The GlideScope® video laryngoscope

I read with interest the article by Rai et al. [1] concerning the GlideScope® video laryngoscope (GVL). At my institution, we have used the GVL in more than 700 patients since March 2003, including over 20 cases of awake intubation [2] as well as a number of successful ‘airway rescues’ where I was called to assist. Overall, our experience with the GVL has been highly favourable, and I fully expect that with time it will have a profound impact on clinical airway management. In particular, the common teaching that patients with a known difficult airway must be managed by awake fibreoptic intubation may soon need to be challenged. I have found that the principal limitation in using the GLV is not in getting a good view of the glottis, but rather in manipulating the tracheal tube through the vocal cords. My experience is that successful tracheal tube placement is usually best achieved by using a stylet formed in the shape of a ‘hockey stick’ (with a 90° bend) to help ensure that the tube is directed sufficiently anteriorly to enter the glottis. I have also found that once the tube enters the glottis, it is very helpful to withdraw the stylet by about 3 cm, followed by advancing the tube slightly, so as to avoid it hitting against the tracheal wall. I have also found the GVL to be useful in some cases of difficult fibreoptic intubation [3]. Here, the GVL is introduced in the usual manner, followed by introduction of the fibreoptic bronchoscope. Such an arrangement provides simultaneous ‘micro’ and ‘macro’ views that can be particularly helpful. Should the tracheal tube get caught on the arytenoids or other laryngeal structures, it becomes evident on the GVL display, and appropriate corrective action (such as twisting the tube) can easily be taken. Readers may be interested in a GlideScope website (http://www.glidescope.net) that we have established, where educational resources such as video clips and a teaching slide set may be downloaded. Note: The author has declared that he has no conflict of interest in relation to the GlideScope, its manufacturer or its distributors.