Comparison of the success rate of tracheal intubation between stylet and bougie with a hyperangulated videolaryngoscope: a randomised controlled trial

Hyperangulated videolaryngoscopes are known to increase the success rate of tracheal intubation in the setting of difficult airway management when used with a stylet or bougie. However, there is controversy over which adjunct is more useful. This randomised study aimed to compare first attempt tracheal intubation success rate between a stylet and bougie when using a hyperangulated videolaryngoscope. We recruited patients aged > 20 years who were scheduled for elective surgery under general anaesthesia and required tracheal intubation. We only included patients with factors predicting difficult tracheal intubation based on pre-anaesthesia airway evaluation. Tracheal intubation was attempted using a Glidescope® with either a stylet or bougie as an adjunct according to group assignment. Primary outcome was the success rate of the first tracheal intubation attempt, and secondary outcomes were success of second and third attempts; tracheal intubation time; and occurrence of sore throat, dysphagia or hoarseness. A total of 166 patients were included. The success rate of the first tracheal intubation attempt was significantly higher in patients allocated to the bougie group compared with those allocated to the stylet group (81/83 (98%) vs. 73/83 (88%), respectively; p = 0.032). The number of patients who needed two attempts was significantly lower in those allocated to the bougie group compared with those allocated to the stylet group (1/83 (1%) vs. 9/83 (11%), respectively; p = 0.018). Each group had one patient (1%) where tracheal intubation was achieved after a third attempt. There was no significant difference in the occurrence of sore throat, dysphagia and hoarseness between the two groups. When difficult tracheal intubation is anticipated and a hyperangulated videolaryngoscope is used, the success rate of the first attempt is higher when a bougie is used compared with a stylet.

GlideScope versus C-MAC D-blade videolaryngoscope for double-lumen tube intubation in patients with anticipated difficult airways: A multi-center, prospective, randomized, controlled trial

STUDY OBJECTIVE

Videolaryngoscopes are widely used to visualize difficult airways. Our aim was to compare the GlideScope and C-MAC D-blade videolaryngoscopes for double-lumen tube (DLT) intubation in patients with difficult airways.

DESIGN

A multi-center, prospective, randomized controlled trial.

SETTING

Three comprehensive tertiary, high-volume hospitals from 5 December 2020 to 4 November 2021.

PATIENTS

We included 348 adult patients with anticipated difficult airways who underwent elective thoracic surgery.

INTERVENTIONS

Patients were randomized into two groups: GlideScope and C-MAC D-blade. Following anesthesia induction, DLT intubation was performed using different videolaryngoscopes.

MEASUREMENTS

The primary outcome was the first-pass success rate of DLT intubation. All other results were recorded as secondary outcomes.

MAIN RESULTS

No significant differences were observed in the first-pass success rate of DLT intubation between the GlideScope and C-MAC D-blade (86.21% and 89.66%, respectively; P = 0.323). However, compared with the GlideScope, the C-MAC D-blade provided a lower Cormack-Lehane grade (P < 0.001), lower rates of external laryngeal pressure (48 vs. 15, P < 0.001), and postprocedure sore throat (26 vs. 8, P < 0.001). The numerical rating score for difficulty of videolaryngoscope insertion into the oral cavity, delivery to the glottis, and intubation into the main bronchus were significantly lower when using the C-MAC D-blade (P < 0.001). Moreover, the duration of DLT intubation was shorter in the C-MAC D-blade group (81 s [70-97 s] vs. 95 s [78-115 s], P < 0.001). In each group, two patients underwent fiberoptic intubation after three attempts with a videolaryngoscope failed.

CONCLUSIONS

In patients with difficult airways, the GlideScope and C-MAC D-blade provided a similar success rate on the first DLT intubation attempt; however, the C-MAC D-blade offers a better glottic view, easier and faster intubation, and lower incidence of sore throat.

Use of GlideScope in Patients Undergoing NIM Thyroidectomy

OBJECTIVES

Thyroidectomy and parathyroidectomy using the nerve integrity monitor (NIM) require proper placement of the endotracheal tube with electrodes aligned correctly within the larynx. The purpose of this study is to determine the percentage of patients who require positional adjustments of the endotracheal tube prior to beginning surgery and to understand the value of using the GlideScope to assure proper NIM tube placement within the larynx.

