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Wednesday, April 2, 2014

Is it time to go to video larygoscopy?

We had a patient recently who should have been intubated yesterday, and despite several gallant attempts by various experts, including two anaesthesiologists, we were unable to intubate this man.  That was when the anaesthesiologist said, "Keep bagging.  I'll be right back."

He returned with the Glidescope.  It consisted of a stand with a monitor, and a laryngoscope handle that was connected to a cord and had a camera at it's proximal end.  He connected a disposable blade to this, and he was ready to go.

He inserted the blade and performed the usual technique, and, instead of looking into the patient's airway looking for the white vocal cords, he was looking at the monitor, where you could clearly see the cords.  We watched, on the screen, as he pushed the blade through the cords.  It was that easy.

Everyone was impressed.

Later the anesthesilogist said there were two available in surgery, and also one available in the emergency room.  All that was needed, he said, was for physicians to practice with it and get comfortable.

A recent article by Phyllis Hanlon in the March, 2014, issue of rt magazine, "Vidoe Laryngoscope: High-tech Disaster Airway Management," said that video laryngoscopes are:
  • Lightweight
  • Portable
  • Waterproof
  • Battery opperated
Hanlon listed the following advantages of using video laryngoscope, according to studies:
  • Emergency Department intubations were more successful with video than with direct laryngoscopy
  • There was a shorter learning curve with video laryngoscopy than with direct laryngoscopy
  • There was a higher first attempt succcess rate than with direct laryngoscope
While video laryghoscope may be used for any intubation, it is particularly ideal in the following situations:
  • High stress situations 
  • Our of hospital settings
  • Patients with large necks
  • Any difficult intubation
  • Patient has already been subjected to a physically distressing situation
  • Damage to mouth, pharynx or glottis 
RT magazine notes video laryngoscopy has been practiced by the military in combat zones, such as Afghanistan and Iraq, and the results were quite positive.

Hanlon said the image can be sent to any device with a USB port, such as a small monitor like the one I observed, or even an iPhone or iPad.  

To view a video of the GlideScope in use, check out the website of Verathon, the manufacturers of the produce:  

Note:  This post is meant to be an endorsement of video laryngoscopy in general, and not any particular product.  

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1 comment:

Amanda Marie said...

Our RT's use the McGrath video scopes all the time. It makes us look like rock stars at intubations.