Procedure

Video Laryngoscope

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Video Laryngoscope, Rigid Video Laryngoscope, Glidescope Video Laryngoscope, Storz C-Mac Video Laryngoscope, McGrath Video Laryngoscope

  • See Also
  1. Advanced Airway
  2. Rapid Sequence Intubation
  3. Endotracheal Intubation Preparation
  4. Endotracheal Tube
  5. Endotracheal Intubation Preoxygenation (and Apneic Oxygenation)
  6. Direct Laryngoscope
  7. Endotracheal Intubation
  8. Extraglottic Device (e.g. Laryngeal Mask Airway or LMA)
  9. Tactile Orotracheal Intubation (Digital Intubation)
  10. Nasotracheal Intubation
  11. Cricothyrotomy
  12. Needle Cricothyrotomy
  • Preparations
  • Glidescope Video Laryngoscope
  1. Has sizes for all ages available (neonate, infant, child, adolescent, adult)
  2. Simple device to use with a high successful cord visualization rate
    1. Once practiced with passing the ET Tube with hyperangulated blade, success rates >96%
    2. High success rates in morbid Obesity or C-Spine Immobilization as well as a rescue device
  3. Unlike Direct Laryngoscopy, glidescope blade is inserted in midline
    1. Gradually advance until airway landmarks are visualized
  4. Difficulty is in passing the ET Tube (requires a different technique than Direct Laryngoscopy)
    1. Glidescope is a hyperangulated device (up to 80 degree)
      1. Visualizes around the tight angle from behind Tongue into pharynx
    2. Hyperangulated devices do not straighten the airway
      1. Stylet must also be hyperangulated (60-80 degrees) to reach the cords
        1. Exception: Standard stylet may be used in very young children
      2. Glidescope uses its own, expensive ($80 each) reusable stylets
        1. A curled Elastic Bougie (stored in pocket for 1-2 min) will also work
    3. Once tube passes through cords, catches on anterior tracheal rings due to hyperangulation
      1. Stylet must be at withdrawn 5 cm (should NOT be firmly inserted at start) AND
      2. Tube rotated 90 degrees (counter-clockwise) to further insert ET
    4. Common mistake is inserting glidescope blade too close to Vocal Cords
      1. Passing Endotracheal Tube is difficult to impossible in this position
      2. Withdraw glidescope to obtain a wider view of the airway
  5. Resources
    1. http://verathon.com/products/glidescope-video-laryngoscope
  • Preparations
  • C-MAC Video Laryngoscope
  1. Storz device is a "cadillac", popular in teaching hospitals
    1. Allows Direct Laryngoscopy for resident, while attending views screen
  2. Most expensive of Video Laryngoscopy devices ($25,000)
  3. Very bright (high lumen) with a high quality monitor (semiconductor chip)
  4. First pass success as high as 93% in predicted difficult airways
  5. Unlike Glidescope, is not hyperangulated, more similar to DL, and passing the ET Tube is more straight forward
  6. Same screen unit may be attached to Storz Nasolaryngoscope
  7. Has all pediatric sizes available (Miller 0,1 and Macintosh 2-5)
  8. http://www.karlstorz.com/cps/rde/xchg/SID-288120FD-483BDF71/karlstorz-en/hs.xsl/9549.htm
  • Preparations
  • McGrath Video Laryngoscope
  1. Reasonably priced ($3700) with inexpensive disposable blades (100 supplied)
  2. Device may be used as Direct Laryngoscope as well as Video Laryngoscope
  3. Lithium ion battery lasts 250 minutes, non-rechargable, and costs $60 to replace
  4. Lightweight, self-contained device (32.5 g) allows for portability
  5. Provides Grade I or II Views in 99% of patients and effective as rescue device (failed DL) in 95% of cases
  6. http://www.covidien.com/rms/pages.aspx?page=OurProducts/McGrathVideoLaryngoscopy
  • Preparations
  • Other devices
  1. Standard Video Laryngoscopes
    1. Pentax AWS Video Laryngoscope
      1. Challenging device to use in larger patients
      2. Channel is difficult to thread ET through (although could easily thread bougie)
      3. Not recommended for prehospital use due to screen glare in outdoor lighting
    2. CoPilot Video Laryngoscope
      1. http://copilotvl.com/
    3. VividTrac
      1. http://vividmed.com/products/adult-vividtrac-100
    4. Clarus Video system (fiberoptic)
      1. http://clarus-medical.com/airway/products/cvs-clarus
  2. Lowest cost solutions (channeled devices)
    1. Precautions
      1. Channeled devices may be difficult to direct ET Tube into airway despite visualizing it
    2. Airtraq Avant (optical prism device)
      1. Has all pediatric sizes available
    3. King Vision Video Laryngoscope
      1. http://www.owntheairway.com/
  • References
  1. Gauusche-Hill (2016) ACEP-PEM Conference, Difficult Airway Lecture, attended 3/8/2016
  2. Kim, Brown and Sheng (2016) Crit Dec Emerg Med, 30(3): 13-20
  3. Levitan (2013) Practical Airway Management Course, Baltimore