To the Editor:—
I am the Vice-President of a large anesthesia practice based in Massachusetts. Our group provides services to a number of community hospitals, surgery centers, and an academic medical center. During the past 3 yr, our practice has acquired a number of Glidescopes (Verathon Medical, Bothell, WA), and we are using them with increasing frequency. It is now common for the Glidescope to be used as the first-attempt intubation device in patients who clinically present as a potential difficult airway. This is very much the case for patients undergoing bariatric surgery. A number of studies have shown that the Glidescope and other video airway devices, such as the Airway Scope (Pentax, Tokyo, Japan) and the Airtraq (King Systems, Noblesville, IN), have a higher successful intubation rate than that of direct laryngoscopy,1–3so our approach is founded on the principle that securing the airway in the shortest time, with minimal instrumentation, is in the best interest of the patient and represents good clinical care. In addition, there are also occasions when the Glidescope may be used as the first-line airway instrument for teaching purposes in both easy and difficult airways. This practice, though, is making me increasingly uncomfortable because of the implications for those patients in whom no attempt has been made at conventional laryngoscopy who may present for surgery, possibly emergent, at another institution that does not have a Glidescope. We are currently not telling all of our patients whether a Glidescope was used unless it was in the context of a failed conventional laryngoscopy. These patients could present to other facilities and may indeed seem to be a potentially difficult intubation, only to have the anesthesiologist falsely reassured by a report of a prior “uneventful” anesthetic. The question, therefore, is should all patients in whom a Glidescope is used be given a letter indicating such, regardless of circumstance, and/or should all patients have one attempt made at conventional laryngoscopy, before elective Glidescope use, to document the airway classification for future reference?
I think this is an increasingly important clinical issue, with definite patient safety implications, and I would like to bring it to the attention of your readers for further contemplation and discussion.
North Shore Medical Center, Salem, Massachusetts, and Anaesthesia Associates of Massachusetts, Westwood, Massachusetts. firstname.lastname@example.org