The GlideScope Video Laryngoscope (GVL) is an extremely useful tool for managing challenging intubations, but it can be more difficult to use if your patient has a small mouth and a high arched, narrow palate. The problem: once the GlideScope is in place in a small mouth, maneuvering the endotracheal tube around it and into the posterior pharynx can be challenging. If you can pass the endotracheal tube (ETT) at all, the cuff tends to scrape against the teeth, risking rupture. However, there is a modified GlideScope technique you can use in those situations. Continue reading
Awake intubation with the GlideScope can be an especially helpful technique when intubation of a difficult airway under direct vision is optimal. One of the most challenging scenarios to face is a tumor in the airway. Working closely with your surgeon is important. In this particular case, we actually had a video available of what this 8 mm airway polyp looked like popping in and out of a laryngeal opening of about the same size with each breath like a potential cork. According to the surgeon our patient had come to the clinic because she had been experiencing some increased shortness of breath. Having the video was a rare advantage. Follow this link to youtube video showing pedunculated vocal cord polyp obstructing the glottic opening. Here are some stills from that video.
Glidescopes, one of the several videolaryngoscopes in use, are very easy to use. However, intubation with the Glidescope is very different than direct laryngoscopy. I have seen many novice Glidescope users struggle to intubate, despite having great views of the larynx. Failure to recognize the differences of using the Glidescope can make intubation not only frustrating but also hazardous to your patient. Beginners almost always make the same few easy to correct mistakes. Let’s explore those mistakes and discuss how to correct them. Continue reading