Video laryngoscopy: Difference between revisions
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**Place hyperangulated blade midline and slowly advance with progressive identification of airway landmarks | **Place hyperangulated blade midline and slowly advance with progressive identification of airway landmarks | ||
**Advance blade into vallecula | **Advance blade into vallecula | ||
**When cords fill entire screen (Cormack-Lehane Grade I), slightly retract laryngoscopy so that cords only occupy upper 1/3 of screen (CL Grade II, allows for passage of ETT with rigid stylet) | **When cords fill entire screen (Cormack-Lehane Grade I), slightly retract laryngoscopy so that cords only occupy upper 1/3 of screen (CL Grade II, allows for passage of ETT with rigid stylet)<ref>Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Une vue laryngée délibérément restreinte à l'aide du vidéolaryngoscope GlideScope® est associée à une intubation trachéale plus rapide et plus aisée qu'une vue glottique totale: une étude clinique randomisée. Can J Anaesth. 2016;63(8):928-937. doi:10.1007/s12630-016-0654-6</ref> | ||
***If intubation is attempted with the best view possible, operators often have difficulty advancing the tube around the tongue and hypopharyngeal soft tissues | ***If intubation is attempted with the best view possible, operators often have difficulty advancing the tube around the tongue and hypopharyngeal soft tissues | ||
Revision as of 23:11, 10 December 2020
Overview
- Two principal versions are the C-MAC and the Glidescope
- Glidescope first introduced in 2001, features a hyperangulated blade
- CMAC features a Macintosh or standard geometry blade
- Today, both CMAC and Glidescope systems offer hyperangulated and standard geometry blades
- Increasingly utilized in emergency airway management[1]
Indications
- Any patient requiring intubation
- Particularly useful in patients with known or anticipated difficult intubation
Contraindications
- Relative:
- Blood or emesis in airway
- Foreign body removal
Equipment Needed
- Video laryngoscope
- Rigid stylet if hyperangulated blade is used
- All other equipment necessary for endotracheal intubation
Procedure
- Hyperangulated Video Laryngoscope
- Patient ideally in neutral spine position (as opposed to "sniffing" position for direct laryngoscopy)
- After induction, use right hand to "scissor" mouth open
- Place hyperangulated blade midline and slowly advance with progressive identification of airway landmarks
- Advance blade into vallecula
- When cords fill entire screen (Cormack-Lehane Grade I), slightly retract laryngoscopy so that cords only occupy upper 1/3 of screen (CL Grade II, allows for passage of ETT with rigid stylet)[2]
- If intubation is attempted with the best view possible, operators often have difficulty advancing the tube around the tongue and hypopharyngeal soft tissues
- Standard Geometry Video Laryngoscope
- Same technique utilized with direct laryngoscopy
- Can either visualize directly or utilize video screen for tube delivery
Complications
- Risk of equipment failure with hyperangulated laryngoscope (unable to obtain direct view if screen fails)
- Risk of camera contamination with blood or emesis in airway
- Foreign body removal with hyperangulated laryngoscope less successful than with Macintosh laryngoscope [3]
See Also
Airway Pages
- Pre-intubation
- Induction
- Intubation
- Surgical airways
- Post-intubation
References
- ↑ Brown CA 3rd, Bair AE, Pallin DJ, Walls RM; NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations [published correction appears in Ann Emerg Med. 2017 May;69(5):540]. Ann Emerg Med. 2015;65(4):363-370.e1. doi:10.1016/j.annemergmed.2014.10.036
- ↑ Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Une vue laryngée délibérément restreinte à l'aide du vidéolaryngoscope GlideScope® est associée à une intubation trachéale plus rapide et plus aisée qu'une vue glottique totale: une étude clinique randomisée. Can J Anaesth. 2016;63(8):928-937. doi:10.1007/s12630-016-0654-6
- ↑ Je, S. M., Kim, M. J., Chung, S. P., & Chung, H. S. (2012). Comparison of GlideScope® versus Macintosh laryngoscope for the removal of a hypopharyngeal foreign body: A randomized cross-over cadaver study. Resuscitation, 83(10), 1277–1280.