Anesthesiology, V 114 • No 1 34-41
GlideScope use was studied in the Oregon Health and Science University, Portland and also the University of Michigan , Ann Arbor where during the study period 71,570 endotracheal intubations were reviewed and there were 2,004 GlideScope applications .
Overall GlideScope success: 97% (1,944 / 2,004)
Primary GlideScope use success: 98% (1,712 / 1,755)
Predictors of difficult DL GlideScope success 96% (1,377 / 1,428)
GlideScope rescue after failed DL 94% (244 / 239)
GlideScope rescue after failed Fiberoptic scope 80% (8 / 100)
Complications:
Minor - soft tissue injury 1% (21 / 2,004)
Major 0.3 % - Pharyngeal, tracheal ,laryngeal injury 0.3% (6 / 2,004)
Limitations:
The GlideScope failure was associated with neck radiation, neck mass, or a surgical scar by the Aziz group study.
Comment:
This study is significant because the GlideScope was used in institutions where the use is taught on a regular basis and use as a rescue device is well established. The ASA difficult airway algorithm is used and regularly taught as well. The use for failed FOB use is interesting because the FOB is widely regarded as the "Gold Standard" technology for difficult airway management.
The effectiveness shown in this excellent study supports the anecdotal information in the field where many users consider GlideScope 60 degree angle scopes to be the most effective rescue available for difficult airway management.
The use of video laryngoscopy as a first line with GlideScope has been practiced in many ED units and some ORs and this practice is growing.
Caldiroli devised what he considered to be an optimal practice where the GlideScope was used according to a pre-application assessment using the El Ganzouri index. The reported results on 6,276 patients demonstrated difficult GlideScope video laryngoscopy in only 0.14% or 14 patents. The predictive value was very high when EGRI was 0-6 . The other advantage of this strategy is that regular use leads to very high skill levels among the anesthesiology team. The least optimal pattern of behaviour is when rescue tools are only used with unexpected difficult conditions where skills may be found to be wanting.
Reference:
1. Caldiroli A new difficult airway algorithm based on the El Ganzouri Index GlideScope video laryngoscope. a new look for intubation. Minerva Anesthesiologica vol. 77 2011
2. El Ganzouri Preoperative Airway Assessment: predictive value of a multivariate risk index. Anesth Analg 1996; 82;1197-2004.
