The GlideScope^® Video Laryngoscope and the Macintosh Laryngoscope Compared in a Simulated Difficult Airway with Immobilization and Bleeding—A Randomized, Prospective, Crossover Study

Wiebke Ackermann, Leonardus M. Pott, Sonia J. Vaida, Arne O. Budde

Milton S. Hershey Medical Center—Department of Anesthesiology, Penn State University, Columbus, USA..
Milton S. Hershey Medical Center—Department of Anesthesiology, Penn State University, Hershey, USA.

DOI: 10.4236/ojanes.2012.22007                

Abstract

Background: This study assesses the effectiveness of the GlideScope^? Videolaryngoscope (GS) in comparison with the Macintosh laryngoscope in a simulated difficult airway with blood in the airway and restricted range of motion of the neck. 39 participants experienced with the GS and the Macintosh laryngoscope were used. Methods: This analysis is a prospective, randomized, crossover study. Our study was performed on an intubation simulation model with artificial blood in the airway and restricted range of motion. The intubation time was recorded from picking up the laryngoscope to advancing the endotracheal tube through the glottic opening. Secondary endpoints were the Cormack & Lehane score, the percentage of the glottis seen, the subjective difficulty of the procedure on a scale of 0 to 10, the number of adjustment maneuvers, the number of attempts, and the number of failed intubations. Attempts were defined as removal of instruments from the airway and reinsertion. Failed intubations were defined as esophageal intubations or intubations lasting longer than 120 seconds. Results: The mean intubation time was 47.6 seconds with the GS and 21.4 seconds with the Macintosh laryngoscope. There were 3 failed intubations with the Macintosh laryngoscope and 4 failed intubations with the GS. The failed intubations with the Macintosh laryngoscope were all esophageal intubations. The failed intubations with the GS were due to exceeding the time limit of 120 seconds. Both devices had a mean Cormack & Lehane score of 1.8 and the mean percentage of the Glottis seen was 58% for both devices. The average subjective difficulty on a scale from 0 to 10 was ranked 4.16 for the Macintosh and 5.14 for the GS. Participants needed an average of 1 adjustment maneuvers with the Macintosh laryngoscope and 2.7 adjustments with the GS. Conclusion: The GS, used by experienced anesthesiologists in a simulated difficult airway, had an inferior performance compared to the Macintosh laryngoscope in terms of intubation time, number of intubation attempts, number of adjustment maneuvers, and number of failed intubations.

