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Glidescope...from blind intubation into blind spot


During glidescope directed intubation the common factor associated with intraoral injuries such as palatopharyngeal, anterior tonsillar pillar or soft palate perforations, is blind advancement of the endotra- cheal tube. 

 Injuries have occurred despite apparent gentle technique and the lack of resistance encoun- tered by the operator. When upward force is applied to the GlideScope® to achieve better laryngeal visualisa- tion, the tonsillar pillars and related structures may be stretched taut and become susceptible to perforation.1

 This highlights the need for constant visual assessment of the tip of the endotracheal tube under direct vision during the initial oral- pharyngeal insertion, as well as during subsequent advancement of the tube on the GlideScope® monitor.

  In the interim, there may be a blind spot, depending on the patient’s oral anatomy.2

 A strategy to overcome such problems is to advance the endotracheal tube right next to the GlideScope® blade, near the midline. This provides maximal space for endotracheal tube advancement. 

 Another strategies  recommended by manufacturer ,
1.The GlideScope® is first intro- duced into the midline of the oral pharynx with the left hand.
2. The epiglottis is identified on the screen and the scope is manipu- lated to obtain the best glottic view.
3. The endotracheal tube is then guided into position near the tip of the laryngoscope by direct vision.
4. When the distal tip of the endotra- cheal tube disappears from direct view, it should be viewed on the monitor. Gently rotate or angle the tube to redirect as needed. 

1-Cooper RM. Complications associ- ated with the use of the GlideScope® videolaryngoscope. Can J Anaesth. 2007 Jan;54(1):54–7.
2-Choo MK, Yeo VS, See JJ. Another complication associated with vide- olaryngoscopy. Can J Anaesth. 2007 Apr;54(4):322–4. 


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