Nasotracheal intubation with GlideScope is an alternative to difficult orotracheal intubation with GlideScope

Lai, Hou-Chuan; Lai, Meng-Fu

doi:10.1016/j.jclinane.2019.01.028

Cited by 1 publication

(2 citation statements)

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“…Oral edema, a macroglossia, and partial edentulousness along with a concomitant cervical orthosis for immobilization may render the oral passage of the endotracheal tube to be at a sharp angle and impractical for entering the larynx. Consequently, GlideScope-assisted NTI has been proposed as an alternative to difficult orotracheal intubation for patients in an intensive care unit 17 or under cervical orthosis 18 . However, our results do not necessarily apply to all types of video laryngoscopies.…”

Section: Discussionmentioning

confidence: 99%

“…The GlideScope video laryngoscope has been deemed to be an ideal intubation device for NTI 15 , 16 . GlideScope-assisted NTI was reported an alternative to difficult orotracheal intubation for critical patients in the intensive care unit 17 or under cervical orthosis 18 . However, whether cervical collars, which are frequently used among patients with myelopathy to prevent possible harm during laryngoscopy or transfer, impede NTI during anesthetic induction remain unanswered.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cervical spine immobilization does not interfere with nasotracheal intubation performed using GlideScope videolaryngoscopy: a randomized equivalence trial

Kuo

Lai

Tan

et al. 2022

Sci Rep

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GlideScope-assisted nasotracheal intubation (NTI) has been proposed as an alternative to difficult orotracheal intubation for critical patients or those under cervical immobilization. We evaluated the difficulty of performing NTI using GlideScope under cervical orthosis. A total of 170 patients scheduled for elective cervical spinal surgery that required NTI were randomized to receive cervical immobilization using a cervical collar (collar group) or no cervical immobilization at all (control group) before anesthetic induction (group assignment at 1:1 ratio). All NTI during anesthetic induction were performed using the GlideScope. The primary outcome was time to intubation. The secondary outcomes were ease of intubation, including the necessity of auxiliary manipulations to assist intubation, and the nasotracheal intubation difficulty scale (nasoIDS). An exploratory analysis identified morphometric parameters as predictors of time to intubation, the necessity of auxiliary manipulations, and a nasoIDS score ≥ 4. For time to intubation, the mean difference (collar group—control) was − 4.19 s, with a 95% confidence interval (CI) of − 13.9 to 5.52 that lay within our defined equivalence margin of 16 s. Multivariate regressions precluded the association of cervical immobilization with a necessity for auxiliary manipulations (adjusted odds ratio [aOR] 0.53, 95% CI [0.26–1.09], P = 0.083) and a nasoIDS ≥ 4 (aOR 0.94 [0.84–1.05], P = 0.280). Among all morphometric parameters, the upper lip bite test class was predictive of a longer time to intubation (all analyses relative to class 1, 14 s longer for class 2, P = 0.032; 24 s longer for class 3, P = 0.070), increased necessity for auxiliary manipulation (aOR 2.29 [1.06–4.94], P = 0.036 for class 2; aOR 6.12 [1.04–39.94], P = 0.045 for class 3), and nasoIDS ≥ 4 (aOR 1.46 [1.14–1.89], P = 0.003 for class 3).The present study demonstrated that GlideScope achieved NTI in patients with or without cervical immobilization equivalently with respect to intubation time and ease.

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Section: Discussionmentioning

confidence: 99%