The use of the GlideScope to facilitate nasotracheal intubation: in patients with a difficult airway
We read with interest the case report in which the GlideScope was used to facilitate the insertion of a nasogastric tube . The use of the GlideScope for orotracheal intubation has been shown to improve the laryngoscopic view of the larynx in patients with a difficult airway . We have observed that the GlideScope can also facilitate nasotracheal intubation in patients with a difficult airway.
Three patients aged 45–65 years were scheduled for oral surgery requiring nasotracheal intubation. Following preoxygenation and application of a vasoconstrictor to the selected nostril, anaesthesia was induced with intravenous propofol and 0.6 mg/kg rocuronium. Laryngoscopy (Macintosh blade) revealed a view of the larynx, which was Cormack and Lehane classification II or III. This was improved to grade I by using a GlideScope. The nasotracheal tube was then introduced through the selected nostril into the pharynx. The cuff of the nasotracheal tube was inflated with air to raise its tip anteriorly to the level of the glottis and slightly advanced beyond the arytenoids. An endotracheal tube introducer with a soft curved tip (Metti, VBM, Sulz, Germany) was passed through the nasotracheal tube into the glottis and trachea to act as a guide [3,4]. The cuff of the nasotracheal tube was then deflated, and the tube was easily advanced over the introducer into the trachea and the introducer withdrawn. The whole procedure was undertaken with clear vision of the pharynx and larynx, and all patients were successfully intubated.
We conclude that the GlideScope can improve the glottic view when performing nasotracheal intubation in patients with a difficult airway and the technique may also be of value in patients with a normal airway.
1 Pandian A, Raval M, Bailey CR. A nonairway management use of the video laryngoscope (GlideScope). Eur J Anaesthesiol 2008; 25:511.
2 Cooper RM. Early experience with a new video laryngoscope. Can J Anesth 2005; 52:191–198.
3 Muallem M, Baraka A. Tracheal intubation using the GlideScope with a combined curved pipe stylet, and endotracheal tube introducer. Can J Anaesth 2007; 54:77–78.
© 2009 European Society of Anaesthesiology
4 Muallem M. Endotracheal tube introducer: an aid for the difficult airway. Middle East J Anaesthesiol 2000; 15:687–692.