Parker Flex-Tip Tube® provides higher intubation success with the Pentax-AWS Airwayscope® despite the AWS tip being inserted into the vallecula

The Parker Flex-Tip^® tube, in combination with the Pentax-Airwayscope^® (AWS), is anecdotally reported to facilitate intubation when the AWS tip fails to be inserted behind the epiglottis. We examined whether the Parker tube facilitates intubation when the AWS tip is inserted into the vallecula. Forty patients were randomly assigned into either the standard or Parker tube group. Following general anesthesia induction, AWS intubation was attempted with the blade tip inserted into the vallecula. After obtaining an optimal laryngeal view, the tube was advanced toward the glottis. The laryngoscopist allowed additional adjustment of the blade tip direction when the first tube insertion failed because of involvement or folding of the epiglottis resulting from advancement of the tube. The primary outcome was defined as the success rate for intubation and secondary outcome as the time needed for tube placement. The Parker tube provided both a higher intubation success rate (17/20 vs. 4/20, P < 0.01), and a faster intubation time (17 ± 5 s vs. 25 ± 4 s, P < 0.01), than the standard tube. We conclude the use of the Parker tube in combination with the AWS is an optional technique allowing the laryngoscopist to obtain more reliable intubation success despite insertion of the AWS tip into the vallecula.     

Comparison of the GlideScope® videolaryngoscope and the Macintosh laryngoscope for double-lumen tube intubation

Intubation with a double‐lumen tube is important for achieving one‐lung ventilation and facilitating thoracic surgery. The GlideScope^® videolaryngoscope (Verathon Inc., Bothell, WA, USA) is designed to assist tracheal intubation for patients with a difficult airway. We wished to compare the GlideScope and direct laryngoscopy for double‐lumen tube intubation. Sixty adult patients requiring a double‐lumen tube for thoracic surgery and predicted uncomplicated laryngoscopy were randomly assigned to a direct Macintosh laryngoscopy group (n = 30) or a GlideScope group (n = 30). The mean (SD) duration of intubation was longer in the Macintosh group (62.5 (29.7) s) than in the GlideScope group (45.6 (10.7) s; p = 0.007). There was no difference in the success of the first attempt at intubation (26/30 (87%) and 30/30 (100%) for Macintosh and GlideScope groups, respectively; p = 0.112). The incidence of sore throat and hoarseness was higher in the Macintosh group (18 (60%) and 14 (47%), respectively) than in the GlideScope group (6 (20%) and 4 (13%), respectively; p = 0.003 and 0.004). We conclude that double‐lumen tube intubation in patients with predicted normal laryngoscopy is easier using the GlideScope videolaryngoscope than the Macintosh laryngoscope.     

Comparison of a single-use GlideScope® Cobalt videolaryngoscope with a conventional GlideScope® for orotracheal intubation

Background

This study was conceived to compare the single-use GlideScope^® Cobalt videolaryngoscope with the conventional GlideScope^® videolaryngoscope for orotracheal intubation, as judged by time to intubation (TTI) and ease of intubation.

Methods

One hundred patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to have their tracheas intubated by a heterogeneous group of operators with the Cobalt GlideScope® or the conventional GlideScope^®. TTI was assessed by a blinded observer. Operators were blinded until the start of laryngoscopy. A visual analogue scale (VAS) assessed the ease of intubation. The number of intubation attempts, number of failures, glottic grades, and fogging of the video screen were recorded.

Results

There was no difference between the median TTI of the GlideScope^® Cobalt and the conventional GlideScope^® (40.1 sec, interquartile range [IQR] 34.1, 51.3 vs 39 sec, IQR 32.6, 48.1, respectively; P = 0.75). The ease of intubation was similar between the two devices (median Cobalt VAS: 16 mm, IQR 10.8, 27.3, vs median conventional VAS: 12.5 mm, IQR 10, 20.5, respectively; P = 0.12). There were no significant differences between the two devices with respect to glottic exposure, intubation attempts, failures, or video screen fogging.

Conclusions

The GlideScope^® Cobalt has similar performance characteristics compared with the conventional GlideScope^® videolaryngoscope when used for orotracheal intubation. The two devices can likely be used interchangeably. (ClinicalTrials.gov number, NCT00459797.)     

Epistaxis during nasotracheal intubation: a randomized trial of the Parker Flex-Tip™ nasal endotracheal tube with a posterior facing bevel <Emphasis Type="Italic">versus</Emphasis> a standard nasal RAE endotracheal tube

Purpose

Nasotracheal intubation is a widely performed technique to facilitate anesthesia induction during oral, dental, and maxillofacial surgeries. The technique poses several risks not encountered with oropharyngeal intubation, most commonly epistaxis due to nasal mucosal abrasion. The purpose of this study was to test whether the use of the Parker Flex-Tip? (PFT) nasal endotracheal tube (ETT) with a posterior facing bevel reduces epistaxis when compared with the standard nasal RAE ETT with a leftward facing bevel.

