II. Preparations: Glidescope Video Laryngoscope
- Has sizes for all ages available (neonate, infant, child, adolescent, adult)
- Simple device to use with a high successful cord visualization rate
- Once practiced with passing the ET Tube with hyperangulated blade, success rates >96%
- High success rates in morbid Obesity or C-Spine Immobilization as well as a rescue device
- Unlike Direct Laryngoscopy, glidescope blade is inserted in midline
- Gradually advance until airway landmarks are visualized
- Difficulty is in passing the ET Tube (requires a different technique than Direct Laryngoscopy)
- Glidescope is a hyperangulated device (up to 80 degree)
- Visualizes around the tight angle from behind Tongue into pharynx
- Hyperangulated devices do not straighten the airway
- Stylet must also be hyperangulated (60-80 degrees) to reach the cords
- Exception: Standard stylet may be used in very young children
- Glidescope uses its own, expensive ($80 each) reusable stylets
- A curled Elastic Bougie (stored in pocket for 1-2 min) will also work
- Stylet must also be hyperangulated (60-80 degrees) to reach the cords
- Once tube passes through cords, catches on anterior tracheal rings due to hyperangulation
- Stylet must be at withdrawn 5 cm (should NOT be firmly inserted at start) AND
- Tube rotated 90 degrees (counter-clockwise) to further insert ET
- Common mistake is inserting glidescope blade too close to Vocal Cords
- Passing Endotracheal Tube is difficult to impossible in this position
- Withdraw glidescope to obtain a wider view of the airway
- Glidescope is a hyperangulated device (up to 80 degree)
- Resources
III. Preparations: C-MAC Video Laryngoscope
- Storz device is a "cadillac", popular in teaching hospitals
- Allows Direct Laryngoscopy for resident, while attending views screen
- Most expensive of Video Laryngoscopy devices ($25,000)
- Very bright (high lumen) with a high quality monitor (semiconductor chip)
- First pass success as high as 93% in predicted difficult airways
- Unlike Glidescope, is not hyperangulated, more similar to DL, and passing the ET Tube is more straight forward
- Same screen unit may be attached to Storz Nasolaryngoscope
- Has all pediatric sizes available (Miller 0,1 and Macintosh 2-5)
- http://www.karlstorz.com/cps/rde/xchg/SID-288120FD-483BDF71/karlstorz-en/hs.xsl/9549.htm
IV. Preparations: McGrath Video Laryngoscope
- Reasonably priced ($3700) with inexpensive disposable blades (100 supplied)
- Device may be used as Direct Laryngoscope as well as Video Laryngoscope
- Lithium ion battery lasts 250 minutes, non-rechargable, and costs $60 to replace
- Lightweight, self-contained device (32.5 g) allows for portability
- Provides Grade I or II Views in 99% of patients and effective as rescue device (failed DL) in 95% of cases
- http://www.covidien.com/rms/pages.aspx?page=OurProducts/McGrathVideoLaryngoscopy
V. Preparations: Other devices
- Standard Video Laryngoscopes
- Pentax AWS Video Laryngoscope
- Challenging device to use in larger patients
- Channel is difficult to thread ET through (although could easily thread bougie)
- Not recommended for prehospital use due to screen glare in outdoor lighting
- CoPilot Video Laryngoscope
- VividTrac
- Clarus Video system (fiberoptic)
- Pentax AWS Video Laryngoscope
- Lowest cost solutions (channeled devices)
- Precautions
- Channeled devices may be difficult to direct ET Tube into airway despite visualizing it
- Airtraq Avant (optical prism device)
- Has all pediatric sizes available
- King Vision Video Laryngoscope
- Precautions
VI. References
- Gauusche-Hill (2016) ACEP-PEM Conference, Difficult Airway Lecture, attended 3/8/2016
- Kim, Brown and Sheng (2016) Crit Dec Emerg Med, 30(3): 13-20
- Levitan (2013) Practical Airway Management Course, Baltimore