METHODS

This prospective study examines operative data from 297 patients who underwent NIM thyroidectomy and parathyroidectomy. After routine orotracheal intubation by an anesthesiologist and positioning of the patient for surgery, a GlideScope was used to check the position of the tube in 2 planes: depth of tube placement and rotation of the tube within the larynx assuring proper placement of the electromyogram electrodes within the glottis.

RESULTS

Tube adjustment was required for 66.5% of patients. In 48.1% of cases, tube retraction or advancement to a proper depth was needed. Tube rotation was required for 30.1% of patients, and 11.8% of patients required both adjustment of tube depth and tube rotation to properly align electrodes.

CONCLUSIONS

After the anesthesiologist places the NIM endotracheal tube, and the patient is positioned for surgery, additional tube adjustment is often needed prior to the start of surgery. The GlideScope is readily available in the operating suite, its use adds little time to the procedure, and assures proper NIM tube placement. The use of the GlideScope is recommended.

Comparison of GlideScope™ visualization and neck flexion with lateral neck pressure nasogastric tube insertion techniques in anesthetized patients: a randomized clinical study

OBJECTIVE

Nasogastric tube (NGT) insertion in anesthetized and intubated patients can be challenging, even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between GlideScope™ visualization and neck flexion, with lateral neck pressure techniques.

MATERIAL AND METHODS

This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery, under relaxant general anesthesia, who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope™ group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of the first and second attempts, duration of insertion, and complications were recorded.

RESULTS

The total success rate was 79.1% in group G, compared with 76.7% in group F (P = 1). The median time required for NGT insertion was significantly longer in group G, for both first and second attempts (97 vs 42 s P < 0.001) and (70 vs 48.5 s P = 0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications for both techniques.

CONCLUSION

Using GlideScope™ visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique, in the degree of success rates of insertion. Although complications were not statistically significant between groups, neck flexion with lateral neck pressure technique was significantly less time-consuming for both first and second attempts.

TRIAL REGISTRATION

Retrospectively registered: Thai Clinical Trial Registry (TCTR)20171229003 . Registered on 19 December 2017.

Comparison of hemodynamic responses to endotracheal intubation with the GlideScope video laryngoscope and Macintosh laryngoscope in patients undergoing cardiovascular surgery

Background

This study aimed to compare hemodynamic response to endotracheal intubation using GlideScope and Macintosh laryngoscopes in patients who underwent cardiovascular surgery.

Methods

A total of 74 patients were enrolled in the study. Patients were randomly assigned into two groups either a GlideScope (n=37) or a Macintosh laryngoscope (n=37). Laryngoscopy time, heart rate, invasive arterial pressure and rate pressure product were compared during induction and until five minutes after laryngoscopy at 11 time points.

Results

Seventy patients completed the study. The intubation time was similar in both groups (14.1±4.0 sec vs. 13.2±4.2 sec; p=0.22). Hemodynamic values including heart rate, systolic, diastolic and mean arterial pressure and rate pressure product were similar at all-time points. The laryngoscopy time was also similar between groups.

Conclusion

The GlideScope video laryngoscope did not show any advantage on hemodynamic response in patients undergoing cardiovascular surgery when compared to Macintosh laryngoscope.

The GlideScope with modified Magill forceps facilitates nasogastric tube insertion in anesthetized patients: A randomized clinical study

Objective

Insertion of a nasogastric tube (NGT) in patients who have been intubated with an endotracheal tube while under general anesthesia can cause difficulties and lead to complications, including hemorrhage. A visualization-aided modality was recently used to facilitate NGT insertion. Some studies have focused on the role of modified Magill forceps, which have angles similar to those of the GlideScope blade (Verathon, Bothell, WA, USA).

Methods

Seventy patients were divided into a control group (Group C) and an experimental group (GlideScope and modified Magill forceps, Group M).

