Children with challenging airways: What about GlideScope® video-laryngoscopy?

Abstract

Background: GlideScope^® video-laryngoscopy is becoming increasingly used, including in paediatrics. However, to date, very few data are available on efficiency during situations involving difficult intubation. Our objective was to describe the usefulness of the GlideScope^® in children with presumed challenging airway criteria.

Methods: In this observational study, all children with predicted criteria of potential difficult intubation and requiring general anaesthesia with tracheal intubation were prospectively enrolled over a 12-month period. The Cormack and Lehane (CMK) grade was first assessed by direct laryngoscopy. In case of a CMK≥3, the same experienced anaesthesiologist scored the CMK scale under GlideScope^® videoscopy. Data related to GlideScope^® use under difficult intubation conditions were analysed.

Results: Out of the sixty-one patients (median [25^th-75^th interquartile range] age of 12 [4-37] months) included, 37 (62%) patients have confirmed a high probability of difficult intubation. Compared to direct laryngoscopy, GlideScope^® video-laryngoscopy was significantly associated with an improved CMK grade (P<0.001). Tracheal intubation with the GlideScope^® was successful after the first attempt in almost one half of cases and ultimately in 100% of patients. The median time required for successful GlideScope^® intubation was 42.5 [30-60] s. No per procedure complications were recorded.

Conclusion: In children with challenging airways, GlideScope^® video-laryngoscopy resulted in a significant improvement of the glottic view with an excellent success rate and satisfactory time to intubation. How these devices are to be positioned in difficult airway management algorithms and guidelines remain to be defined.

Keywords: Difficult airway; GlideScope; Paediatric anaesthesia; Video-laryngoscopy.