Simultaneous en bloc endotracheal tube insertion with GlideScope® Titanium™ video laryngoscope use: a randomized-controlled trial

Purpose Intubation-associated trauma with the GlideScope is rare, but when it occurs, it is likely due to advancing the endotracheal tube (ETT) blindly between the direct view of the oropharynx and the video view of the glottis. It is also occasionally difficult to advance the ETT to the glottic aperture despite a good view of the glottis on the monitor. One technique to potentially address both issues is to introduce the ETTen blocwith the GlideScope, thus visualizing the ETT tip throughout its entire path. We hypothesized that thisen bloctechnique could be faster and potentially easier than the standard technique. Methods Fifty patients with normal-appearing airways who required orotracheal intubation for elective surgery were randomly allocated to intubation with either theen blocor the standard (GlideScope-first-then-ETT) technique. A three-dimensional printed clip was utilized to secure the ETT to the GlideScope duringen blocinsertion. The primary outcome was time to intubation, defined from mask removal to first end-tidal carbon dioxide detection, recorded by a blinded observer. Secondary outcomes were subjective ease of intubation (100-mm visual analogue scale [VAS], 0 = easy; 100 = difficult), number of intubation attempts/failures, and incidence of oropharyngeal trauma (bleeding). Results The median [interquartile range (IQR)] intubation time was 36 [31-42] sec with theen bloctechniquevs41 [37-50] sec with the standard technique (difference in medians, 5 sec; 95% confidence interval [CI], 2 to 11;P= 0.008). The median [IQR] ease of intubation VAS was 11 [9-21] mm with theen bloctechnique, and 15 [11-24] mm with the standard technique (difference in medians, 4 mm; 95% CI, -2 to 8;P= 0.19). Laryngoscopic grade and number of intubation attempts were similar between the groups; there was no oropharyngeal trauma noted. Conclusion In this study of video laryngoscopy, intubation was slightly faster with theen bloctechnique than with the standard GlideScope intubation technique, although the clinical importance of this difference is unknown.