Results

The total NGT insertion time was significantly shorter in Group M than C (71.3 ± 22.6 vs. 96.7 ± 57.5 s; mean difference, –25.3 s; 95% confidence interval [CI], 20.8–71.5). There were also significantly fewer mean insertion attempts in Group M than C (1.0 ± 0.0 vs. 2.11 ± 0.93). The success rate for the first attempt in Group C was 37.1%, while that in Group M was 100% (relative risk, 2.7; 95% CI, 1.7–4.1).

Conclusion

The use of the GlideScope with modified Magill forceps for insertion of an NGT in patients who are already intubated and under general anesthesia will shorten the insertion time and improve the success rate.

A Randomized, Blinded, Clinical Study of Injury Incidence During Endotracheal Intubation: Comparison of GlideScope Video Laryngoscopy and Direct Laryngoscopy

Injuries can occur during endotracheal intubation. This prospective, randomized, blinded study aimed to determine if a difference exists in incidence of injury following endotracheal intubation using either direct laryngoscopy or the GlideScope video laryngoscope (Verathon Inc). A convenience sample of 155 patients scheduled to undergo surgery to the head, face, neck, or throat were randomized to either GlideScope or conventional direct laryngoscopy groups. Following induction of general anesthesia and endotracheal intubation, the patients were assessed for injuries to the mouth and pharynx by an otolaryngologist who was not part of the study staff and was blinded to the method of intubation. The difference between injury rates in the 2 groups was analyzed using a χ² test, which yielded a P = 0.3976 and a χ² statistic of 1.0445 (critical value = 3.841), indicating that no statically significant difference in the incidence of injury exists between conventional direct laryngoscopy and GlideScope-facilitated endotracheal intubation.

Effect of Cricoid Pressure on Laryngeal View During Macintosh, McGrath MAC X-Blade and GlideScope Video Laryngoscopies

Objective

Cricoid pressure is useful in fasted patients requiring emergency intubation. We compared the effect of cricoid pressure on laryngeal view during Macintosh, McGrath MAC X-Blade and GlideScope video laryngoscopy.

Methods

After obtaining approval from the Human Research Ethics Committee and written informed consent from patients, we enrolled 120 patients (American Society of Anesthesiologists I-II, age 18-65 years) undergoing elective surgery that required endotracheal intubation in this prospective randomised study. Patients were divided into three groups (Macintosh, McGrath MAC X-Blade and GlideScope).

Results

Demographic and airway variables were similar in the groups. Cormack-Lehane grades were improved or unchanged on using cricoid pressure in Macintosh and McGrath MAC X-Blade groups. However, laryngeal views worsened in 12 patients (30%), remained unchanged in 26 patients (65%) and improved in 2 patients (5%) in the GlideScope group (p<0.001). Insertion and intubation times for Macintosh and McGrath MAC X-Blade video laryngoscopes were similar. Insertion times for GlideScope and Macintosh video laryngoscopes were similar, but were longer than those for the McGrath MAC X-Blade video laryngoscope (p=0.02). Tracheal intubation took longer with the GlideScope video laryngoscope than with the other devices (p<0.001 and p=0.003). Mean arterial pressures after insertion increased significantly in Macintosh and GlideScope groups (p=0.004 and p=0.001, respectively) compared with post-induction values. Heart rates increased after insertion in all three groups compared with post-induction values (p<0.001). Need for optimisation manoeuvres and postoperative minor complications were comparable in all three groups.

Conclusion

Although all three devices are useful for normal or difficult intubation, cricoid pressure improved Cormack-Lehane grades of Macintosh and McGrath MAC X-Blade video laryngoscopes but statistically significantly worsened that of the GlideScope video laryngoscope.

A Randomized Controlled Trial Comparing the Utility of Lighted Stylet and GlideScope for Double-Lumen Endobronchial Intubation

OBJECTIVE

To compare GlideScope and lighted stylet for double-lumen endobronchial tube (DLT) intubation in terms of intubation time, success rate of first attempt at intubation, difficulty in DLT advancement toward the glottis, and postoperative sore throat and hoarseness.

