Journal of Research & Innovation in Anesthesia

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VOLUME 6 , ISSUE 2 ( July-December, 2021 ) > List of Articles

CLINICAL TECHNIQUE

A Novel Special-shaped Stylet Technique for Intubation with GlideScope® Video Laryngoscope Devices

Tural Alekberli, Leslie Yarmush

Keywords : Airway, Difficult intubation, Glidescope, Laryngoscope, Videolaryngoscope

Citation Information : Alekberli T, Yarmush L. A Novel Special-shaped Stylet Technique for Intubation with GlideScope® Video Laryngoscope Devices. Res Inno in Anesth 2021; 6 (2):57-60.

DOI: 10.5005/jp-journals-10049-0097

License: CC BY-NC 4.0

Published Online: 26-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

The GlideScope® video laryngoscope (VL) provides direct visualization of the larynx in patients with a potentially difficult airway. A specialized rigid stylet or tracheal introducer should be used to guide the tip of the endotracheal tube (ETT) into the glottis while using the GlideScope® devices. Several studies showed the success of the GlideScope® VL. However, there have been reports of problems, complications, including failure to intubate patients successfully. Laryngeal exposure is generally the simple part of the procedure, and conversely, tube delivery to the glottic opening and advancement into the trachea is sometimes not straightforward. Alekberli–Yarmush technique: Our novel technique for improving the GlideScope® intubation\'s success requires preparation of the stylet and ETT before the intubation. Requirements are the following: any brand and model shapable ETT stylet, ETT, and lubricant. Firstly, lubricate the stylet with a lubricant, insert the stylet into ETT, and bend the stylet into a unique shape. Firstly bend the ETT into the two-dimensional circular C shape, then bend the tip again two-dimensionally, approximately 100–110° against the circular angle. For the final step, bend the tip toward the 3rd dimension medially, proximally 45°. Endotracheal tube insertion is usually performed in our method, as the manufacturer recommends a four-step insertion technique when using the GlideScope®. However, holding the tube with two fingers, palm up, 2/3 of the way down the tube toward the tip, is different from the traditional technique. To intubate using our novel technique, first, the GlideScope® should be introduced into the oropharynx\'s midline with the left hand. When the epiglottis is identified on the screen, the scope should be manipulated, and the tip of the blade should be put in vollecula and elevate the epiglottis to obtain the best view of the glottis. The ETT should then be guided into position under direct vision. The ETT should be hugging the undersurface of the tongue. When the distal tip of the ETT disappears from the direct view, it should be viewed on the monitor. In this time, rotation and angulation maneuvers are not required in our technique different than the traditional technique to direct the ETT through the glottis. After visualizing the successful intubation, a stylet should be pulled out to remove easily from the ETT. The unique shape of the novel technique described here can improve the GlideScope® intubation by decreasing the manipulation, rotation, and angulation maneuvers. Due to the medially 45° shaped tip of the ETT, the intubation may be smoother and more comfortable. The ETT\'s C type circular shape allows it to hug the tongue\'s undersurface and slide quickly and smoothly to the laryngeal space. Studies with larger patient populations are needed to determine if the new technique improves the GlideScope® intubation, better understand the mechanisms and the clinical significance, and ascertain whether this technique evolves into a useful technique.


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