Early clinical experience with a new videolaryngoscope (GlideScope®) in 728 patients

  • Richard M. Cooper
  • John A. Pacey
  • Michael J. Bishop
  • Stuart A. McCluskey
Cardiothoracic anesthesia, respiration and airway



To evaluate a new videolaryngoscope and assess its ability to provide laryngeal exposure and facilitate intubation.


Five centres, involving 133 operators and a total of 728 consecutive patients, participated in the evaluation of a new videolaryngoscope [GlideScope® (GS)]. Many operators had limited or no previous GS experience. We collected information about patient demographics and airway characteristics, Cormack-Lehane (C/L) views and the ease of intubation using the GS. Failure was defined as abandonment of the technique.


Data from six patients were incomplete and were excluded. Excellent (C/L 1) or good (C/L 2) laryngeal exposure was obtained in 92% and 7% of patients respectively. In all 133 patients in whom both GS and direct laryngoscopy (DL) were performed, GS resulted in a comparable or superior view. Among the 35 patients with C/L grade 3 or 4 views by DL, the view improved to a C/L 1 view in 24 and a C/L 2 view in three patients. Intubation with the GS was successful in 96.3% of patients. The majority of the failures occurred despite a good or excellent glottic view.


GS laryngoscopy consistently yielded a comparable or superior glottic view compared with DL despite the limited or lack of prior experience with the device. Successful intubation was generally achieved even when DL was predicted to be moderately or considerably difficult. GS was abandoned in 3.7% of patients. This may reflect the lack of a formal protocol defining failure, limited prior experience or difficulty manipulating the endotracheal tube while viewing a monitor.


Tracheal Intubation Difficult Airway Direct Laryngoscopy Difficult Tracheal Intubation Laryngeal View 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Expérience clinique préliminaire avec un nouveau vidéolaryngoscope (GlideScope®) chez 728 patients



Évaluer un nouveau vidéolaryngoscope et tester sa capacité à fournir une exposition du larynx et à faciliter l’intubation.


Cinq centres, impliquant 133 opérateurs et 728 patients consécutifs, ont participé à l’évaluation du nouveau vidéolaryngoscope [GlideScope® (GS)]. De nombreux opérateurs avaient une expérience nulle ou limitée du GS. Nous avons noté les données démographiques et les caractéristiques des voies aériennes, la classification Cormack-Lehane (C/L) des visualisations et la facilité à intuber avec le GS. Un échec était défini comme un abandon de la technique. Résultats: Six patients ont été exclus à cause de données incomplètes. Une excellente (C/L 1) ou une bonne (C/L 2) exposition du larynx a été obtenue chez 92 % et 7 % des patients respectivement. Chez les 133 patients soumis aux deux tests avec le GS et à la laryngoscopie directe (LD), le GS a donné des résultats comparables ou une vue supérieure. Parmi les 35 patients avec un grade 3 ou 4 de C/L par LD, la visualisation s’est améliorée à 1 C/L chez 24 patients et à 2 C/L chez trois patients. L’intubation avec le GS a été réussie chez 96,3 % des patients. La majorité des échecs sont survenus malgré une bonne ou une excellente visualisation glottique.


La laryngoscopie avec le GS fournit toujours une vision glottique comparable ou supérieure à la LD malgré l’expérience nulle ou limitée avec l’appareil. L’intubation a été généralement réussie même lorsqu’on prévoyait une difficulté modérée ou importante de la LD. Le GS a été abandonné chez 3,7 % des patients. Cela pourrait correspondre au manque de protocole formel définissant l’échec, à l’expérience antérieure limitée ou à la difficulté de manipuler le tube endotrachéal tout en surveillant l’écran.


