The GlideScope ® videolaryngoscope

I read with interest the article by Rai et al.[1] and subsequent correspondence by Doyle [2] regarding the GlideScope® videolaryngoscope. Both have described findings similar to recent reports [3, 4] by others including ours involving 133 relatively inexperienced operators performing laryngoscopy and intubation on 722 patients [4]. Rai et al. succeeded in intubating 47 of 50 patients. We reported a success rate of 698/722 (96.4%). Doyle's experience was ‘favourable’ but his success rate was not specified. Rai et al. found that their failures occurred early and despite good laryngeal exposure. We found 14 of our 26 failures occurred despite a Cormack & Lehane grade I view. This gives rise to an interesting, but hopefully correctable, paradox that whereas conventional direct laryngoscopy often succeeds despite failure to visualize the airway [5], intubation by early GlideScope® users occasionally fails despite an excellent laryngeal view. The technique of delivering and advancing the tracheal tube seems to be the limiting factor. My own experience with the GlideScope® now extends to approximately 1400 patients, thus far without failure. I am less convinced than Dr Doyle that a specific stylet configuration is critical. I prefer to reproduce the shape of the distal laryngoscope blade, whereas others like a ‘dynamic stylet’ like the Parker Flex-It (Parker Medical, Englewood, CO). The manufacturer of the GlideScope® (Saturn Biomedical Systems, Burnaby, B.C., Canada) will soon be introducing a preformed metal stylet. Midline blade insertion and avoidance of contact of the tracheal tube with the teeth are probably more important than a specific shape. Declaration of potential conflict of interest Dr Cooper is a consultant to Saturn Biomedical Systems.