Clinical - GlideScope and intubation assistant devices..

heartICU · Oct 7, 2005

One of our facility's outlying centers just purchased a GlideScope intubation device. It looks like a Mac 3.5 on steriods with a video feed that allows you to see the intubation field on a monitor. I would imagine it would be an EXCELLENT teaching device of true anatomy for new SNRAs or RRNAs or NAGs....
I have used this twice, once with a regular 8.0 and then today with a 37 Fr DLT. I was wondering if anyone else has used a device similar to this and your opinion of the device. It does create somewhat of an awkward angle that usually necessitates a stylet to be used. It seems to me that the angle required due to the shape of the C on the blade makes you need a sharp angle on the OETT tip to make the cut to get the tube into the VC but then this sharp angle makes you butt up against the anterior wall of the trachea. One of the main benefits I could see is using it for FO intubation where using the FO wand alone fails. The wand is able to generate no lifting force whatsoever and if you needed lifiting force, then if you ever played Xbox in your life, this would be the easiest intubation ever. Almost same scenario with a bougie. While large bore OETTs are not simple, I imagine I just need to play with it some more.
Any suggestions guys??

I hve used the glidescope many times, and you are right - it can be difficult to manipulate the ETT because of that curve. Our glidescope has a special stylet that we use that greatly increases our success. The GlideScope has saved many airways for us - some people are so comfortable with it they call for it instead of the fiberoptic first.

I actually just did a joint presentation on the GlideScope and LMA CTrach with a student from my school at the Fall Meeting of the Ohio State Assn of Nurse anesthetists. One of the anesthesiologists at my institution actually has a website on the Glidescope with many videos you can watch. The link is at the bottom.

http://glidescope.homestead.com/

jwk · Oct 7, 2005

The GlideScope is our hottest new toy. The view is amazing, even if it is a black and white screen.

Use a stylet, always, and mold the curve to the blade of the GlideScope. At the distal end, curve the tube/stylet just a little downward, in the opposite direction of the other curve. This helps by keeping the tip of the tube just a little less anterior than it would otherwise go.

We are using them a lot on our gastric bypass patients. I've used it on several cervical fusions where we didn't want to be manipulating the head and neck while placing our tube.

The biggest limitation I've found so far is that the blade itself is thick, and in people with relatively small mouths or limited opening, it can be hard getting the blade in, and then you have very little room left to get the tube in and manipulate it. If I can't get the tube in with the GlideScope, that's always been the reason, because the view is great 100% of the time. The manufacturer tells us that the next generation device will have a blade that is not as thick, which should be a great improvement.

rn29306 · Oct 7, 2005

The GlideScope is our hottest new toy. The view is amazing, even if it is a black and white screen.
Use a stylet, always, and mold the curve to the blade of the GlideScope. At the distal end, curve the tube/stylet just a little downward, in the opposite direction of the other curve. This helps by keeping the tip of the tube just a little less anterior than it would otherwise go.
We are using them a lot on our gastric bypass patients. I've used it on several cervical fusions where we didn't want to be manipulating the head and neck while placing our tube.
The biggest limitation I've found so far is that the blade itself is thick, and in people with relatively small mouths or limited opening, it can be hard getting the blade in, and then you have very little room left to get the tube in and manipulate it. If I can't get the tube in with the GlideScope, that's always been the reason, because the view is great 100% of the time. The manufacturer tells us that the next generation device will have a blade that is not as thick, which should be a great improvement.

Ours is in color..Pretty kewl display of anatomy. :) The only problem I forsee is others thinking once again what we do is easy. Yes, it is fun to group around your co-workers and rag them when using it, but others in the room are seeing it also.

Sank a GlideScope-assisted 39 FR DLT today...

WAREAGLE · Oct 11, 2005

I really like the glidescope, but for new students it has good & bad sides. It is great to view the airway anatomy, but like you all have mentioned a little hard to manipulate the tube for intubation. Also, when you are first starting out & trying to get the feel of not rocking but lifting up & forward it can throw you off a little. Just putting out this info for new students to keep in mind. It is an awesome addition for difficult airways & cervical precautions.

zrmorgan · Oct 15, 2005

Regarding the awkward angle...

I agree with the prior post of actually molding the tube to the scope itself with a stylet in the ett. One of our attendings (much to the techs chagrin who has to clean the fiber) uses a flexible fiber optic as a stylet so he can articulate (with the thumb lever) the fiber through the cords under glidescope view, then slide the ett over the fiber through the cords. He jokingly refers to it as a "fiberglide" technique. I guess you can switch to the fiber eye piece as a back up for an additional perspective.

I have found it is also easy to take your eyes off of the patients mouth/ teeth when looking at the screen, and even though the blade is plastic, I believe it could cause some considerable trauma there.

Other than that, it is a great option. Unfortunately, I think my experience with fast-trach / light-wand techniques have suffered because it is so easy to roll the glidescope into a room - an easy crutch for a novice at difficult airways. I have yet to see a Glidescope intubation fail...I would be interested to hear if someone has, and what may have worked instead.