Skip to main content
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 11/2020

19.08.2020 | Reports of Original Investigations

Simultaneous en bloc endotracheal tube insertion with GlideScope® Titanium™ video laryngoscope use: a randomized-controlled trial

verfasst von: Timothy P. Turkstra, MD, MEng, FRCPC, Daniel C. Turkstra, Alexander W. Pavlosky, MD, Philip M. Jones, MD, MSc, FRCPC

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 11/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Intubation-associated trauma with the GlideScope is rare, but when it occurs, it is likely due to advancing the endotracheal tube (ETT) blindly between the direct view of the oropharynx and the video view of the glottis. It is also occasionally difficult to advance the ETT to the glottic aperture despite a good view of the glottis on the monitor. One technique to potentially address both issues is to introduce the ETT en bloc with the GlideScope, thus visualizing the ETT tip throughout its entire path. We hypothesized that this en bloc technique could be faster and potentially easier than the standard technique.

Methods

Fifty patients with normal-appearing airways who required orotracheal intubation for elective surgery were randomly allocated to intubation with either the en bloc or the standard (GlideScope-first-then-ETT) technique. A three-dimensional printed clip was utilized to secure the ETT to the GlideScope during en bloc insertion. The primary outcome was time to intubation, defined from mask removal to first end-tidal carbon dioxide detection, recorded by a blinded observer. Secondary outcomes were subjective ease of intubation (100-mm visual analogue scale [VAS], 0 = easy; 100 = difficult), number of intubation attempts/failures, and incidence of oropharyngeal trauma (bleeding).

Results

The median [interquartile range (IQR)] intubation time was 36 [31–42] sec with the en bloc technique vs 41 [37–50] sec with the standard technique (difference in medians, 5 sec; 95% confidence interval [CI], 2 to 11; P = 0.008). The median [IQR] ease of intubation VAS was 11 [9–21] mm with the en bloc technique, and 15 [11–24] mm with the standard technique (difference in medians, 4 mm; 95% CI, −2 to 8; P = 0.19). Laryngoscopic grade and number of intubation attempts were similar between the groups; there was no oropharyngeal trauma noted.

Conclusion

In this study of video laryngoscopy, intubation was slightly faster with the en bloc technique than with the standard GlideScope intubation technique, although the clinical importance of this difference is unknown.

