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Nasotracheal Intubation, Direct Laryngoscopy and the GlideScope®

Section Editor(s): Saidman, LawrenceDupanovic, Mirsad MD

doi: 10.1213/ane.0b013e31818fa274
Letters to the Editor: Letters & Announcements
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Department of Anesthesiology; Kansas University Medical Center; Kansas City, Kansas; mdupanovic@kumc.edu

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To the Editor:

Jones et al.1 demonstrated that nasotracheal intubation using the GlideScope® (GVL) is faster than using direct laryngoscopy (DL). The necessity to use Magill forceps in almost 50% of patients in the DL group and in none in the GVL group may explain these results.1

Use of Magill forceps is time consuming. An operator has to reach for the forceps, grab it, insert it into the oropharynx, grasp the nasotracheal tube (NTT), direct the tip through the glottis, and advance it. None of these maneuvers is required for nasotracheal intubation with the GVL. An operator inserts the GVL, displays the glottis, and advances the NTT without need for any accessory device. Due to minimal distortion of the upper airway the pre-shaped NTT usually follows the natural trajectory toward the glottis as it would during a successful blind nasotracheal intubation. Thus a seperate analysis of time to intubation in DL cases in which the Magill forceps were used and in those in which they were not used would be helpful. The difference in time to intubation between the latter DL subgroup and the GVL group may have not been significant.

Mirsad Dupanovic, MD

Department of Anesthesiology

Kansas University Medical Center

Kansas City, Kansas

mdupanovic@kumc.edu

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REFERENCE

1. Jones PM, Armstrong KP, Armstrong PM, Cherry RA, Harle CC, Hoogstra J, Turkstra TP. A comparison of GlideScope® videolaryngoscopy to direct laryngoscopy for nasotracheal intubation. Anesth Analg 2008;107:144–8
© 2009 International Anesthesia Research Society