Methods

Sixty American Society of Anesthesiologists physical status I and II patients undergoing oral or maxillofacial surgery with nasotracheal intubation were recruited. Patients were randomized to either a standard nasal RAE ETT or a PFT nasal ETT. The ETT was thermosoftened and lubricated for both study groups prior to insertion, and the size of the tube was chosen at the discretion of the attending anesthesiologist. The primary outcome was the incidence of epistaxis, with a secondary outcome of epistaxis severity (scored as none, mild, moderate, or severe). An investigator measured both outcomes five minutes after intubation was completed.

Results

Mild or moderate epistaxis was experienced by 22 of 30 (73%) patients in the PFT group compared with 21 of 30 (70%) patients in the standard nasal RAE ETT group (absolute risk reduction, 3%; 95% confidence interval, ?19 to 25; P = 0.78). There were no occurrences of severe epistaxis in either group.

Conclusion

There was no difference in the incidence or severity of epistaxis following nasal intubation using the Parker Flex-Tip nasal ETT when compared with a standard nasal RAE ETT. This trial was registered at ClinicalTrials.gov, identifier: NCT02315677.

     

The use of the GlideScope® for tracheal intubation in patients with halo vest

ObjectiveGlideScope^® provides better laryngoscopic view and is advantageous in tracheal intubation in ankylosing spondylitis patients with difficult airway.MethodsThis study was performed to investigate the use of the GlideScope^® for tracheal intubation in 15 patients wearing halo vests scheduled for elective surgery under general anesthesia. Preoperative airway assessments were evaluated to predict the difficulty of tracheal intubation. Before intubation, all patients were given a modified Cormack and Lehane (MCLS) grade and percentage of glottic opening (POGO) score by the intubating anesthesiologist having resorted to direct laryngoscopy (DL) with a Macintosh Size 3 blade depiction. Then intubation with the GlideScope^® was performed, during which the larynx was inspected and given another MCLS grade and POGO score.ResultsFourteen of the 15 patients had MCLS Grade III or IV by direct Macintosh laryngoscopy and were considered to have a difficult laryngoscopy. Nasal tracheal intubation by the GlideScope^® was successful on all occasions. The GlideScope^® improved the MCLS grade and POGO score in all patients who had put on a halo vest as compared with those on DL (p < 0.01). The GlideScope^® also provided a better laryngoscopic view than that by a DL. All of the patients who wore halo vests and presented with suspected difficult airways could be intubated successfully with the GlideScope^®.ConclusionThe use of the GlideScope^® for tracheal intubation could be an alternative option in patients with a difficult airway, whose surgery was circumscribed under general anesthesia with tracheal intubation.     

Nasotracheal fibreoptic intubation: a randomised controlled trial comparing the GlideRite® (Parker-Flex® Tip) nasal tracheal tube with a standard pre-rotated nasal RAE™ tracheal tube

In a randomised controlled study, we compared the ease of railroading a GlideRite^® nasal tracheal tube over a fibrescope with that of a pre‐rotated RAE? nasal tracheal tube. We studied 110 anaesthetised patients with no known airway difficulties undergoing elective dental or maxillofacial surgery. Impingement was more common with the GlideRite tubes (11/55 (20%)) compared with the pre‐rotated RAE tubes (3/55 (5%); p = 0.02). The median (IQR [range]) time to intubation (GlideRite 7.6 (4.7–10.8 [3.0–46.2]) s; RAE 8.0 (6.2–10.7 [2.4–30.0]) s) and postoperative sore throat numerical ratings (GlideRite 2 (0–3 [0–10]); RAE 2 (0–5 [0–8])) were similar. A 90° anticlockwise pre‐rotation of a standard nasal RAE tube has a higher initial rate of successful railroading at first attempt and is therefore superior to a GlideRite nasotracheal tube during nasal fibreoptic intubation.     

A randomized comparison of the GlideRite® Rigid Stylet to a malleable stylet for orotracheal intubation by novices using the GlideScope®

Purpose

A stylet is usually necessary when using the GlideScope^® videolaryngoscope for orotracheal intubation. A special stylet, the GlideRite^® Rigid Stylet (GRS), was designed for this purpose. A previous trial involving experienced operators showed that the GRS offered no performance improvement vs a standard malleable stylet (SMS). In our trial, we compared the performance of the GRS with that of the SMS in terms of time to intubation and ease of intubation when used by novice GlideScope^® operators.

Methods

Sixty patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to be intubated by novice operators with the GlideScope^®, using either the GRS or the SMS. Time to intubation was assessed by a blinded observer, and the operators were blinded until just prior to tracheal intubation. Ease of intubation was assessed by a five-point ordinal scale (from 1- easy to 5 -difficult). Intubation attempts/failures, glottic grades, and usage of external laryngeal manipulation were recorded.

Results

There were no significant differences between the GRS and the SMS in terms of the median time to intubation (60 sec, interquartile range [IQR] 48-75 vs 61 sec, IQR 49-75, respectively; P = 0.94) and the ease of intubation (GRS median score: 1.5, IQR 1-2 vs SMS median score: 1, IQR 1-2; P = 0.94). There were no other significant differences between groups.

Conclusion

The GRS and the SMS have similar performance characteristics when used by novice operators for GlideScope^®-assisted orotracheal intubation. (Registered at ClinicalTrials.gov: NCT00884754).