Video laryngoscopy: Difference between revisions
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==Procedure== | ==Procedure== | ||
[[File:Glidescope.png|thumb|Hyperangulated blade and rigid stylet typical of the Glidescope video laryngoscope]] | [[File:Glidescope.png|thumb|Hyperangulated blade and rigid stylet typical of the Glidescope video laryngoscope]] | ||
[[File:CMAC.png|thumb|The C-MAC video laryngoscope (pictured above) has a Macintosh or "standard geometry" blade similar to that of a Macintosh | [[File:CMAC.png|thumb|The C-MAC video laryngoscope (pictured above) has a Macintosh or "standard geometry" blade similar to that of a Macintosh]] | ||
*Hyperangulated video laryngoscope | *Hyperangulated video laryngoscope | ||
**Patient ideally in neutral spine position (as opposed to "sniffing" position for direct laryngoscopy) | **Patient ideally in neutral spine position (as opposed to "sniffing" position for direct laryngoscopy) | ||
Revision as of 21:13, 17 April 2024
Overview
[1] direct laryngoscope (pictured below)]]
- Two most common devices are the C-MAC and the Glidescope
- Both CMAC and Glidescope systems offer both hyperangulated and standard geometry blades
- Increasingly utilized in emergency airway management[2]
Indications
- Any patient requiring intubation
- Particularly useful in patients with known or anticipated difficult intubation
Contraindications
- No absolute 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)[3]
- 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 [4]
See Also
Airway Pages
- Pre-intubation
- Induction
- Intubation
- Surgical airways
- Post-intubation
External Links
- COPA STRONG: Battle of the Blades: The Death of DL?
- Merk Manual - How To Do Orotracheal Intubation Using Video Laryngoscopy
References
- ↑ Peterson K, Ginglen JG, Valenzuela FI, et al. Direct Laryngoscopy. [Updated 2020 Mar 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513224/[Category:Procedures]]
- ↑ Brown CA 3rd, Bair AE, Pallin DJ, Walls RM; NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations [published correction appears in Ann Emerg Med. 2017 May;69(5):540]. Ann Emerg Med. 2015;65(4):363-370.e1. doi:10.1016/j.annemergmed.2014.10.036
- ↑ Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Une vue laryngée délibérément restreinte à l'aide du vidéolaryngoscope GlideScope® est associée à une intubation trachéale plus rapide et plus aisée qu'une vue glottique totale: une étude clinique randomisée. Can J Anaesth. 2016;63(8):928-937. doi:10.1007/s12630-016-0654-6
- ↑ 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.