Difficult airway management practice changes after introduction of the GlideScope videolaryngoscope

Abstract

BACKGROUND Introduction of the GlideScope videolaryngoscope caused a change in use of other devices for difficult airway management. OBJECTIVE The influence of the GlideScope videolaryngoscope on changes in the indications for and the frequency of use of flexible fibreoptic-assisted intubation and other difficult airway management techniques. DESIGN Retrospective cohort study. SETTING Tertiary care referral centre. METHODS Two periods of equal length (647 days each) before and after introducing the GlideScope were compared. Information about patients who were intubated using nondirect laryngoscopic techniques were analysed. Data were retrieved from the anaesthesia and hospital information management systems. RESULTS Difficult airway management techniques were used in 235/8306 (2.8%) patients before and in 480/8517 (5.6%) (P < 0.0001) patients after the introduction of the GlideScope. There was an overall 44.4% reduction in use of flexible fibreoptic bronchoscopy after GlideScope introduction [before 149/8306 (1.8%); after 85/8517 (1.0%), P < 0.0001]. The GlideScope replaced flexible fibreoptic bronchoscopy in most cases with expected and unexpected difficult intubation. In patients with limited mouth opening, flexible fibreoptic bronchoscopy was still mostly the first choice after the introduction of the GlideScope. There was a 70% reduction in the use of other difficult intubation techniques after the introduction of the GlideScope [before 84/8306 (1.0%); after 22/8517 (0.3%), P < 0.0001)]. CONCLUSION The GlideScope videolaryngoscope replaced flexible fibreoptic bronchoscopy for most patients with expected and unexpected difficult intubation. In the case of limited mouth opening, flexible fibreoptic bronchoscopy was still the first choice after the introduction of the GlideScope. The reduced use of flexible fibreoptic bronchoscopy raises concerns that residents may not be adequately trained in this essential airway management technique. GlideScope use was disproportionately greater than the reduction in the use of flexible fibreoptic bronchoscopy and other difficult intubation techniques. This may be attributed to resident teaching and use in patients with low-to-moderate suspicion of difficult intubation.

A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods

“…Recently, the method of intubation has changed from that involving a direct glottic view to an indirect glottic view because video laryngoscopes (VL) have several advantages such as improvement of glottis visualization, a higher intubation success rate, reduction in intubation attempts and complications compared to direct laryngoscopes [2][3][4][5][6][7][8][9][10].…”

“…Recently, the method of intubation has changed from that involving a direct glottic view to an indirect glottic view because video laryngoscopes (VL) have several advantages such as improvement of glottis visualization, a higher intubation success rate, reduction in intubation attempts and complications compared to direct laryngoscopes [ 2 – 10 ]. The VL that uses an indirect glottis view can confirm the location of the glottis on an external monitor via a camera located in the middle or tip of the blade.…”

Successful use of C-MAC® video laryngoscope for unexpected severe airway narrowing during anesthesia induction in a patient with a moderate-sized laryngeal tumor

“…12 This new tool has given various aids in solving difficult airway situations. 3,13 It has also replaced the need of using awake fiberoptic bronchoscopy or surgical airways. 12,13 There is good evidence of using videolaryngoscope in priority in situations of difficult airways.…”

The Anesthesiologist’s Role in Teaching Airway Management to Nonanesthesiologists

“…Once unquestioned airway experts, anesthesiologists now find themselves operating in an environment where multiple specialties, including emergency medicine (EM), critical care, and surgery, have accessed and practice an ever-increasing range of airway management techniques. As noted by Chrimes and colleagues [ 1 ] in a recent editorial, “The landscape on which airway management is practiced is rapidly changing.” In the past 20 years, the introduction and widespread acceptance of video laryngoscopy (VL) [ 2 , 3 ]; increased emphasis on invasive rescue techniques for the cannot intubate, cannot oxygenate scenario [ 4 ]; and expanded airway training for nonanesthesiologists have disrupted the old paradigm of “Call anesthesia!” when the need for airway management outside the operating room (OR) occurs. This should be viewed as a disruptive, but positive, innovation by the anesthesia community, with a net effect of moving toward a universal airway management approach that can be applied independent of experience, specialty, or clinical context [ 1 ].…”

“…As noted by Chrimes and colleagues [1] in a recent editorial, ''The landscape on which airway management is practiced is rapidly changing.'' In the past 20 years, the introduction and widespread acceptance of video laryngoscopy (VL) [2,3]; increased emphasis on invasive rescue techniques for the cannot intubate, cannot oxygenate scenario [4]; and expanded airway training for nonanesthesiologists have disrupted the old paradigm of ''Call anesthesia!'' when the need for airway management outside the operating room (OR) occurs.…”