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Table of Contents
LETTER TO EDITOR
Year : 2015  |  Volume : 31  |  Issue : 2  |  Page : 274-275

Alternatives to GlideRite ® for flexometallic endotracheal tube insertion with GlideScope ®


Department of Anaesthesiology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication16-Apr-2015

Correspondence Address:
Tony Thomson Chandy
Department of Anaesthesia, Chrisitan Medical College, Vellore, Tamil Nadu, 632004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.155211

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How to cite this article:
Chandy TT, Singh G. Alternatives to GlideRite ® for flexometallic endotracheal tube insertion with GlideScope ®. J Anaesthesiol Clin Pharmacol 2015;31:274-5

How to cite this URL:
Chandy TT, Singh G. Alternatives to GlideRite ® for flexometallic endotracheal tube insertion with GlideScope ®. J Anaesthesiol Clin Pharmacol [serial online] 2015 [cited 2019 Nov 18];31:274-5. Available from: http://www.joacp.org/text.asp?2015/31/2/274/155211

To the Editor,

GlideScope ® Video Laryngoscope (Verathon, Bothell, WA, USA) (GVLS) helps in easier visualization [1] and reduced lifting force [2] of the anterior placed larynx.

GlideScope ® Video Laryngoscope is often used in the intubation of patients with cervical spine pathology. Spiral embedded flexometallic cuffed endotracheal tubes (ETTs) (Mallinckrodt™, Covidien™, Covidien Ireland Limited, Tullamore, Ireland), resistant to external compression, are useful in these surgeries. These are floppy tubes requiring a stylet for insertion, and have fixed lengths as the reinforcing wire is sealed tightly against a bonded connector.

GlideScope ® specific stylet, GlideRite ® , is 35 cm long, which is appropriate for an ETT without connectors. However, a #8.0 mm internal diameter flexometallic ETT measures 39 cm [Figure 1], leaving a 4 cm floppy distal end after full insertion of GlideRite ® making intubation difficult. The large blade and an anterior larynx together compounds the difficulty in introduction of the flexometallic ETT.

We found initially placing a Portex Bougie Coudé Tip (Smith Medical International Ltd., Hythe, Kent, UK) [Figure 2] and then rail roading the ETT over it, aids in the placement of the flexometallic tubes with GVLS. The Bougie with its longer length is convenient for rail roading and manipulations to guide the Bougie into the anterior larynx and is easier than with a styleted flexometallic ETT.
Figure 1: Flexometallic endotracheal tube with GlideRite®

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Figure 2: Flexometallic endotracheal tube rail roaded over a Portex Bougie

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Difficulty in positioning the Bougie, as it tends to unfold and slip posteriorly could be overcome by initially directing the Bougie Coudéé toward the laryngeal inlet and then rotating it anticlockwise. Hang up at the posterior arytenoids, which has been described [3] was prevented by anterior lift of the Bougie making the passage of the ETT easier. Thus the commonly used Bougie [4] is an effective alternative to GlideRite ® in GVLS aided flexometallic tube insertion. This technique has been described for a different indication-difficult intubation with videolaryngoscopy. [5]

Alternatively an unfolded Mallinckrodt™ Satin Slip stylet may be used after recreating a curvature similar to GVLS.

Although not commonly attempted, it is feasible to wrench off the connector from the 8/0 flexometallic ETT and then use a GlideRite ® , however, the authors do not recomend this as we noticed dislodgement of the connector as its secure bonding thereafter is not guaranteed.

To our knowledge, the need for longer stylets for GVLS assisted flexometallic ETT insertion has not been addressed.

 
  References Top

1.
Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth 2005;52:191-8.  Back to cited text no. 1
    
2.
Russell T, Lee C, Firat M, Cooper RM. A comparison of the forces applied to a manikin during laryngoscopy with the GlideScope and Macintosh laryngoscopes. Anaesth Intensive Care 2011;39:1098-102.  Back to cited text no. 2
    
3.
Nielsen AA, Hope CB, Bair AE. GlideScope videolaryngoscopy in the simulated difficult airway: Bougie vs standard stylet. West J Emerg Med 2010;11:426-31.  Back to cited text no. 3
    
4.
Rai MR. The humble bougie… forty years and still counting? Anaesthesia 2014;69:199-203.  Back to cited text no. 4
    
5.
Heitz JW, Mastrando D. The use of a gum elastic bougie in combination with a videolaryngoscope. J Clin Anesth 2005;17:408-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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