healy, M.D., F.R.C.A., M.R.C.P., Sachin Kheterpal, M.D., Dawn Dillman,

The Role of the Glidescope Videolaryngoscope in the Difficult
1
Airway
Michael Aziz, M.D., David Healy, M.D., F.R.C.A., M.R.C.P., Sachin Kheterpal, M.D., Dawn
Dillman, M.D., Ansgar Brambrink, M.D., Ph.D.
Introduction:
Glidescope
Attempted First
(Primary)
This investigation evaluates the
use of the Glidescope video
laryngoscope at two large tertiary
care academic medical centers
utilizing anesthesia information
management systems. The study
aims to identify the success rate of
Glidescope intubation in normal
airways, in airways predicted to be
difficult by direct laryngoscopy, and
after failed direct laryngoscopy.
1.
Successful on
first attempt?
No
907
Yes
Total
UHMS
No
Successful on
repeated
attempts?
Yes
OHSU
1610
Rescued with
an alternate
device?
Direct
Laryngoscopy
Attempted first
(Unsuccessful)
Flexible Fiberoptic
Attempted first
(Unsuccessful)
Rescued with
Glidescope
Rescued with
Glidescope
37
UHMS
65
OHSU
16
Yes
UHMS
27
OHSU
143
Yes
UHMS
81
No
OHSU
5
UHMS
10
OHSU
6
Yes
UHMS
2
No
OHSU
1
UHMS
Results:
703
Total
102
Total
43
Total
224
Total
15
Total
8
Total
2
No
Methods:
Electronic anesthesia information
systems at two large tertiary care
academic medical centers were
queried for Glidescope intubations.
Patient history and physical
examination details regarding
airway management were
evaluated as well as the intubation
narrative from the anesthetic
record. Each intubation was
classified into categories to
determine the role of the
Glidescope during the intubation
sequence.
OHSU
1
100
2,004 Glidescope intubations were
recorded and included for analysis out of
71,570 potential intubations. The
Glidescope was used to successfully
intubate with one attempt 1,610/1,755=
92% and 1,712/1,755= 98% for one or
more attempts. The Glidescope was used
in patients without any predictors of difficult
direct laryngoscopy 576 times (24%). The
success rate for this group was 98%. For
patients with at least one predictor of
difficult direct laryngoscopy (1428), the
success rate was 96%. The Glidescope
rescued a failed direct laryngoscopy
224/239= 94%. Several cases were
identified where the Glidescope rescued
failed flexible fiberoptic intubation 7/10.
90
Conclusion:
80
70
60
50
All (2004)
Primary
(1755)
Intubation success (%)
Rescued Rescued
DL (239)
FOI (10)
multiple attempts (%)
This investigation speaks to the
effectiveness of the Glidescope for
intubation of patients who have known or
predicted difficult airways. Results from
this study merit consideration for use of
rigid videolaryngoscopes in the
management of difficult airways.
Aziz, M. Healy, D. Kheterpal, S. Fu, R. Dillman, D. Brambrink, A. The Routine Clinical Practice Effectiveness of the Glidescope in Difficult Airway Management: An Analysis of 2,004 Glidescope Intubations, Complications, and Failures from Two Institutions. Anesthesiology. n Press