DESIGN

A prospective, randomized study.

SETTING

Medical center governed by a university hostpial.

PARTICIPANTS

Sixty-two adult patients undergoing thoracic surgery using DLT intubation.

INTERVENTION

After the induction of anesthesia, DLT intubation was performed using GlideScope (n = 32) or lighted stylet (n = 32).

MEASUREMENTS AND MAIN RESULTS

Number of intubation attempts, difficulty of DLT advancement toward the glottis, time taken for DLT intubation, and the incidence and severity of postoperative sore throat and hoarseness at 1 and 24 hours after surgery were evaluated. Time taken for DLT intubation was shorter in the lighted stylet group compared with the GlideScope group (30 [28-32] s v 45 [38-53] s, median [interquartile range], respectively; p < 0.001). DLT advancement toward the glottis was easier in the lighted stylet group than in the GlideScope group (p = 0.016). The success rate of DLT intubation in the first attempt (96.9% v 90.6% for lighted stylet and GlideScope, respectively), and the incidence and severity of postoperative sore throat and hoarseness were not different between the two groups.

CONCLUSIONS

The use of lighted stylet allowed easier advancement of the DLT toward the glottis in the oropharyngeal space and reduced time for achieving DLT intubation compared with GlideScope.

A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in Humans by Users With Mixed Experience: A Randomized Controlled Study

OBJECTIVES

To test the hypothesis that laryngoscopy using the Airtraq (Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu A/S, Ballerup, Denmark) would result in a shorter time for successful double-lumen endobronchial tube (DLT) intubation by users with mixed experience than the time required using the Macintosh or GlideScope (Verathon Inc., Bothell, WA) laryngoscopes.

DESIGN

A randomized, prospective, blind study.

SETTING

A single university hospital.

PARTICIPANTS

The study comprised 133 patients undergoing elective thoracic surgery.

INTERVENTIONS

Patients were randomly allocated into the following 4 groups of DLTs: Macintosh (n = 32), GlideScope (n = 34), Airtraq (n = 35), or KVL (n = 32).

MEASUREMENTS AND MAIN RESULTS

The following data were recorded: time required for achieving successful DLT intubation; glottis visualization; optimization maneuvers; first-pass success rate; intubation difficulty; failure to intubate, defined as an attempt taking >150 seconds to perform or if peripheral oxygen saturation <92% was noted; and postoperative sore throat and hoarseness were recorded. Compared with GlideScope, the Airtraq resulted in shorter times for achieving successful DLT intubation (median times: 21 s [95% confidence interval 23.9-70.8 s] v 57.5 s [95% confidence interval 46.2-89.1 s], respectively; p = 0.021); a lower score for difficult intubations (p = 0.023); and fewer optimization maneuvers. The 4 laryngoscopes were associated with comparable glottis visualization; first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p = 0.522); incidence of oropharyngeal trauma; postoperative sore throat; and hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures using the Airtraq due to the inability to advance the DLT through the glottis opening. The experience of the anesthesiologists in using the 4 devices had a statistically significant negative correlation with the time to confirmation of endobronchial intubation (Spearman r -0.392; p < 0.001).

CONCLUSION

When used by operators with mixed experience, the channeled Airtraq required less time for DLT intubation and was easier to use than the GlideScope, although failures did occur with the Airtraq, whereas they did not occur with the other systems.

A comparison of the video laryngoscopes with Macintosh laryngoscope for nasotracheal intubation

Nasotracheal intubation (NTI) is usually required in patients undergoing maxillofacial surgery. Though video-scopes have been demonstrated to perform well in oral endotracheal intubation, limited information is available concerning NTI. The aim of the study is to compare the efficiency of video-scopes and the traditional direct laryngoscopy in NTI. One hundred and eight patients scheduled for elective oro-maxillofacial surgery under nasotracheal intubation general anesthesia were randomly allocated into one of 3 groups of GlideScope, Pentax AirWay Scope, or Macintosh laryngoscope respectively. The primary outcome measures were total intubation time and each separate time interval (time A: for placement for the nasotracheal tube from selected nostril to oropharynx; time B: for use of devices to view the glottic opening; time C: for advancing nasotracheal tube from oropharynx into trachea and removing the scope from the oral cavity). The secondary outcomes were measurement of scores of modified naso-intubation difficulty scale (MNIDS) and attempts at intubation.

