Case series: The McGrath® videolaryngoscope — an initial clinical evaluation

Case Reports/Case Series

Abstract

Purpose

To document tracheal intubation success rates and airway instrumentation times using the newly designed McGrath® videolaryngoscope.

Methods

We prospectively recorded factors associated with difficult tracheal intubation, factors causing actual difficulty in tracheal intubation, as well as complications arising from use of the new McGrath® videolaryngoscope in a series of adult patients with normal preoperative airway examinations. All patients were undergoing scheduled or elective surgery. In the first 75 patients (phase I), experience with airway instrumentation was documented, while in the second 75 patients (phase II), the time required to obtain an optimal view of the larynx was recorded, as well as the time to complete tracheal intubation.

Results

Ninety-eight percent of all tracheal intubations were successful using the McGrath® videolaryngoscope. Cormack and Lehane grade I views were obtained in 143 patients (95%) and grade II views were achieved in six (4%). In phase II, the median time required to obtain an adequate view was 6.3 sec [interquartile range 4.7-8.7 (range 2-26.3)], and to complete tracheal intubation was 24.7 sec [18.5-34.4(11.4-286)]. Forty-nine (65%) of the tracheal intubations were completed within 30 sec, and 72 (96%) were completed within one minute. No complications were encountered in any patient.

Conclusions

The McGrath® videolaryngoscope is an effective aid to airway management in patients with normal airways, based upon intubation success rates and the ability to rapidly secure the airway. Its potential advantages of convenience and portability warrant further evaluation in comparison with other airway devices and in patients with difficult airways.

Série de cas: Le vidéolaryngoscope McGrath® — une première évaluation clinique

Résumé

Objectif

Documenter les taux de réussite d’intubation trachéale et les temps d’instrumentation des voies aériennes pour le nouveau vidéolaryngoscope McGrath®.

Méthode

Nous avons enregistré, de façon prospective, les facteurs associés à une intubation trachéale difficile, ceux causant une difficulté réelle de l’intubation trachéale ainsi que les complications dues à l’utilisation du nouveau vidéolaryngoscope McGrath® chez une série de patients adultes présentant une anatomie des voies aériennes normales avant l’opération. Tous les patients devaient subir une chirurgie élective. Nous avons documenté notre expérience de prise en charge des voies aériennes chez les 75 premiers patients (Phase I) et, chez les 75 autres patients (Phase II), nous avons mesuré le temps requis jusqu’à obtention d’une visualisation optimale du larynx ainsi que le temps jusqu’à l’intubation trachéale complète.

Résultats

Le taux de réussite des intubations trachéales pratiquées à l’aide du vidéolaryngoscope McGrath® a été de 98%. Nous avons obtenu une visualisation de type I sur l’échelle de Cormack et Lehane chez 143 patients (95 %) et de type II chez six patients (4 %). Pendant la phase II, le temps moyen requis pour obtenir une visualisation adéquate était de 6,3 sec [écart interquartile 4,7-8,7 (écart 2-26,3)], et de 24,7 sec avant intubation trachéale complète [18,5-34,4 (11,4-286)]. On a effectué 49 (65 %) intubations trachéales en 30 sec ou moins, et 72 (96 %) en une minute ou moins. II n’y a eu aucune complication.

Conclusion

Le vidéolaryngoscope McGrath® est un outil efficace pour la prise en charge des voies aériennes chez des patients avec une anatomie normale, si l’on se base sur les taux de réussite d’intubation et la capacité de sécuriser rapidement les voies aériennes. Sa facilité d’utilisation et sa portabilité justifient une évaluation plus poussée, incluant une comparaison avec d’autres dispositifs semblables et une utilisation chez des patients présentant des difficultés d’intubation.

