Video laryngoscopy

Overview

• Two principal versions are the C-MAC and the Glidescope
  • Glidescope first introduced in 2001, features a hyperangulated blade
  • CMAC features a Macintosh or standard geometry blade
  • Today, both CMAC and Glidescope systems offer hyperangulated and standard geometry blades
• Increasingly utilized in emergency airway management

Indications

• Anticipated difficult intubation

Contraindications

• Relative:
  • Blood or emesis in airway
  • Foreign body removal

Equipment Needed

• Video laryngoscope
• Rigid stylet if hyperangulated blade is used
• All other equipment necessary for endotracheal intubation

Procedure

• Hyperangulated Video Laryngoscope
  • Patient ideally in neutral spine position (as opposed to "sniffing" position for direct laryngoscopy)
  • After induction, use right hand to "scissor" mouth open
  • Place hyperangulated blade midline and slowly advance with progressive identification of airway landmarks
  • Advance blade into vallecula
  • When cords fill entire screen (Cormack-Lehane Grade I), slightly retract laryngoscopy so that cords only occupy upper 1/3 of screen (CL Grade II, allows for passage of ETT with rigid stylet)
    • If intubation is attempted with the best view possible, operators often have difficulty advancing the tube around the tongue and hypopharyngeal soft tissues

• Standard Geometry Video Laryngoscope
  • Same technique utilized with direct laryngoscopy
  • Can either visualize directly or utilize video screen for tube delivery

Complications

• Risk of equipment failure with hyperangulated laryngoscope (unable to obtain direct view if screen fails)
• Risk of camera contamination with blood or emesis in airway
• Foreign body removal with hyperangulated laryngoscope less successful than with Macintosh laryngoscope

See Also

Airway Pages

• Pre-intubation
  • Predicting the difficult airway
  • Bag valve mask ventilation
  • Apneic oxygenation
    • EBQ:ED Preoxygenation
• Induction
  • Critical care quick reference
  • Rapid sequence intubation
  • Delayed sequence intubation
• Intubation
  • Intubation (peds)
  • Direct laryngoscopy
  • Video Laryngoscopy
  • Bougie
  • The difficult airway
  • Advanced airway adjuncts
    • Supraglottic airway
  • Non-traditional intubation
    • Awake intubation
    • Nasal intubation
    • Blind Digital Intubation
• Surgical airways
  • Surgical cricothyrotomy
  • Needle cricothyrotomy
  • Pediatric jet ventilation
• Post-intubation
  • Mechanical ventilation (main)
  • Deterioration after intubation (DOPE)

References

1. Je, S. M., Kim, M. J., Chung, S. P., & Chung, H. S. (2012). Comparison of GlideScope® versus Macintosh laryngoscope for the removal of a hypopharyngeal foreign body: A randomized cross-over cadaver study. Resuscitation, 83(10), 1277–1280.