RESULTS

Mean total intubation time and time C interval were taken with GlideScope (33.1 s and 9.7 s), Pentax (38.4 s and 12.9 s), and Macintosh (42.2 s and 14.9 s) respectively. There was a significant difference among the groups (total time, P = 0.03; time C, P = 0.02). The median score of MNIDS was significantly lower using GlideScope or Pentax compared with using Macintosh in NTI (P = 0.037) and difficult intubation grading by MNIDS presented as easier in the GlideScope group than in the Macintosh group (0.016). Using GlideScope, intubation was successful at the first attempt in 80% patients whereas only 65% and 72.5% with the Pentax and Macintosh (P = 0.02).

CONCLUSION

As compared with the Macintosh laryngoscope, the GlideScope video laryngoscope facilitated nasotracheal intubations with shortened intubation time and reduced intubation difficulty in patients undergoing oromaxillofacial surgery.

Lingual Tonsil Hypertrophy: rescuing the airway with videolaryngoscopy

Lingual tonsils are lymphatic tissues located at the base of the tongue that may hypertrophy causing difficulty and sometimes inability to ventilate or intubate during anesthesia. Routine airway assessment fails to diagnose lingual tonsil hypertrophy. There is limited experience with use of videolaryngoscopy in cases of lingual tonsil hypertrophy. We present a case of difficult airway due to unanticipated lingual tonsil hypertrophy successfully managed by atypical video laryngoscope positioning.

Review of videolaryngoscopy pharyngeal wall injuries

OBJECTIVES

Reports of patient injuries associated with videolaryngoscopy are increasing in the literature. There are a wide variety of opinions regarding both safe use of the device and patient care following aerodigestive tract injury. We have seen an increase in videolaryngoscopy-associated injuries in recent years at our institution. Because of this, we wanted to determine if video-assisted laryngoscopy presents a greater risk of injury compared with direct laryngoscopy. Furthermore, we wanted to determine if there were patient and/or surgical factors that could contribute to patient injuries following videolaryngoscopy.

DATA SOURCES

MAMC anesthesia records, PubMed, Ovid.

REVIEW METHODS

We compared rates of injury between videolaryngoscopy to direct laryngoscopy at our institution by searching anesthesia records to identify laryngoscopy procedures that resulted in injury to the soft palate or oropharynx. We also identified 19 published cases in the literature, in addition to our cases, that we reviewed for patient characteristics (e.g., body mass index, age and sex, Mallampati grade), type of videolaryngoscope, location of injury, and type of repair (if any) required.

RESULTS

At our institution, we have a statistically higher rate of injury using videolaryngoscopy compared to direct laryngoscopy. Our data also indicate that women are more commonly injured during videolaryngoscope intubation than men. The right tonsillar pillars and soft palate are the most frequently injured, with through-and-through perforation of the soft tissues being the most common type of injury. The most common repair of injuries required simple closures, and long-term harm was very rare.

CONCLUSION

Our data suggests that using video-assisted laryngoscopy for intubation puts a patient at significantly greater risk for injury compared to direct laryngoscopy. Laryngoscope, 2016 127:349-353, 2017.

Comparison of GlideScope video laryngoscope with Macintosh laryngoscope in adult patients undergoing elective surgical procedures

Background:

GlideScope (GS) is a video laryngoscope that allows a real-time view of the glottis and endotracheal intubation. It provides a better view of the larynx without the need for alignment of the airway axes.

Aim:

This prospective randomized comparative study is designed to compare the intubation time, hemodynamic response, and complications associated with intubation using a GS or Macintosh laryngoscope (ML) in adult subjects undergoing elective surgical procedures.

Materials and Methods:

Sixty American Society of Anesthesiologists physical status 1–2 patients were included in this prospective randomized comparative study. Patients were randomized to be intubated using either a GS or an ML. The primary outcome measure was the intubation time. The secondary outcome measures were the hemodynamic response to intubation and the incidence of mucosal injury.

