GlideScope Not Easy to Use in Kids

June 4, 2018

Written by Clay Smith

Spoon Feed
The GlideScope in pediatric patients was not easy to use.  Experienced intubators had technical difficulty 58% of the time, most often just as the tube passed the cords.  Clockwise rotation helped passage.  You must practice with it before you use it on live patients.

Why does this matter?
The GlideScope has a hyperangulated blade that only allows indirect visualization of the glottic opening and requires practice for success.  How good is it in the pediatric population?

Not so hot
This was a prospective study of experienced intubators in 187 children under age 6.  Technical difficulty was experienced in 58%, most often at the point when the tube was passing just beyond the cords.  They found clockwise rotation was the most helpful maneuver to correct this.  First-pass success was 80%; overall success was 98%.  Given the hyperangulated blade, the stylet is also hyperangulated.  Once past the cords, the tube curves up into the anterior tracheal wall and gets stuck.  Options are to rotate clockwise, as in this study, or to back out the stylet and allow the tube to straighten.  That is the way I was trained to do it with a GlideScope.

Source
A Prospective Observational Study of Technical Difficulty With GlideScope-Guided Tracheal Intubation in Children.  Anesth Analg. 2018 May 9. doi: 10.1213/ANE.0000000000003412. [Epub ahead of print]

Peer reviewed by Thomas Davis