Skip to main content

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. 


Labels:

Comments

Post a Comment

Popular posts from this blog

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by:   the area of the curve  the slope of the line from points C to D  the distance of the line from points C to D  the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by:  the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.
Post a Comment
Read more

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body
Post a Comment
Read more

Steroids In Perioperative period...The Multi-purpose Drugs

1-Steroids are not Bronchodilator ,but have well established usefulness in hyper-reactive airway. They are also said to have a permissive role for bronchodilator medication. They can be administered orally, parenterally or in aerosol form 2- Steroids have been commonly used in chemotherapy for prevention of nausea along with other anti-emetic agents . Dexamethasone was found to be highly effective when given immediately before induction rather than at the end of anesthesia . 3- Steroids do exert analgesic effects. Various routes of administration of steroids include parentral, local infiltration at operated site , as an adjuvant in nerve blocks and central-neuraxial blockade. 4 - Steroids cannot be the mainstay of therapy in anaphylaxis because of the delayed onset of action, so they are used as adjunct after initial treatment with epinephrine. 5- Steroids (Dexamethsone) are of value in reduction or prevention of cerebral edema associated with parasitic infections and neopla...
1 comment
Read more