La vía aérea y el Glidescope

Estudio comparativo sobre la utilidad del Glidescope o  laringoscopía Macintosh al intubar vías aéreas normales A comparative study on the usefulness of the Glidescope or Macintosh laryngoscope when intubating normal airways. Choi GS, Lee EH, Lim CS, Yoon SH. Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Daejeon, Korea. Korean J Anesthesiol. 2011 May;60(5):339-43. Epub 2011 May 31. Abstract BACKGROUND: The Glidescope Videolaryngoscope (GVL) is a newly developed video laryngoscope. It offers a significantly improved laryngeal view and facilitates endotracheal intubation in difficult airways, but it is controversial in that it offers an improved laryngeal view in normal airways as well. And the price of GVL is expensive. We hypothesized that intubation carried out by fully experienced anesthesiologists using the GVL with appropriate pre-anesthetic preparations offers an improved laryngeal view and shortened intubation time in normal airways. Therefore, the aim of this study was to compare the GVL with the Macintosh laryngoscope in normal airways and to determine whether GVL can substitute the Macintosh laryngoscope. METHODS: This study included 60 patients with an ASA physical status of class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups, GVL (group G) or Macintosh (group M). ADS (airway difficulty score) was recorded before induction of anesthesia. The anesthesiologist scored vocal cord visualization using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). The time required to intubate was recorded by an assistant. RESULTS: There was a significant increase in POGO when using the GVL (P < 0.05). However, there was no difference in the time required for a successful tracheal intubation using the GVL compared with the Macintosh laryngoscope. The VAS score on the ease of intubation was significantly lower for the GVL than for the Macintosh laryngoscope (P < 0.05). CONCLUSIONS: GVL could be a first-line tool in normal airways http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110292/pdf/kjae-60-339.pdf   Videolaringoscopía con GlideScope en la vía aérea difícil simulada: Bougie versus Estilete Estándar  GlideScope Videolaryngoscopy in the Simulated Difficult Airway: Bougie vs Standard Stylet. Nielsen AA, Hope CB, Bair AE. University of California, Davis School of Medicine. West J Emerg Med. 2010 Dec;11(5):426-31. Abstract OBJECTIVE: GlideScope(®) videolaryngoscopy (GVL) has been shown to improve visualization of the glottis compared to direct laryngoscopy (DL). However, due to the angle of approach to the glottis, intubation can still be challenging. We hypothesized that novice GVL users would be able to intubate faster and easier using an airway introducer (frequently known as a bougie) than with a standard intubating stylet. METHODS: Intubations were performed on a human airway simulator with settings for easy and difficult airways. Participants were emergency medicine (EM) residents or faculty (n=21) who were novice GVL users. Participants were intubated a total of eight times (four GVL, four DL) using either a bougie or an intubating stylet. We recorded time to intubate (TTI) and difficulty rating using a visual analog scale (VAS) and non-parametric statistical methods for analysis. We reported medians with interquartile range (IQR). RESULTS: The median TTI with difficult airway settings and the bougie-GVL was 76 seconds (IQR 50, 102) versus 64 seconds (IQR 50.5, 125), p=0.76 for the stylet-GVL combination. The median VAS difficulty score, on difficult airway settings, for the bougie-GVL was 5 cm (IQR 3.3, 8.0) versus 6.2 cm (IQR 5.0, 7.5) with the stylet-GVL, p=0.53. CONCLUSION: Among novices using GVL for simulated difficult airway management, there was no benefit, in terms of speed or ease of intubation, by using the bougie over the standard stylet. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027433/pdf/wjem11_5p426.pdf     Efectividad de la rutina clínica del Glidescope en el manejo de la vía aérea difícil: análisis de 2,004 intubaciones con Glidescope, complicaciones, y fallas en dos instituciones Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA. Anesthesiology. 2011 Jan;114(1):34-41. Abstract INTRODUCTION: The Glidescope video laryngoscope has been shown to be a useful tool to improve laryngeal view. However, its role in the daily routine of airway management remains poorly characterized. METHODS: This investigation evaluated the use of the Glidescope at two academic medical centers. Electronic records from 71,570 intubations were reviewed, and 2,004 cases were identified where the Glidescope was used for airway management. We analyzed the success rate of Glidescope intubation in various intubation scenarios. In addition, the incidence and character of complications associated with Glidescope use were recorded. Predictors of Glidescope intubation failure were determined using a logistic regression analysis. RESULTS: Overall success for Glidescope intubation was 97% (1,944 of 2,004). As a primary technique, success was 98% (1,712 of 1,755), whereas success in patients with predictors of difficult direct laryngoscopy was 96% (1,377 of 1,428). Success for Glidescope intubation after failed direct laryngoscopy was 94% (224 of 239). Complications were noticed in 1% (21 of 2,004) of patients and mostly involved minor soft tissue injuries, but major complications, such as dental, pharyngeal, tracheal, or laryngeal injury, occurred in 0.3% (6 of 2,004) of patients. The strongest predictor of Glidescop e failure was altered neck anatomy with presence of a surgical scar, radiation changes, or mass. CONCLUSION: These data demonstrate a high success rate of Glidescope intubation in both primary airway management and rescue-failed direct laryngoscopy. However, Glidescope intubation is not always successful and certain predictors of failure can be identified. Providers should maintain their competency with alternate methods of intubation, especially for patients with neck pathology. http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2011&issue=01000&article=00017&type=abstract

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