British Journal of Anaesthesia 112 (2): 348–54 (2014)
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.
* Corresponding author. E-mail: h.groeben@kliniken-essen-mitte.de
Background. Odentogenous abscesses with involvement of the facial or cervical spaces can be
life-threatening andoften have to be drained under general anaesthesia. Trismus andswelling
can make intubation with a Macintosh laryngoscope difficult or even impossible. However,
indirect laryngoscopy has been successful when conventional direct laryngoscopy has
failed. Therefore, we evaluated the efficacy of the Glidescope laryngoscope in patients with
odentogenous abscesses and the improvement in mouth opening after neuromuscular block.
Methods. After approval of the ethics committee, 100 patients with odentogenous abscesses
were randomized to undergo tracheal intubation with the Glidescope or Macintosh
laryngoscope. Success rate, visualization of the glottis, intubation duration, and need for
supporting manoeuvres were evaluated.
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); P.0.0001], 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.
Keywords: intubation, difficult; intubation, tracheal; laryngoscope, Glidescope; laryngoscope,
Macintosh
Accepted for publication: 26 June 2013
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