Statistical Analysis:

Mean and standard deviation were calculated for different parameters under the study. The observed results were analyzed using Student's t-test for quantitative data and Z-test of proportions. P<0.05 was considered statistically significant.

Results:

Intubation time was longer in GS group (45.7033 ± 11.649 s) as compared to ML (27.773 ± 5.122 s) P< 0.0001 with 95% confidence interval (95% CI) −13.2794 to −22.5806. GS provided better Cormack and Lehane laryngoscopic view (P = 0.0016 for grade 1 view) with 95% CI −0.1389 to −0.5951. GS group exhibited more laryngoscopic response than ML group with more increase in blood pressure and heart rate, but the difference was not statistically significant. More cases of mucosal trauma were documented in GS group.

Conclusion:

Use of GS to facilitate intubation led to better glottic view but took a longer time to achieve endotracheal intubation. GS was associated with more hemodynamic response to intubation and mucosal injury in comparison with an ML.

Does the incidence of sore throat postoperatively increase with the use of a traditional intubation blade or the GlideScope?

STUDY OBJECTIVE

The GlideScope video-guided laryngoscope is an alternative standard of care for rescue laryngoscopies when direct laryngoscopy is unsuccessful. During postoperative checks by an anesthesiologist, it was noticed that patients who reported sore throat often required GlideScope laryngoscopy. Consequently, it is difficult to determine whether postoperative sore throats are caused by irritation inflicted by multiple laryngoscopic attempts or the actual utilization of the GlideScope itself. The goal of this study was to determine whether the use of the GlideScope leads to a greater or lesser incidence of sore throat when compared with traditional laryngoscope blades used for intubation.

DESIGN

Eligible patients scheduled for elective inpatient surgeries requiring endotracheal tube intubation were enrolled into this single-blinded prospective cohort study. χ(2) Test, Fisher exact test, and t tests were used to compare differences across the primary end point and other demographic categories.

SETTING

Operating rooms and postanesthesia recovery unit, Albany Medical Center, Albany, NY.

PATIENTS

There were a total of 151 patients with American Society of Anesthesiologists grades 1 to 3 included in the study.

INTERVENTIONS

Eighty-one patients were randomized to a control group that received traditional laryngoscopy via Macintosh/Miller blades and 70 patients received video-guided intubation via the GlideScope.

MEASUREMENTS

The incidence of postoperative sore throat was recorded via a yes/no questionnaire within 24 hours after extubation. Secondary parameters such as provider type, sex, and perceived difficulty were also recorded.

MAIN RESULTS

There was no significant difference in the proportion of patients reporting sore throat by type of blade used (Mac/Miller 36.3% vs GlideScope 32.4%, P = .619). For secondary outcomes, women were significantly more likely to report sore throat as compared with men (men 24.3% vs women 43.2%, P = .015), and the provider type was significantly associated with the occurrence of postoperative sore throat (attendings 26.8% vs certified registered nurse anesthetists 52.3% vs third-year clinical anesthesia residents 30%, P = .012).

CONCLUSIONS

Use of the GlideScope videolaryngoscopy was not significantly associated with increased occurrence of postoperative sore throat when compared with traditional intubation techniques. Our results may enable more trainees to acquire intubation skills with the GlideScope during an initial intubation attempt in patients with American Society of Anesthesiologist grades 1 to 3, with optimization of patient satisfaction in respect to postoperative sore throats. In addition, a provider's choice of intubation technique based on either Macintosh/Miller blades or the GlideScope does not significantly impact a patient's risk of postoperative sore throat.

Influence of GlideScope assisted endotracheal intubation on intraocular pressure in ophthalmic patients

Background:

Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure (IOP), tachycardia and hypertension. These changes are not desirable in patients with glaucoma and open globe injury. GlideScope is a video laryngoscope that functions independent of the line of sight, reduces upward lifting forces for glottic exposure and requires less cervical neck movement for intubation, making it less stimulating than Macintosh laryngoscopy.

