Anesth Analg 2004;99:1263-1264
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000132717.45860.DA
LETTERS TO THE EDITOR
Topicalization of the Airway Using the GlideScope
Kaew Supbornsug, MD, and
Irene P. Osborn, MD
Department of Anesthesiology, Mount Sinai Medical Center, New York, NY
To the Editor:
The GlideScope (Saturn Biomedical System Inc, Burnaby, British Columbia, Canada) is a video laryngoscope that may be a useful alternative in difficult airway management. Reports have indicated that the GlideScope can provide adequate vision of the glottis (Cormack and Lehane grade I-II) even when the oral, pharyngeal and laryngeal axes are not aligned (1–2). The GlideScope incorporates a high-resolution digital camera located in the middle of the blade tip. The glottis is visualized through a video cable, using a high-resolution LCD monitor. The blade design of the GlideScope has several advantages; an embedded anti-fogging mechanism, a reduced overall thickness of 18 mm, and 60-degree curvature to match the anatomical alignment.
Topicalization of the larynx and trachea can prevent increases in arterial blood pressure during intubation and positioning of patients (3). Cough and laryngospasm in response to intubation can be troublesome. Anesthesiologists frequently try to prevent these responses using medications delivered either topically or IV. The larynx and trachea are easily anesthetized with local anesthetic sprays such as lidocaine and tetracaine.
MADgic (Wolfe Tory Medical Inc, Salt Lake City, UT) is a new device for spraying topical anesthetics in the laryngotracheal region. This device can provide atomized topical solution directly to the mucosa of the nose, larynx, and through the vocal cords. The applicator portion can be adapted to an individual patient’s anatomy.
We have combined these two devices to provide topicalization of the glottis. In our experience of 22 patients (20 anesthetized and 2 awake), the GlideScope reliably produced a Cormack and Lehane grade I-II view for spraying the vocal cords. The curvature of the Wolfe Tory device provided optimal positioning for this purpose (Fig. 1) Previous attempts using the LTA kit (Abbott Laboratories, Abbott Park, IL) spray did not give optimal placements.
The GlideScope provides superior vision of the glottis, allowing for spray of the larynx and vocal cords when combined with the Wolfe Tory device. This technique is easy to perform and allows others to observe airway anatomy and successful topicalization.
References
- Agro F, Barzoi G, Montecchia F. Tracheal intubation using a Macintosh laryngoscope or GlideScope in 15 patients with cervical spine immobilization. Br J Anaesth 2003; 90: 705–6.[Free Full Text]
- Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anesthesia 1984; 39: 1105–11.
- Hamaya Y, Dohi S. Differences in cardiovascular response to airway stimulation at different sites and blockade of the responses by lidocaine. Anesthesiology 2000; 93: 95–103.[Web of Science][Medline]
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F. S. Xue, Q. Y. Yang, and X. Liao
Topical anaesthesia of the airway using TrachlightTM and MADgic(R) atomizer in patients with predicted difficult tracheal intubation
Br. J. Anaesth.,
December 1, 2007;
99(6):
920 - 921.
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