Using a long semi-rigid catheter with a controllable tip to facilitate tracheal intubation with a GlideScope®
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KeywordsCatheter Tracheal Intubation Vocal Cord Tracheal Tube Fibreoptic Bronchoscope
To the Editor,
The recently developed GlideScope® (GS) (Original model, Verathon Inc., Bothel, WA, USA) has become very popular for managing both difficult and routine tracheal intubations. The GS allows improved visualization of the vocal cords, but occasionally inserting the endotracheal tube (ETT) may be difficult.1 In cases where the glottic opening is situated very anterior, the ETT tends to be directed into the larynx with an angle almost perpendicular to the axis of the trachea. This situation can lead to the failure of intubation.
A number of solutions for this well-known problem have been suggested already, including the use of a preformed stylet or an Eschmann® Tracheal Tube Introducer (gum elastic bougie),2,3 or possibly using a combination of a GlideScope® and a fibreoptic bronchoscope (FOB) to facilitate intubation.4,5 This latter combination is especially beneficial when the GS view is suboptimal. We frequently use this technique, and in our view, the crucial factor for success is the FOB’s flexibility, which allows the ETT to pass easily through the glottis. In the majority of cases, the fibreoptic bronchoscope is not absolutely necessary and could be replaced by a catheter with a controllable tip.
To our knowledge, the endobronchial blocker set (Cook®) is the only device that has the ability to steer the tip of the catheter in different directions. This endobronchial blocker is relatively expensive, but a catheter with an adjustable tip may be considered a prototype. The development of a simple device with a controllable tip would be a useful adjunct for indirect laryngoscopic intubation techniques.
Conflicts of interest
None of the authors has commercial or non-commercial interests that may be considered a conflict of interest in this work.
- 4.Sukernik MR, Bezinover DS, Stahlman B, Vaida S, Pott L. Combination of Glidescope with fiberoptic bronchoscope for the optimization of difficult endotracheal intubation. A case series of three patients. Anesthesia On-Line, January 2009. http://www.priory.com/medicine/Glidescope_bronchoscope.htm. Accessed June 2009.