A Novel Use of Laryngoscope for Difficult Papanicolaou Smear Collection

The prevalence of cervical cancer has dropped significantly since introduction of the Papanicolaou (Pap) screen. The greatest risk factor for cervical cancer is inadequate screening. Altered pelvic anatomy can limit the ability to collect a Pap smear. In the presented case, a woman with a history of fibroids and bleeding presented for an exam under anesthesia. Traditional approaches for collecting a Pap smear failed. A GlideScope video laryngoscope was used to visualize the cervix, and a Pap smear was collected. The specimen was satisfactory, negative for intraepithelial lesion or malignancy, and HPV negative. A laryngoscope can be repurposed to visualize collection of a challenging Pap smear. Novel approaches for Pap smear collection and cervical cancer screening are needed and have the potential to save lives.

Neutral Position Facilitates Nasotracheal Intubation with a GlideScope Video Laryngoscope: A Randomized Controlled Trial

The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups according to head position, neutral position (group N), and sniffing position (group S). The primary outcome was the degree of intubation difficulty according to the Intubation Difficulty Scale (IDS): Easy (IDS = 0), mildly difficult (IDS = 1 to 4), and moderately to severely difficult (IDS ≥ 5). Eighty-seven patients completed the study and their data were analyzed. The degree of intubation difficulty was significantly different between the two groups (p = 0.004). The frequency of difficult intubation (IDS > 0) was 12 (27.9%) in group N and 28 (63.6%) in group S (difference in proportion, 35.7%; 95% confidence interval [CI], 14.8 to 52.6%; p = 0.001). The neutral position facilitates nasotracheal intubation with GlideScope by aligning the nasotracheal tube and the glottis inlet more accurately than the sniffing position.

Comparison of Macintosh Laryngoscope and GlideScope® for Orotracheal Intubation in Children Older Than One Year

Background: We compared intubation conditions, intubation times, and hemodynamic response with the GlideScope video laryngoscope or the Macintosh direct laryngoscope in children older than one year. Methods: In total, 80 patients aged 1–12 years, scheduled to undergo elective surgery under general anesthesia with endotracheal intubation were included in a prospective, randomized trial.After standard anesthesia induction, patients were randomized into two groups.The group G patients(n = 40) were intubated with the GlideScope and the group M patients(n = 40) were intubated with the Macintosh laryngoscope.Intubation time, number of attempts,Cormack–Lehane score, airway maneuvers,visual analog score were recorded. Hemodynamic variables were recorded before and after anesthesia induction, at intubation, and one,three, and five minutes after intubation. Results: The demographic data and operation time were similar between the two groups. The intubation time was longer in Group G. The incidence of Cormack–Lehane score 1 was higher in Group G and that of Cormack–Lehane score 2 was higher in Group M. The hemodynamic parameters were similar between the two groups. Conclusion: We concluded that the GlideScope video laryngoscope provided better glottis visualization, but prolonged intubation time. No beneficial hemodynamic effect was found with the video laryngoscope. Keywords: Macintosh Laryngoscope, Orotracheal Intubation, Videolaringoscope, Pediatric Trial registration: ClinicalTrial.gov, NCT03326882, retrospectively registered, October 31, 2017

Should the Glidescope video laryngoscope be used first line for all oral intubations or only in those with a difficult airway? A review of current literature

The purpose of this study was to review literature that looked into the efficacy of the Glidescope video laryngoscope versus the Macintosh laryngoscope in oral endotracheal intubations. We aimed to answer the question ‘Should the Glidescope video laryngoscope laryngoscopes be used as first line intubation aids or only in the difficult airway?’ A systematic search of electronic databases was made. The inclusion criteria included: Glidescope, video laryngoscope, and Macintosh laryngoscope in human studies. The study aimed to compare first attempt success rate, glottic view and intubation time in papers dating between 2009 and 2017. Eleven trials with a total of 7,919 patients with both difficult and normal airways were included. The trials showed an improvement in first attempt success rate and glottic view with the Glidescope video laryngoscope especially in those with difficult airways. Overall time to intubate showed no significant differences between the Glidescope video laryngoscope and the Macintosh laryngoscope although it was identified that with increased training and experience with the Glidescope video laryngoscope, intubation time was reduced. Glidescope video laryngoscopes show advantages over the Macintosh laryngoscopes in obtaining better glottic views in those with difficult airways. However its use is not supported in all routine intubations.

The GlideScope Video Laryngoscope: A Narrative Review

The GlideScope video laryngoscope has had a profound impact on clinical airway management by virtue of providing a glottic view superior to direct laryngoscopy. Since its introduction circa 2003, hundreds of studies have attested to its value in making clinical airway management easier and safer. This review will update the reader on the art and science of using the GlideScope videolaryngoscope in a variety of clinical settings and its relation to other airway management products. Topics covered include GlideScope design considerations, general usage tips, use in obese patients, use in pediatric patients, use as an adjunct to fiberoptic intubation, and other matters. Complications associated with the GlideScope are also discussed.