Abstract
Purpose
The GlideScope® videolaryngoscope usually provides excellent glottic visualization, but directing an endotracheal tube (ETT) through the vocal cords can be challenging. The goal of the study was to compare the dedicated GlideScope®-specific rigid stylet to the standard malleable stylet, assessed by time to intubation (TTI).
Methods
Eighty patients requiring orotracheal intubation for elective surgery were randomly allocated to either the GlideScope® rigid stylet (GRS) or a standard malleable stylet to facilitate intubation using the GlideScope®. Time to intubation was recorded by blinded assessors; operators were blinded until after laryngoscopy. The operator assessed the ease of intubation using a visual analogue scale (VAS). The number of intubation attempts, number of failures, glottic grades, and use of external laryngeal manipulation were documented.
Results
The median TTI was 42.7 sec (inter-quartile range (IQR) 38.9-56.7) for the GRS group compared to 39.9 sec (IQR 34.1-48.2) for the control group (P = 0.07). The median VAS score for ease of intubation was 20 (IQR 12.0-33.0) for the GRS group compared to 18 (IQR 9.5-29.5) for the control group (P = 0.21). There was no significant difference in TTI or VAS between stylets. The overall incidence of a Cormack-Lehane grade I or II glottic view was 98%.
Conclusions
In a group of experienced operators using the GlideScope®, the dedicated GRS and the standard malleable ETT stylet are equally effective in facilitating endotracheal intubation.
Résumé
Objectif
Le vidéolaryngoscope GlideScope® fournit en général une excellente visualisation glottique, mais diriger une sonde endotrachéale (SET) entre les cordes vocales peut être un défi. L’objectif de cette étude était de comparer le mandrin rigide spécifique au GlideScope® au mandrin flexible standard, évalués par le temps requis pour l’intubation (TTI).
Méthode
Quatre-vingts patients nécessitant une intubation orotrachéale pour une chirurgie élective ont été randomisés à être intubés à l’aide soit du mandrin rigide GlideScope® (GRS), soit du mandrin flexible standard pour faciliter l’intubation avec le GlideScope®. Le temps requis pour l’intubation a été mesuré par des évaluateurs en aveugle; les opérateurs étaient également en aveugle jusqu’à ce que la laryngoscopie soit terminée. L’opérateur a évalué la facilité d’intubation à l’aide d’une échelle visuelle analogique (EVA). Le nombre de tentatives d’intubation, le nombre d’échecs, le grade d’intubation et le recours à une manipulation laryngée externe ont été notés.
Résultats
Le TTI médian était de 42,7 sec (intervalle interquartile (IQR) 38,9-56,7) pour le groupe GRS comparé à 39,9 sec (IQR 34,1-48,2) pour le groupe témoin (P = 0,07). Le score EVA médian pour la facilité d’intubation était de 20 (IQR 12,0-33,0) pour le groupe GRS comparé à 18 pour le groupe témoin (P = 0,21). Il n’y a pas eu de différence significative dans le TTI ou l’EVA entre les mandrins. L’incidence globale de la visualisation glottique selon l’échelle de Cormack-Lehane de grade I ou II était de 98 %.
Conclusion
Dans un groupe d’opérateurs expérimentés se servant du GlideScope®, le mandrin GRS spécial et le mandrin flexible standard ont la même efficacité pour faciliter l’intubation endotrachéale.
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Disclosure statement: This study was internally funded. No author has any competing interests related to the medical devices evaluated. This trial was registered at www.ClinicalTrials.gov, NCT00434720.
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Turkstra, T.P., Harle, C.C., Armstrong, K.P. et al. The GlideScope®-specific rigid stylet and standard malleable stylet are equally effective for GlideScope® use. Can J Anesth 54, 891–896 (2007). https://doi.org/10.1007/BF03026792
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DOI: https://doi.org/10.1007/BF03026792