1. Julia Dixon-Ernst RN, BSN, SRNA University of Pittsburgh
Gliding Past Video Assisted Intubation Complications Identification, Treatment and Prevention of GlideScope-Associated Injury
Julia Dixon-Ernst RN, BSN, SRNA
University of Pittsburgh

2. Upper teeth
tongue
Lower teeth

3. Glidescope Laryngoscopy
Improved glottic view
 anterior displacement of lower jaw
 manipulation of cervical spine
 lifting force
 traction on soft tissue
 success with difficult airway

6. Case 1 Scheduled teeth extraction and alveoplasty Airway Assessment
MP 3
Small oral opening
Slightly limited A/O extension
Loose teeth
Glidescope intubation!

8. Case 2 Elective nasal valve reconstruction Airway
MP 2
Glidescope attempts X2
2nd attempt impaled right soft palate
Procedure aborted
Transfer to ICU
Intubated overnight
Steroids and antibiotics
Extubated without primary closure
1cm full thickness defect
2 week follow up in clinic: mucosa healing and no deficits

10. Case 3 Upper teeth Airway: MP 1 Induction Blood noted in oropharynx.
Glidescope attempts x2
Placed LMA
Blood noted in oropharynx.
ENT consulted
2cm deep laceration closed with sutures
Well healed laceration with no functional impairment
Tongue
Lower teeth

11. Oropharyngeal injuries are more likely to occur while using the Glidescope

12. Trends in the literature
Primary Location of Injury:
Tongue base
Palate
Tonsils

13. Site of Surgery

14. Trends in the literature
Only 30% of injuries were recognized during intubation
Injury was seen more often in women than men

15. Mechanism of Injury Attention on monitor during oral insertion
Rigid stylet
Increased flexion to accommodate stylet
Anatomic strains
Blind spot

16. Identification is Key
As blade is withdrawn assess the path of the ETT and the oral cavity for injury

17. Management of Palatal Injury

18. Prevention
Look in the Mouth
Look at the Screen

19. Clinical Pearls for Prevention
Insert blade midline under direct vision
Introduce ETT close to the blade
Visualize tip during any advancement
Other strategies for prevention of injury include:
Inserting the blade midline to the tongue and epiglottis under direct vision
You can use the blade in the vallecula like a MAC blade or to pin up the epiglottis like a miller blade
Introduce ETT close to the blade to avoid blind, traumatic insertion as the space created by the blade will allow for improved visualization of ETT until it I sable to be seen on the monitor
Using a stylet is recommended to enhance control of the ETT.
A malleable stylet can be used bent to a degree angle
Glidescope rigid stylet is also acceptable
Evidence shows there is no difference in intubation success between the stylets however increased risk is seen with the ridgid stylet
Visualize tip during any advancement either by direct visualization or on the monitor
advancement of ETT and blade should always be midline, gentle and under direct vision
It is important to insert the ETT with beveled tip facing against the blade of glidescope to avoid cutting of the soft tissues in the oropharynx

20. Clinical Pearls for Prevention
Insert ETT with beveled tip facing against the blade of GlideScope

21. Clinical Pearls for Prevention

22. Clinical Pearls for Prevention
Soft tip EET may avoid trauma
As blade is withdrawn assess for tissue injury

23. What About the Novice? Pro Con Better intubation instruction
Improved visualization of anatomy
Higher success rate for successful intubation for difficult airway
Higher trainee satisfaction rates
No change in performance between VAL and DL with normal airway
Higher incidence of injury
Large percent of case studies have involved students

24. What about the novice Review the basics prior to induction
Look in the Mouth
Look at the Screen
Bevel front and center!
Moves always gentle

25. In Summary
The Glidescope is a great tool that has the potential to cause injury
Patient and User factors may contribute to increased risk of injury
Providers can reduce injury incidence with increase vigilance
Provider should always have visualization of blade/ETT tip while advancing
Glidescope is a good educational tool for trainees when they are instructed to avoid injury

26. Questions?