Keywords

GlideScope; Difficult Airway

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	B. T. Finucane and A. H. Santora, “Principles of Airway Management,” 3rd Edition, Springer-Verlag Inc., New York, 2003.
[2]	F. S. Xue, G. H. Zhang, J. Liu, X. Y. Li, Q. Y. Yang, Y. C. Xu and C. W. Li, “The Clinical Assessment of Glidescope in Orotracheal Intubation under General Anesthesia,” Minerva Anestesiologica, Vol. 73, No. 9, 2007, pp. 451-457.
[3]	R. M. Cooper, J. A. Pacey, M. J. Bishop and S. A. McCluskey, “Early Clinical Experience with a New Videolaryngoscope (GlideScopeR)in 728 Patients,” Canadian Journal of Anaesthesia, Vol. 52, No. 2, 2005, pp. 191-198. doi:10.1007/BF03027728
[4]	T. J. Lim, Y. Lim and E. H. Liu, “Evaluation of Ease of Intubation with the (GlideScopeR) or Macintosh Laryngoscope by Anaesthetists in Simulated Easy and Difficult Laryngoscopy,” Anaesthesia, Vol. 60, No. 2, 2005, pp. 180-183. doi:10.1111/j.1365-2044.2004.04038.x
[5]	H. J. Kim, S. P. Chung, I. C. Park, J. Cho, H. S. Lee and Y. S. Park, “Comparison of the GlideScope Video Laryngoscope and Macintosh Laryngoscope in Simulated Tracheal Intubation Scenarios,” Emergency Medicine Journal, Vol. 25, 2008, pp. 279-282. doi:10.1136/emj.2007.052803
[6]	M. R. Rai, A. Dering and C. Verghese, “The GlidescopeR System: A Clinical Assessment of Performance,” Anaesthesia, Vol. 60, No. 1, 2005, pp. 60-64. doi:10.1111/j.1365-2044.2004.04013.x
[7]	M. A. Malik, C. H. Maharaj, B. H. Harte and J. G. Laffey, “Comparison of Macintosh, Truview EVO2R, GlidescopeR, and AirwayscopeR Laryngoscope Use in Patients with Cervical Spine Immobilization,” British Journal of Anaesthesia, Vol. 101, No. 5, 2008, pp. 723-730. doi:10.1093/bja/aen231
[8]	D. A. Sun, C. B. Warriner, D. G. Parsons, R. Klein, H. S. Umedaly and M. Moult, “The GlideScopeR Video Laryngoscope: Randomized Clinical Trial in 200 Patients,” British Journal of Anaesthesia, Vol. 94, No. 3, 2005, pp. 381-384. doi:10.1093/bja/aei041
[9]	Y. Hirabayashi, T. Hakozaki, K. Fujisawa, N. Sata, S. Kataoka, O. Okada, M. Yamada, K. Hotta, N. Seo and K. Ikeda, “Use of a New Video-Laryngoscope (GlideScope) in Patients with a Difficult Airway,” Masui, Vol. 56, No. 7, 2007, pp. 854-857.
[10]	G. L. Savoldelli, E. Schiffer, C. Abegg, V. Baeriswyl, F. Clergue and J. L. Waeber, “Comparison of the GlidescopeR, the McGrathR, the AirtraqR and the Macintosh Laryngoscopes in Simulated Difficult Airways,” Anaesthesia, Vol. 63, No. 12, 2008, pp. 1358-1364. doi:10.1111/j.1365-2044.2008.05653.x
[11]	M. A. Malik, C. O’Donoghue, J. Carney, C. H. Maharaj, B. H. Harte and J. G. Laffey, “Comparison of the GlidescopeR, the Pentax AWSR, and the Truview EVO2R with the Macintosh Laryngoscope in Experienced Anaesthetists: A Manikin Study,” British Journal of Anaesthesia, Vol. 102, No. 1, 2009, pp. 128-134. doi:10.1093/bja/aen342
[12]	P. Nouruzi-Sedeh, M. Schumann and H. Groeben, “Laryngoscopy via Macintosh Blade versus GlideScope: Success Rate and Time for Endotracheal Intubation in Untrained Medical Personnel,” Anesthesiology, Vol. 110, No. 1, 2009, pp. 32-37. doi:10.1097/ALN.0b013e318190b6a7
[13]	S. Nasim, C. H. Maharaj, M. A. Malik, J. O’Donnell, B. D. Higgins and J. G. Laffey, “Comparison of the GlidescopeR and Pentax AWSR Laryngoscopes to the Macintosh Laryngoscope for Use by Advanced Paramedics in Easy and Simulated Difficult Intubation,” BMC Emergency Medicine, No. 17, 2009, p. 9. doi:10.1186/1471-227X-9-9
[14]	M. A. Malik, P. Hassett, J. Carney, B. D. Higgins, B. H. Harte and J. G. Laffey, “A Comparison of the GlidescopeR, Pentax AWSR, and Macintosh Laryngoscopes When Used by Novice Personnel: A Manikin Study,” Canadian Journal of Anaesthesia, Vol. 56, No. 11, 2009, pp. 802-811. doi:10.1007/s12630-009-9165-z
[15]	A. T. Narang, P. F. Oldeg, R. Medzon, A. R. Mahmood, J. A. Spector and D. A. Robinett, “Comparison of Intubation Success of Video Laryngoscopy versus Direct Laryngoscopy in the Difficult Airway Using High-Fidelity Simulation,” The Journal of the Society for Simulation in Healthcare, Vol. 4, No. 3, 2009, pp. 160-165. doi:10.1097/SIH.0b013e318197d2e5
[16]	L. Powell, J. Andrzejowski, R. Taylor and D. Turnbull, “Comparison of the Performance of Four Laryngoscopes in a High-Fidelity Simulator Using Normal and Difficult Airway,” British Journal of Anaesthesia, Vol. 103, No. 5, 2009, pp. 755-760. doi:10.1093/bja/aep232
[17]	M. A. Malik, R. Subramaniam, C. H. Maharaj, B. H. Harte and J. G. Laffey, “Randomized Controlled Trial of the Pentax AWSR, GlidescopeR, and Macintosh Laryngoscopes in Predicted Difficult Intubation,” British Journal of Anaesthesia, Vol. 103, No. 5, 2009, pp. 761-768. doi:10.1093/bja/aep266
[18]	G. Serocki, B. Bein, J. Scholz and V. Dorges, “Management of the Predicted Difficult Airway: A Comparison of Conventional Blade Laryngoscopy with Video-Assisted Blade Laryngoscopy and the GlideScope,” European Journal of Anaesthesiology, Vol. 27, No. 1, 2010, pp. 24-30. doi:10.1097/EJA.0b013e32832d328d
[19]	G. L. Murrell, K. M. Sandberg and S. A. Murrell, “GlideScope Video Laryngoscopes,” Otolaryngology—Head and Neck Surgery, Vol. 136, 2007, pp. 307-308. doi:10.1016/j.otohns.2006.10.003
[20]	W. A. Dow and D. G. Parsons, “‘Reverse Loading’ to Facilitate GlidescopeR Intubation,” Canadian Journal of Anaesthesia, Vol. 54, No. 2, 2007, pp. 161-162. doi:10.1007/BF03022022