To the Editor:—
The difficult airway continues to challenge anesthesiologists. Recently, the development of laryngoscopes that have video cameras built in has led to some improvement in visualization of airway anatomy. One such device is the GlideScope®1(Saturn Biomedical Systems, Burnaby, British Columbia, Canada). It is equipped with a patent antifogging system that, together with a design that tends to keep the camera free of blood and secretions, has made visualization of airway structures better. However, despite better glottic visualization, on some occasions the endotracheal tube may still be difficult to pass into the larynx.
We recently provided general anesthesia to an obese female patient, aged 32 yr, weighing 142 kg, with a Mallampati class 4 airway. The patient had a short neck with a hyomental space of three finger-breadths. We chose to use the GlideScope® to facilitate the intubation. Although the camera revealed a class II view (only a portion of the vocal cords were visualized), it was impossible to maneuver the endotracheal tube into the laryngeal opening even using the stylet supplied by the manufacturer of the GlideScope®. We then removed the stylet while leaving the endotracheal tube tip still visible in the GlideScope® monitor. We threaded a fiberoptic scope through the endotracheal tube until its tip also became visible on the GlideScope® monitor. Then, by using the thumb lever on the fiberoptic scope to control the tip, we managed to pass the fiberoptic scope through the vocal cords into the trachea and then pass the tube over the scope. In essence, the fiberoptic endoscope provides a “controllable stylet” to facilitate entry into the airway.
*University of California, Irvine, California. firstname.lastname@example.org