  1. 1.
    Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth 1998; 45: 757–76.PubMedGoogle Scholar
  2. 2.
    Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth 1994; 41: 372–83.PubMedGoogle Scholar
  3. 3.
    Domino KB, Posner KL, Caplan RA, Cheney FW. Airway injury during anesthesia. A closed claims analysis. Anesthesiology 1999; 91: 1703–11.PubMedCrossRefGoogle Scholar
  4. 4.
    Cooper SD, Benumof JL, Ozaki GT. Evaluation of the Bullard laryngoscope using the new intubating stylet: comparison with conventional laryngoscopy. Anesth Analg 1994; 79: 965–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Rosenblatt WH, Wagner PJ, Ovassapian A, Kain ZN. Practice patterns in managing the difficult airway by anesthesiologists in the United States. Anesth Analg 1998; 87: 153–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Jenkins K, Wong DT, Correa R. Management choices for the difficult airway by anesthesiologists in Canada. Can J Anesth 2002; 49: 850–6.PubMedGoogle Scholar
  7. 7.
    Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487–90.PubMedCrossRefGoogle Scholar
  8. 8.
    Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Adnet F, Borron SW, Dumas JL, Lapostolle F, Cupa M, Lapandry C. Study of the “sniffing position” by magnetic resonance imaging. Anesthesiology 2001; 94: 83–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Konrad C, Schupfer G, Wietlisbach M, Gerber H. Learning manual skills in anesthesiology: is there a recommended number of cases for anesthetic procedures? Anesth Analg 1998; 86: 635–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Mulcaster JT, Mills J, Hung OR, et al. Laryngoscopic intubation. Learning and performance. Anesthesiology 2003; 98: 23–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Combes X, Le Roux B, Suen P, et al. Unanticipated difficult airway in anesthetized patients. Prospective validation of a management algorithm. Anesthesiology 2004; 100: 1146–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Adnet F, Racine SX, Borron SW, et al. A survey of tracheal intubation difficulty in the operating room: a prospective observational study. Acta Anaesthesiol Scand 2001; 45: 327–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Karkouti K, Rose DK, Ferris LE, Wigglesworth DF, Meisami-Fard T, Lee H. Inter-observer reliability of ten tests used for predicting difficult tracheal intubation. Can J Anaesth 1996; 43: 554–9.PubMedGoogle Scholar
  15. 15.
    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
  16. 16.
    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
  17. 17.
    Cooper RM. Use of a new videolaryngoscope (GlideScope®) in the management of a difficult airway. Can J Anesth 2003; 50: 611–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Agro F, Barzoi G, Montecchia F. Tracheal intubation using a Macintosh laryngoscope or a GlideScope® in 15 patients with cervical spine immobilization (Letter). Br J Anaesth 2003; 90: 705–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Levitan RM. A new tool for teaching and supervising direct laryngoscopy. Acad Emerg Med 1996; 3: 79–81.PubMedCrossRefGoogle Scholar
  20. 20.
    Shulman GB, Nordin NG, Connelly NR. Teaching with a video system improves the training period but not subsequent success of tracheal intubation with the Bullard laryngoscope. Anesthesiology 2003; 98: 615–20.PubMedCrossRefGoogle Scholar
  21. 21.
    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
  22. 22.
    Kaplan MB, Ward DS, Berci G. A new videolaryngoscope-an aid in intubation and teaching. J Clin Anesth 2003; 14: 620–6.CrossRefGoogle Scholar
  23. 23.
    Doyle DJ, Zura A, Ramachandran M. Videolaryngoscopy in the management of the difficult airway (Letter). Can J Anesth 2004; 51: 95.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Richard M. Cooper
    • 1
    • 2
  • John A. Pacey
    • 3
  • Michael J. Bishop
    • 4
  • Stuart A. McCluskey
    • 1
  1. 1.From the Department of Anesthesia and Pain ManagementToronto General HospitalTorontoCanada
  2. 2.University of TorontoToronto
  3. 3.University of British ColumbiaVancouverCanada
  4. 4.the Departments of Anesthesiology and MedicineUniversity of Washington and Veterans Affairs Puget Sound Health Care SystemSeattleUSA

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