GlideScope Superiority  for  patients with Neck abscesses of Dental Origin  and  reduced Mouth opening.

      The treatment of Neck infections , Epiglotitis, and Abscesses present a daunting challenge for the Anesthesiologist who must manage the toxic physiology at the same time as plan a method of Pain relief and anesthetic management. Relief of gross abcesses prior to anesthesia is always beneficial and can take the risk level down to some extent. Unfortunately drainage is usually not possible into the lumen  but can sometimes be accomplished via needle aspiration combined with imaging or external drainage. Extensive swelling and cellulitis cannot be managed this way. High doses of appropriate broad spectrum antibiotics are essential at first encounter.

     The Glidescope has been used effectively  for Epiglotittis. The risk of this entity is that pus will discharge unexpectedly or that in some other way control will be lost so management must be individualzed to control risk.

     Infections of Odontogenic origin associated with reduced mouth opening or trismus  present great risk for anesthesia and following observation that the 60 degree angle Glidescope Video laryngoscope was successful when used for failed Direct Laryngoscopy Schumann et. al. decided to test this phenomenon with a randomized study comparing patients whose care was started with DL versus those whose care was started with GlideScope 60 degree VL. 

    The results prove that in these high risk patients Glidescope intubation was clearly superior as reported here.

"Results. Intubation with the Glidescope was always successful, while conventional intubation failed in 17 out of 50 patients (P,0.0001). In all patients in whom conventional tracheal intubation failed, a subsequent attempt with the Glidescope was successful. The view at the glottis (according to Cormack and Lehane; P,0.0001), intubation duration [34 s (CI 27–41) vs 67 s (CI 52–82), mean (95% confidence interval); P1⁄40.0001], and need for supporting manoeuvres (P,0.0001) were significantly different. The inter-incisor distance improved overall with induction of anaesthesia from 2.0 cm (CI 1.8–2.2) to 2.6 cm (CI 2.3–2.9; P,0.0001) and was correlated with the duration of symptoms.

Conclusions. In patients with odentogenous abscesses, the use of a Glidescope laryngoscope was associated with significantly faster tracheal intubation, with a better view, fewer supporting manoeuvres, and a higher success rate than with a conventional laryngoscope. Improvement of the inter-incisor distance after induction of anaesthesia correlated with the duration of symptoms. "1.

Appendix:

1. Tracheal intubation in patients with odentogenous abscesses and reduced mouth opening
M. Schumann1, I. Biesler1, A. Borgers1, R. Pfortner2, C. Mohr2 and H. Groeben1*
1 Department of Anaesthesiology, Critical Care Medicine and Pain Therapy and 2 Department of Oral and Cranio-Maxillofacial Surgery, Kliniken Essen-Mitte, Henricistr. 92, Essen 45136, Germany .

British Journal of Anaesthesia 112 (2): 348–54 (2014) 

AdvanceAccesspublication26September2013 . doi:10.1093/bja/aet310