Trial registration

www.​clinicaltrials.​gov (NCT02787629); registered 1 June 2016.
Literatur
1.
Zurück zum Zitat Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M. The GlideScope video laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2005; 94: 381-4.CrossRef Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M. The GlideScope video laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2005; 94: 381-4.CrossRef
2.
Zurück zum Zitat Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anesth 2005; 52: 191-8.CrossRef Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anesth 2005; 52: 191-8.CrossRef
3.
Zurück zum Zitat Xue FS, Zhang GH, Liu J, et al. The clinical assessment of Glidescope in orotracheal intubation under general anesthesia. Minerva Anestesiol 2007; 73: 451-7.PubMed Xue FS, Zhang GH, Liu J, et al. The clinical assessment of Glidescope in orotracheal intubation under general anesthesia. Minerva Anestesiol 2007; 73: 451-7.PubMed
4.
Zurück zum Zitat Andersen LH, Rovsing L, Olsen KS. GlideScope videolaryngoscope vs. Macintosh direct laryngoscope for intubation of morbidly obese patients: a randomized trial. Acta Anaesthesiol Scand 2011; 55: 1090-7. Andersen LH, Rovsing L, Olsen KS. GlideScope videolaryngoscope vs. Macintosh direct laryngoscope for intubation of morbidly obese patients: a randomized trial. Acta Anaesthesiol Scand 2011; 55: 1090-7.
5.
Zurück zum Zitat Griesdale DE, Liu D, McKinney J, Choi PT. Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. Can J Anesth 2012; 59: 41-52.CrossRef Griesdale DE, Liu D, McKinney J, Choi PT. Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. Can J Anesth 2012; 59: 41-52.CrossRef
6.
Zurück zum Zitat Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105-11.CrossRef Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105-11.CrossRef
7.
Zurück zum Zitat Law JA, Broemling N, Cooper RM, et al. The difficult airway with recommendations for management-part 2: the anticipated difficult airway. Can J Anesth 2013; 60: 1119-38.CrossRef Law JA, Broemling N, Cooper RM, et al. The difficult airway with recommendations for management-part 2: the anticipated difficult airway. Can J Anesth 2013; 60: 1119-38.CrossRef
8.
Zurück zum Zitat Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118: 251-70.CrossRef Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118: 251-70.CrossRef
9.
Zurück zum Zitat Chin KJ, Arango MF, Paez AF, Turkstra TP. Palatal injury associated with the GlideScope. Anaesth Intensive Care 2007; 35: 449-50.PubMed Chin KJ, Arango MF, Paez AF, Turkstra TP. Palatal injury associated with the GlideScope. Anaesth Intensive Care 2007; 35: 449-50.PubMed
10.
Zurück zum Zitat Malik AM, Frogel JK. Anterior tonsillar pillar perforation during GlideScope video laryngoscopy. Anesth Analg 2007; 104: 1610-1.CrossRef Malik AM, Frogel JK. Anterior tonsillar pillar perforation during GlideScope video laryngoscopy. Anesth Analg 2007; 104: 1610-1.CrossRef
11.
Zurück zum Zitat Hsu WT, Hsu SC, Lee YL, Huang JS, Chen CL. Penetrating injury of the soft palate during GlideScope intubation. Anesth Analg 2007; 104: 1609-10.CrossRef Hsu WT, Hsu SC, Lee YL, Huang JS, Chen CL. Penetrating injury of the soft palate during GlideScope intubation. Anesth Analg 2007; 104: 1609-10.CrossRef
12.
Zurück zum Zitat Cooper RM. Complications associated with the use of the GlideScope videolaryngoscope. Can J Anesth 2007; 54: 54-7.CrossRef Cooper RM. Complications associated with the use of the GlideScope videolaryngoscope. Can J Anesth 2007; 54: 54-7.CrossRef
13.
Zurück zum Zitat Amundson AW, Weingarten TN. Traumatic GlideScope(®) video laryngoscopy resulting in perforation of the soft palate. Can J Anesth 2013; 10: 210-1.CrossRef Amundson AW, Weingarten TN. Traumatic GlideScope(®) video laryngoscopy resulting in perforation of the soft palate. Can J Anesth 2013; 10: 210-1.CrossRef
14.
Zurück zum Zitat Raja J, Clyne S, Levine J, Tebbit C, Mair E. Otorhinolaryngology management of seven patients with iatrogenic penetrating injuries from GlideScope®: our experience. Clin Otolaryngol 2014; 39: 251-4.CrossRef Raja J, Clyne S, Levine J, Tebbit C, Mair E. Otorhinolaryngology management of seven patients with iatrogenic penetrating injuries from GlideScope®: our experience. Clin Otolaryngol 2014; 39: 251-4.CrossRef
15.
