From the Journal archives: Early clinical experience with a new video laryngoscope

Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope®) in 728 patients. Can J Anesth 2005; 52: 191-8. This investigation was an observational study designed to evaluate the newly developed GlideScope video laryngoscope (GVL) and to assess its ability both to provide a laryngeal view and to facilitate intubation. The study, which was conducted from November 2001 to March 2003, included 133 operators from five centres (Ontario and British Columbia, Canada and Washington State, USA) involving 728 patients. The resulting Cormack-Lehane (C/L) laryngeal exposure was excellent (1) in 92% of patients and good (2) in 7% of patients. The GVL provided a comparable or superior view in the 133 patients in whom both the GVL and the direct laryngoscope (DL) were used. Among the 35 patients with a C/L grade ≥ 3 view with the DL, the view improved to a C/L grade 1 view in 24 patients and a C/L grade 2 view in three patients. Tracheal intubation with the GVL was successful in 96.3% of patients and failed in 3.7%. Fifty-four percent of the failed intubations occurred despite achieving a C/L grade 1 view and resulted from the inability to direct the endotracheal tube toward a clearly seen larynx. The GVL consistently yielded a comparable or superior glottic view compared with the DL despite the operators’ limited or lack of prior experience with the device. Successful intubation was typically achieved even when direct laryngoscopy was predicted to be moderately or considerably difficult. Not only was the GVL a novice-friendly device, this novel study also suggested that a video laryngoscope might provide superior performance when compared with the DL, particularly in patients in whom the DL provided a poor laryngeal view.