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Poor visualization during direct laryngoscopy and high upper lip bite test score are predictors of difficult intubation with the GlideScope videolaryngoscope.
Anesth Analg. 2008 May; 106(5):1495-500, table of contents.A&A

Abstract

BACKGROUND

The GlideScope videolaryngoscope allows equal or superior glottic visualization compared with direct laryngoscopy, but predictive features for difficult GlideScope intubation have not been identified. We undertook this prospective study to identify patient characteristics associated with difficult GlideScope intubation.

METHODS

Demographic and morphometric factors were recorded preoperatively for 400 patients undergoing anesthesia with endotracheal intubation. After induction, direct laryngoscopy was performed in all patients to assess the Cormack and Lehane grade of glottic visualization followed by GlideScope intubation. The number of attempts and time needed for intubation were recorded. Univariate and multivariate analyses were performed to identify the characteristics associated with difficult GlideScope intubation.

RESULTS

Intubation required 1, 2, and 3 attempts in 342, 48, and 9 participants, respectively, with one failure. Mean time for intubation was 21 +/- 14 s. After univariate analysis, the following characteristics were significantly correlated (P < 0.05) with longer time to intubate and/or multiple attempts: older age, male sex, history of snoring, high Mallampati class, small mouth opening, short sternothyroid and manubriomental distances, large neck circumference, high upper lip bite test score, and high Cormack and Lehane grade during direct laryngoscopy. However, after introducing these variables in nominal logistic and proportional hazard multiple regression models, only high Cormack and Lehane grade during direct laryngoscopy, high upper lip bite test score, and short sternothyroid distance were significantly associated with multiple attempts or lengthier intubations.

CONCLUSION

Despite a high success rate, intubation with the GlideScope is likely to be more challenging in patients with high Cormack and Lehane grade during direct laryngoscopy, high upper lip bite test score, or short sternothyroid distance.

Authors+Show Affiliations

Department of Anesthesiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke East, Montréal, Canada, H2L 4M1.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18420866

Citation

Tremblay, Marie-Hélène, et al. "Poor Visualization During Direct Laryngoscopy and High Upper Lip Bite Test Score Are Predictors of Difficult Intubation With the GlideScope Videolaryngoscope." Anesthesia and Analgesia, vol. 106, no. 5, 2008, 1495-500, table of contents.
Tremblay MH, Williams S, Robitaille A, et al. Poor visualization during direct laryngoscopy and high upper lip bite test score are predictors of difficult intubation with the GlideScope videolaryngoscope. Anesth Analg. 2008;106(5):1495-500, table of contents.
Tremblay, M. H., Williams, S., Robitaille, A., & Drolet, P. (2008). Poor visualization during direct laryngoscopy and high upper lip bite test score are predictors of difficult intubation with the GlideScope videolaryngoscope. Anesthesia and Analgesia, 106(5), 1495-500, table of contents. https://doi.org/10.1213/ane.0b013e318168b38f
Tremblay MH, et al. Poor Visualization During Direct Laryngoscopy and High Upper Lip Bite Test Score Are Predictors of Difficult Intubation With the GlideScope Videolaryngoscope. Anesth Analg. 2008;106(5):1495-500, table of contents. PubMed PMID: 18420866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Poor visualization during direct laryngoscopy and high upper lip bite test score are predictors of difficult intubation with the GlideScope videolaryngoscope. AU - Tremblay,Marie-Hélène, AU - Williams,Stephan, AU - Robitaille,Arnaud, AU - Drolet,Pierre, PY - 2008/4/19/pubmed PY - 2008/5/2/medline PY - 2008/4/19/entrez SP - 1495-500, table of contents JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 106 IS - 5 N2 - BACKGROUND: The GlideScope videolaryngoscope allows equal or superior glottic visualization compared with direct laryngoscopy, but predictive features for difficult GlideScope intubation have not been identified. We undertook this prospective study to identify patient characteristics associated with difficult GlideScope intubation. METHODS: Demographic and morphometric factors were recorded preoperatively for 400 patients undergoing anesthesia with endotracheal intubation. After induction, direct laryngoscopy was performed in all patients to assess the Cormack and Lehane grade of glottic visualization followed by GlideScope intubation. The number of attempts and time needed for intubation were recorded. Univariate and multivariate analyses were performed to identify the characteristics associated with difficult GlideScope intubation. RESULTS: Intubation required 1, 2, and 3 attempts in 342, 48, and 9 participants, respectively, with one failure. Mean time for intubation was 21 +/- 14 s. After univariate analysis, the following characteristics were significantly correlated (P < 0.05) with longer time to intubate and/or multiple attempts: older age, male sex, history of snoring, high Mallampati class, small mouth opening, short sternothyroid and manubriomental distances, large neck circumference, high upper lip bite test score, and high Cormack and Lehane grade during direct laryngoscopy. However, after introducing these variables in nominal logistic and proportional hazard multiple regression models, only high Cormack and Lehane grade during direct laryngoscopy, high upper lip bite test score, and short sternothyroid distance were significantly associated with multiple attempts or lengthier intubations. CONCLUSION: Despite a high success rate, intubation with the GlideScope is likely to be more challenging in patients with high Cormack and Lehane grade during direct laryngoscopy, high upper lip bite test score, or short sternothyroid distance. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/18420866/Poor_visualization_during_direct_laryngoscopy_and_high_upper_lip_bite_test_score_are_predictors_of_difficult_intubation_with_the_GlideScope_videolaryngoscope_ L2 - http://dx.doi.org/10.1213/ane.0b013e318168b38f DB - PRIME DP - Unbound Medicine ER -