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LETTER TO THE EDITOR

The Glide Scope: Also Helpful with Difficult Transesophageal Echocardiography Probe Placement

Department of Anesthesia; University of California; Irvine, Medical Center; Orange, CA; cmstlaur{at}uci.edu

To the Editor:

Hunter and Cohen (1) reported using the Glide Scope to help with difficult nasogastric tube placement. Herein, we describe using a Glide Scope to insert larger tubes/scopes when all other placement methods have failed.

A 64-year-old female patient had been scheduled to undergo a redo sternotomy for replacement of an infected prosthetic aortic valve. Like the patient described by Hunter and Cohen, intubation was simple and difficulty was noted with the nasogastric tube. Routinely, a nasogastric tube is inserted to remove air from the stomach, and removed, prior to placement of the transesophageal echo probe to obtain optimal visualization. We abandoned the nasogastric tube placement and opted for the insertion of the echo probe.

This too met with difficulty at the 20–25 cm mark. All clinical tricks including direct laryngoscopy were unsuccessful. Cardiology was asked to assist, and their efforts were also unsuccessful. We were faced with an urgent clinical need, and the cardiologist, in frustration, uttered a wish for a video of some kind so he could see what was causing the probe not to pass. Immediately, the Glide Scope was brought to the room. We were able to insert the echo probe and proceed with this difficult and complex case. We alerted the surgeon to the presence of an abscess pocket that had dissected around the valve, necessitating aortic root reconstruction in order to reseat the new prosthetic valve.

The rest of the case proceeded uneventfully.

Three weeks later, when faced with a difficult transesophageal echo probe placement during the testing portion of an electrophysiology lab procedure, the cardiology team asked the anesthesia team present to call for the Glide Scope so that it could be used again¡

REFERENCE

1. Hunter C, Cohen S. A new use for the glide scope. Anesth Analg 2006;103:509.[Free Full Text]

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