A Wonderfully Simple Guide Sheet
To The Use Of The Clarus Levitan Stylet
With The Cook Gas ILA, Version 2.0 [Full Text PDF]
James C. DuCanto, M.D.,Anesthesiologist
St. Luke’s Medical Center
Podcast 73 – Airway Tips and Tricks with Jim DuCanto, MD This is a video podcast.
May 13, 2012 by Scott Weingart
And here is the video podcast:
8:10 to 9:10:
So what I think about Mac shaped devices is that they are more likely to be useful to most practioners in most cases. However, the Glidescope can still outperform these devices (meaning the Mac shaped video laryngoscopes) in certain cases. My opinon is that likely you can get two thirds of difficult airway cases done with a Mac shaped blade that you could do with a Glidescope. In other words, a Glidescope would outperform these Mac shaped devices in about one third of cases [of difficult airways]. This is just sort of an opinion. I don’t have any data to support this opinion. This is just my gut feeling.
So I really am supportive of this idea of Mac shaped laryngoscopes. However, I am not going to throw away my Glidescope any time soon. The Glidescope is my go to device. It is definitely my go to device for me and for many of my partners because we have learned to make it work.
This device, the Glidescope, does require a separate set of skills then it takes to use a standard Mac shaped laryngoscope blade.
And now at 9:10, Dr. Weingart discusses the critical technique required to successfully use the Glidescope or any other video laryngoscope:
Now, Jim’s just made some incredible points that I just want to elaborate on and reiterate.
The Glidescope is entirely different from MacIntosh laryngoscopy, whether that MacIntosh laryngoscopy is video or standard DL. Glidescope is a different beast, especially with its standard shaped blade.
A few things you have to understand with any video laryngoscopy technique but especially with the Glidescope — is that you do not look at the screen exclusively when performing laryngoscopy.
The way it is described to do this properly is — Mouth — Screen — Mouth — Screen.
Now what do I mean by that? I mean that the first place you should look when you are introducing the Glidescope into the mouth – is the mouth not the screen!
Look down at the mouth. Make sure you are going, for the Glidescope, on the midline of the tongue. That you are getting the tongue out of the way. And keep looking into the mouth until the tip of the blade is just about to disappear from your field of vision.
And when it [the tip] is just about to disappear, now, for the first time look up at the screen. Then find the vallecula, seat the blade, expose the cords – which is more of a rotatory motion back towards the teeth as opposed to the standard lifting motion you do with a MacIntosh style blade. And now you have a great view of the cords.
The next step now is to introduce the tube. And for this — you go back to looking at the mouth — not the screen. This is how you are going to get posterior pharyngeal tears is by looking at the screen during this [stage]. You do not do that. You look in the mouth again. And what you want to do is — you want to introduce that tube, styleted to match the shape of the Glidescope, exactly against the blade. And you want to ride the blade until the tip of the endotracheal tube is about to disappear from your field of vision.
I actually hug the blade with my styleted tube. You cannot do things like put the tube towards the back of the mouth and hope that you can reach the cords. The angles are wrong for that. The blade – stylet are made to match and so you have to keep them in close proximity. I ride the blade until I can just about lose the tip. And just as I am about to lose the tip now I look back up at the screen.
And now on the screen I advance the tube further until it is through the cords. . . . use the speech dictation to finish this.