Aim:

The aim was to assess the variations in IOP and hemodynamic changes after GlideScope assisted intubation.

Materials and Methods:

After approval of the local Institutional Research and Ethical Board and informed patient consent, 50 adult American Society of Anesthesiologist I and II patients with normal IOP were enrolled in a prospective, randomized study for ophthalmic surgery requiring tracheal intubation. In all patients, trachea was intubated using either GlideScope or Macintoch laryngoscope. IOP of nonoperated eye, heart rate and blood pressure were measured as baseline, 1 min after induction, 1 min and 5 min after tracheal intubation.

Results:

IOP was not significantly different between groups before and after anesthetic induction and 5 min after tracheal intubation (P = 0.217, 0.726, and 0.110 respectively). The only significant difference in IOP was at 1 min after intubation (P = 0.041). No significant difference noted between groups in mean arterial pressure (P = 0.899, 0.62, 0.47, 0.82 respectively) and heart rate (P = 0.21, 0.72, 0.07, 0.29, respectively) at all measurements.

Conclusion:

GlideScope assisted tracheal intubation shown lesser rise in IOP at 1 min after intubation in comparison to Macintoch laryngoscope, suggesting that GlideScope may be preferable to Macintosh laryngoscope.

Intubation learning curve: comparison between video and direct laryngoscopy by inexperienced students

Background: Direct laryngoscopy (DL) is considered the most common method of tracheal intubation. On the other hand, evidence shows the growing role of video laryngoscopy in danger airway administration. Objectives: Due to the importance of a proper training to accomplish an accurate and fast intubation by the student of anesthesia, this research was conducted to assess the effects of DL and video laryngoscopy (Glidescope VL) training on the success rate of tracheal intubation by low-skill students. Materials/Patients and styles: 50 undergraduate students of anesthesiology took part in this randomized control educational intervention. Having no considerable experience in intubation, they were selected and divided randomly into two equal groups (n = 25); video-laryngoscopy via GlideScope VL and direct laryngoscopy (DL) via a Macintosh blade were prepared by the same experienced anesthesiologist. All the participants practiced intubation six times on the same mannequin within a routine airway situation. The maximum acceptable time for each intubation was 3 minutes and three times of successful intubation was considered as an appropriate intubation skill. The required time for laryngoscopy and intubation at each stage, the grade of glottis view, the reasons for an unsuccessful intubation and the amount of successful intubations were recorded and compared between groups. Results: There was a clear variation between the 2 teams, in all the steps, based on the required time for laryngoscopy and intubation (p = 0.0001). Data analysis was performed by using repeated measures data which demonstrated that the necessary time for laryngoscopy and intubation during the study was clearly lower in the GlideScope VL team (p = .0001). In first five rounds of training, the glottis view in the DL group was significantly better than in the VL group (p < 0.05). Conclusion: Based on the result of today' study, routine airway intubation by using GlideScope VL is significantly faster than direct laryngoscopy. It seems that further studies are needed to investigate the effect of the educational program on different laryngoscopy and intubation situations.

Fiberscope Assisted Videolaryngoscope Intubation in the Surgical Treatment of TMJ Ankylosis

Temporomandibular ankylosis is characterized by the formation of a bony mass which replaces normal temporomandibular joint (TMJ) articulation. Anaesthetic management in these patients requires expertise and dependable intubation technique that allows successful intubation due to anticipated difficulty in accessing the airway. A novel technique of endotracheal intubation is used for the successful airway management during the surgical treatment in patients with TMJ ankylosis with the assistance of fiberscope and GlideScope(®) videolaryngoscope. GlideScope(®) videolaryngoscope is a recently introduced system for tracheal intubation that has a dedicated video camera encased into a laryngoscope blade and provides better panoramic view than the conventional laryngoscopes. This technique avoids complications such as trauma to soft tissue structures surrounding the glottis during the passage of the tube over the fiberscope. It gives a clear view of the tube and its cuff position during intubation. It also abbreviates the time required for intubation which is a crucial determinant in this subset of patients owing to the difficult airway associated with paediatric age group.