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[1]

Indications

  • Any patient requiring intubation
    • Particularly useful in patients with known or 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)[2]
      • 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 [3]

See Also

Airway Pages

References

  1. 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
  2. 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
  3. 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.