Prevention of pulmonary aspiration during endotracheal intubation using the GlideScope videolaryngoscope in anesthetized patients.

摘要

We read with interest the recent letter of Dupanovic and Pichoff [1], regarding use of the GlideScope videolaryngo-scope (GVL) in preventing pulmonary aspiration and a case with a large amount of gastric fluid regurgitation during anesthesia induction. These authors had successfully secured the airway by coordinating laryngoscopy, oropharyngeal suction, and endotracheal intubation with two operators. They provide a useful alternative to prevent pulmonary aspiration during the intubation using a GVL, but some possible technical difficulties must be noted: (a) The wide GVL blade (overall thickness of 18 mm and square design of the posterior part) may occupy significant intraoral room [2]. Also, the requirement of the GVL blade insertion along the midline of mouth can further decrease maneuverability of the airway instrumentation by two operators, particularly in the patients with a limited mouth opening [3]. (b) The GVL blade has a prefabricated curvature of 60°. Even if the larynx is clearly exposed with the GVL, placing a rigid Yankauer suction instrument into the site adjacent to the glottis is sometimes difficult because of its small distal curve, especially in patients with limited neck movement [2], The Yankauer suction instrument is also ineffective for removing large solid materials regurgitated from the stomach, (c) During intubation with the GVL, advancing an endotracheal tube (ETT) into the trachea after removal of the preformed stylet is difficult in some cases [2-5]. If gastric regurgitation occurs under this circumstance, it may undoubtedly increase the risk of pulmonary aspiration due to prolonged intubation time, especially when the intubation is performed by an inexperienced operator.