TECHNIQUE FOR LARYNGOSCOPY USING GLIDESCOPE (4 STEP APPROACH)

GLIDESCOPE VIDEO LARYNGOSCOPY
Turn on the monitor and device at least one minute prior to laryngoscopy to minimize condensation on the lens.
●Insert a stylet into the ETT, making sure that the tip of the stylet does not protrude beyond the end of the ETT. The manufacturer's dedicated rigid stylet (eg, the GlideRite) can be used, or a standard malleable stylet, manually shaped to a similar angle as the GlideRite within the ETT before use .
●Position the head and neck in a neutral or a sniffing position .
●Patients with obesity should be placed in the ramped position because it offers a physiologic and mechanical advantage for ventilation. Insertion of the laryngoscope blade into the patient’s mouth will be easier in the ramped position compared with the neutral position, particularly if augmented by a cross-finger mouth opening maneuver. It is unknown whether the ramped position improves laryngeal visualization when videolaryngoscopy is used.
●Lubricate the VL blade lightly to facilitate passage around the tongue (ensuring that lubricant is not applied near the camera).
●With the patient's mouth opened, insert the blade in the midline, under direct vision until the blade tip is past the soft palate. Rotate the blade in the sagittal plane around the base of the tongue, watching the monitor, and avoid excessively deep insertion. There is no need to advance the blade tip of acute-angle VLs completely into the vallecula, and there are benefits to more shallow insertion.
•Deep insertion of an acute-angle blade rotates the laryngeal axis anteriorly, which may make insertion of the ETT more difficult despite good laryngeal exposure.
•Shallow insertion provides three additional benefits:
-A wider visual field;
-A straighter pathway for ETT delivery from teeth to larynx
-A shorter distance from the lips to the camera, and therefore a shorter blind zone in which the clinician cannot see the tip of the ETT.
●Gently lift the VL upward and forward, in the axis of the laryngoscope handle, to create space beneath the blade.
●Insert the styletted ETT under direct vision, adjacent to the laryngoscope blade, until the tip passes the soft palate. Then direct attention to the monitor, placing the tip of the tube in the midline below the arytenoid cartilages.
●Lift the tip of the tube (vertically) and advance the tip between the vocal cords. Then partially withdraw the stylet and gently advance the ETT into the trachea.
Troubleshooting non-channeled videolaryngoscopy — Although videolaryngoscopy is usually straightforward, problems with insertion of the laryngoscope or the ETT may occur.
●Tip of the ETT not visible – Withdraw the VL until the ETT is visible and then advance both the laryngoscope and ETT.
●Small mouth opening – Insert the tracheal tube before, or concomitantly with, the VL blade .
●Difficulty directing the ETT to the larynx – A flexible scope or optical stylet can be used along with the VL to direct the tip of the ETT between the vocal cords . Alternatively, a dynamic stylet (eg, Parker Flex-It Stylet or Truflex articulating stylet) can be used to direct the tracheal tube toward the larynx.
●Difficulty advancing the ETT in the trachea – If the ETT is not easily advanced in the trachea once it is inserted between the vocal cords and the stylet has been partially withdrawn, gently rotate the ETT to disengage the tip from the tracheal rings. If this maneuver is unsuccessful, insert a coudé-shaped bougie or flexible scope through the ETT into the trachea, and advance the ETT over it

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