References

  1. 1.
    Rai MR, Dering A, Verghese C. The Glidescope system: a clinical assessment of performance. Anaesthesia 2005; 60: 60–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M. The GlideScope VideoLaryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2005; 94: 381–4.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedGoogle Scholar
  4. 4.
    Lim Y, Yeo SW. A comparison of the GlideScope with the Macintosh laryngoscope for tracheal intubation in patients with simulated difficult airway. Anaesth Intensive Care 2005; 33: 243–7.PubMedGoogle Scholar
  5. 5.
    Agro F, Barzoi G, Montecchia F. Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization. Br J Anaesth 2003; 90: 705–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Asai T, Murao K, Shingu K. Training method of applying pressure on the neck for laryngoscopy: use of a videolaryngoscope. Anaesthesia 2003; 58: 602–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Weiss M, Schwarz U, Dillier CM, Gerber AC. Teaching and supervising tracheal intubation in paediatric patients using VideoLaryngoscopy. Paediatr Anaesth 2001; 11: 343–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Lim Y, Lim TJ, Liu EH. Ease of intubation with the GlideScope or Macintosh laryngoscope by inexperienced operators in simulated difficult airways. Can J Anesth 2004; 51: 641–2.PubMedGoogle Scholar
  9. 9.
    Lim TJ, Lim Y, Liu EH. Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngoscopy. Anaesthesia 2005; 60: 180–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Cooper RM. The GlideScope VideoLaryngoscope. Anaesthesia 2005; 60: 1042.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper RM. Use of a new videolaryngoscope (GlideScope) in the management of a difficult airway. Can J Anesth 2003; 50: 611–3.PubMedGoogle Scholar
  12. 12.
    Cuchillo JV, Rodriguez MA. Considerations aimed at facilitating the use of the new GlideScope videolaryngoscope (Letter, reply). Can J Anesth 2005; 52: 661–2.PubMedGoogle Scholar
  13. 13.
    Doyle DJ. The GlideScope video laryngoscope (Letter). Anaesthesia 2005; 60: 414–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Doyle DJ. Miniaturizing the GlideScope video laryngoscope system: a new design for enhanced portability (Letter). Can J Anesth 2004; 51: 642–3.PubMedGoogle Scholar
  15. 15.
    Doyle DJ. Awake intubation using the GlideScope video laryngoscope: initial experience in four cases (Letter). Can J Anesth 2004; 51: 520–1.PubMedGoogle Scholar
  16. 16.
    Fairweather N. Nasal insertion of tube to aid in glidescope use. Anaesth Intensive Care 2005; 33: 823.PubMedGoogle Scholar
  17. 17.
    Gooden CK. Successful first time use of the portable GlideScope® VideoLaryngoscope in a patient with severe ankylosing spondylitis (Letter). Can J Anesth 2005; 52: 777–8.PubMedGoogle Scholar
  18. 18.
    Hernandez AA, Wong DH. Using a Glidescope for intubation with a double lumen endotracheal tube (Letter). Can J Anesth 2005; 52: 658–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Supbornsug K, Osborn IP. Topicalization of the airway using the glidescope (Letter). Anesth Analg 2004; 99: 1263–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Trevisanuto D, Fornaro E, Verghese C. The GlideScope® VideoLaryngoscope: initial experience in five neonates (Letter). Can J Anesth 2006; 53: 423–4.PubMedGoogle Scholar
  21. 21.
    Turkstra TP, Craen RA, Pelz DM, Gelb AW. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth Analg 2005; 101: 910–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Xue FS, Zhang GH, Li XY, et al. Comparison of haemodynamic responses to orotracheal intubation with GlideScope® videolaryngoscope and fibreoptic bronchoscope. Eur J Anaesthesiol 2006: 23: 522–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Kaplan MB, Hagberg CA, Ward DS, et al. Comparison of direct and video-assisted views of the larynx during routine intubation. J Clin Anesth 2006; 18: 357–62.PubMedCrossRefGoogle Scholar
  24. 24.
    Asai T, Shingu K. Use of the VideoLaryngoscope (Letter). Anaesthesia 2004; 59: 513–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Thompson AC. A new video laryngoscope. Anaesthesia 2004; 59: 410.PubMedCrossRefGoogle Scholar
  26. 26.
    Timmermann A, Russo S, Graf BM. Evaluation of the CTrach--an intubating LMA with integrated fibreoptic system. Br J Anaesth 2006; 96: 516–21.PubMedCrossRefGoogle Scholar
  27. 27.
    Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–34.PubMedCrossRefGoogle Scholar
  28. 28.
    Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994; 41(5Pt1): 372–83.PubMedGoogle Scholar
  30. 30.
    el-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996; 82: 1197–204.PubMedCrossRefGoogle Scholar
  31. 31.
    Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology 2005; 103: 429–37.PubMedCrossRefGoogle Scholar
  32. 32.
    Doyle DJ, Zura A, Ramachandran M. VideoLaryngoscopy in the management of the difficult airway (Letter, reply). Can J Anesth 2004; 51: 95–6.PubMedGoogle Scholar
  33. 33.
    Dupanovic M, Diachun CA, Isaacson SA, Layer D. Intubation with the GlideScope VideoLaryngoscope using the “gear stick technique” (Letter). Can J Anesth 2006; 53: 213–4.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2007

Authors and Affiliations

  1. 1.Department of AnesthesiaCritical Care and Pain Medicine, Royal Infirmary of EdinburghEdinburghScotland

Personalised recommendations