Zurück zum Zitat Allencherril JP, Joseph L. Soft palate trauma induced during GlideScope intubation. J Clin Anesth 2016; 35: 278-80.CrossRef Allencherril JP, Joseph L. Soft palate trauma induced during GlideScope intubation. J Clin Anesth 2016; 35: 278-80.CrossRef
16.
Zurück zum Zitat Doyle DJ. The GlideScope video laryngoscope. Anaesthesia 2005; 60: 414-5.CrossRef Doyle DJ. The GlideScope video laryngoscope. Anaesthesia 2005; 60: 414-5.CrossRef
17.
Zurück zum Zitat Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management: a topical review of the literature. Acta Anaesthesiol Scand 2010; 54: 1050-61.CrossRef Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management: a topical review of the literature. Acta Anaesthesiol Scand 2010; 54: 1050-61.CrossRef
18.
Zurück zum Zitat Agrò FE, Doyle DJ, Vennari M. Use of GlideScope® in adults: an overview. Minerva Anestesiol 2015; 81: 342-51.PubMed Agrò FE, Doyle DJ, Vennari M. Use of GlideScope® in adults: an overview. Minerva Anestesiol 2015; 81: 342-51.PubMed
19.
Zurück zum Zitat Turkstra TP, Harle CC, Armstrong KP, et al. The GlideScope-specific rigid stylet and standard malleable stylet are equally effective for GlideScope use. Can J Anesth 2007; 54: 891-6.CrossRef Turkstra TP, Harle CC, Armstrong KP, et al. The GlideScope-specific rigid stylet and standard malleable stylet are equally effective for GlideScope use. Can J Anesth 2007; 54: 891-6.CrossRef
20.
Zurück zum Zitat Jones PM, Loh FL, Youssef HN, Turkstra TP. A randomized comparison of the GlideRite® Rigid Stylet to a malleable stylet for orotracheal intubation by novices using the GlideScope®. Can J Anesth 2011; 58: 256-61.CrossRef Jones PM, Loh FL, Youssef HN, Turkstra TP. A randomized comparison of the GlideRite® Rigid Stylet to a malleable stylet for orotracheal intubation by novices using the GlideScope®. Can J Anesth 2011; 58: 256-61.CrossRef
21.
Zurück zum Zitat Jones PM, Turkstra TP, Armstrong KP, et al. Effect of stylet angulation and endotracheal tube camber on time to intubation with the GlideScope. Can J Anesth 2007; 54: 21-7.CrossRef Jones PM, Turkstra TP, Armstrong KP, et al. Effect of stylet angulation and endotracheal tube camber on time to intubation with the GlideScope. Can J Anesth 2007; 54: 21-7.CrossRef
22.
Zurück zum Zitat Dupanović M, Isaacson SA, Borovcanin Z, et al. Clinical comparison of two stylet angles for orotracheal intubation with the GlideScope video laryngoscope. J Clin Anesth 2010; 22: 352-9.CrossRef Dupanović M, Isaacson SA, Borovcanin Z, et al. Clinical comparison of two stylet angles for orotracheal intubation with the GlideScope video laryngoscope. J Clin Anesth 2010; 22: 352-9.CrossRef
23.
Zurück zum Zitat Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Can J Anesth 2016; 63: 928-37.CrossRef Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Can J Anesth 2016; 63: 928-37.CrossRef
24.
Zurück zum Zitat Hróbjartsson A, Thomsen AS, Emanuelsson F, et al. Observer bias in randomized clinical trials with time-to-event outcomes: systematic review of trials with both blinded and non-blinded outcome assessors. Int J Epidemiol 2014; 43: 937-48.CrossRef Hróbjartsson A, Thomsen AS, Emanuelsson F, et al. Observer bias in randomized clinical trials with time-to-event outcomes: systematic review of trials with both blinded and non-blinded outcome assessors. Int J Epidemiol 2014; 43: 937-48.CrossRef
25.
Zurück zum Zitat Perneger TV. What’s wrong with Bonferroni adjustments. BMJ 1998; 316: 1236-8.CrossRef Perneger TV. What’s wrong with Bonferroni adjustments. BMJ 1998; 316: 1236-8.CrossRef
26.
Zurück zum Zitat Holden JD. Hawthorne effects and research into professional practice. J Eval Clin Pract 2001; 7: 65-70.CrossRef Holden JD. Hawthorne effects and research into professional practice. J Eval Clin Pract 2001; 7: 65-70.CrossRef
Metadaten
Titel
Simultaneous en bloc endotracheal tube insertion with GlideScope® Titanium™ video laryngoscope use: a randomized-controlled trial
verfasst von
Timothy P. Turkstra, MD, MEng, FRCPC
Daniel C. Turkstra
Alexander W. Pavlosky, MD
Philip M. Jones, MD, MSc, FRCPC
Publikationsdatum
19.08.2020
Verlag
Springer International Publishing
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 11/2020
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-020-01778-2

Weitere Artikel der Ausgabe 11/2020

Canadian Journal of Anesthesia/Journal canadien d'anesthésie 11/2020 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.