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Videos from Clarus Medical LLC
Intubation by Alan Shikani, MD, FACS
Obstructive Sleep Apnea Intubation by Alan Shikani, MD, FACS
Obstructive Sleep Apnea (camera view)
Intubation by Alan Shikani, MD, FACS
Anterior Glottic Web Intubation by Alan Shikani, MD, FACS
Cancer Patients SOS Placement by Dr. Carin Hagberg
(click to view) SOS Placement by Dr. Wali (Part 1)
(click to view) SOS Placement by Dr. Wali (Part 2)
(click to view) 4 Intubation Tips by Christopher F. Young, MD
(click to view) Medical Student's First Intubation by
Joseph Koveleskie, MD / Christopher F. Young, MD (click to view) FAST placement by Dr. Wali
(click to view) GlideScope Videos (from the collection of D. John Doyle, MD)
PART 1 - Regular Glidescope Video Clips
MPEG 2 format; size and duration refer to the original recording prior to editing
Case 434
Case 445
Case 455
Case 458
Case 461
Case 464
Case 467
Case 476
Case 480
PART 2 - Special Glidescope Video Clips
MPEG 2 format; size and duration refer to the original recording prior to editing
Case 442
Case 456
Case 475
GlideScope Assisted Fiberoptic Intubation (Patient Asleep) (10.7 MB, 115 sec, 15 fps, 320x240) The above three clips illustrate a new technique for teaching fiberoptic intubation
(FOI) using the GlideScope . Following anesthetic induction, the GlideScope is
introduced in the usual manner, followed by introduction of the fiberoptic bronchoscope
(FOB). While the resident manipulates the FOB into position, the supervisor monitors
the GlideScope display to see where the tip of the FOB is located. (The resident
looks only through the FOB and does not look at the GlideScope display.) The supervisor
then provides verbal feedback to the resident as to the location of the tip of
the FOB. Once the FOB has entered well into the trachea, the endotracheal tube
is then passed over the FOB into the glottis. Here, use of the GlideScope can
again be helpful, since should the endotracheal tube get caught on the arytenoids
or other laryngeal structures, it becomes evident on the GlideScope display, and
appropriate corrective action (such as twisting the endotracheal tube) can easily
be taken. Note that this technique is also useful for other purposes, as in situations
where FOI is difficult even for experienced operators, as may occur, for instance,
in the case of airways soiled by blood.
Note how in this case a “twisting action” was necessary to get the ETT to pass
into the trachea.
This case was a patient with sarcoidosis. I was called to the OR to help when
the patient could not be intubated using a MAC 3 or a MAC 4 laryngoscope blade.
An intubating LMA was placed, but the patient could not be ventilated using it,
so a regular LMA was used. When the GlideScope was introduced the glottis almost
nothing could not be visualized, so use of the GlideScope was abandoned.
This case was a patient with terrible teeth. To document that I had not damaged
the teeth with intubation I used the laryngoscope as a camera to scan the teeth
at the end of intubation.
Case 474 (Parts A and B)
GlideScope “Rescue” Intubation (Clip A 6.08 MB, 66 sec, 15 fps, 320x240) (Clip B 6.71 MB, 73 sec, 15 fps, 320x240) I was called in to help in intubating this patient. The resident first tried
intubating using a MAC 4 blade, and then a Miller 3. When neither of these worked,
the staff tried using a MAC 4 blade. When that failed as well, I was called to
help. In the first attempt (Clip A), no succinylcholine was given. The second
attempt (Clip B) was successful following the administration of succinylcholine.
This 40 year old lady had a large vocal cord polyp. After the induction of general
anesthesia she turned out to be fairly hard to ventilate, presumably because of
airway obstruction. Although we got a good view of the glottis, despite using
a small endotracheal tube (size 5.0 MLT), the tube did not pass all that easily.
Case 485
GlideScope Assisted Topical Anesthesia Using the MADgic Atomizer (3.43 MB, 39 sec, 15 fps, 320x240) Following sedation with midazolam, the airway was anesthetized with gargled and
then atomized 4% lidocaine.The GlideScope was then introduced. Once a good view
of the glottis was obtained additional lidocaine was administered to the vocal
cords under direct vision using a MADgic atomizer (Wolfe Tory Medical, Salt Lake
City, USA). While we could have easily passed the endotracheal tube directly under
GlideScope visualization in this setting, the resident needed experience in awake
fiberoptic intubation, so the GlideScope was used only to assist in airway topicalization.
Note, however, that there are several advantages of using the GlideScope for
awake intubation. First, the view is excellent. Second, the method is less affected
by secretions or blood as compared to fiberoptic intubation. Third, everyone can
view the intubation, while this is the case only for video bronchoscopes. Fourth,
the intubation can be recorded using a regular camcorder. Fifth, there are no
restrictions on the type of endotracheal tube (ETT) that can be placed, while
this is not the case for fiberoptic methods. Sixth, the GlideScope is more rugged
than a bronchoscope, and is less susceptible to damage. Seventh, the GlideScope
is easily cleaned. Finally, while advancing the ETT into the trachea over a bronchoscope
often fails as a result of the ETT impinging on the arytenoid cartilages, this
is not a problem with the GlideScope.
This patient was a morbidly obese woman scheduled for a gastric banding procedure.
Following the induction of general anesthesia, a GlideScope intubation attempt
was carried out by a resident inexperienced with the use of the device. When I
took over from the resident I was poorly positioned (I was off to the patient's
side) and felt rushed (since morbidly obese patients desaturate quickly). Although
the view was not great I felt that I was probably in the trachea - a confidence
inappropriately bolstered by experience in over 500 GlideScope cases. But it soon
became apparent that this was an esophageal intubation.
This 44 year old patient was scheduled for a sinus endoscopy. At a previous anesthetic
he was noted to have a Cormack-Lehane grade IV view (epiglottis and glottis not
visible). As this clip nicely illustrates,in such cases the GlideScope sometimes
offers an excellent view anyway.
Case 610
Severe Subglottic Stenosis (25.5 MB, 4 min 25 sec, 15 fps, 320x240) This patient had severe subglottic stenosis. First we tried a 6.0 size ETT, but
it would not pass. Then we tried a 4.0 MLT, but that would not pass either. What
saved the day was the ENT resident using a Dedo laryngoscope with a 4.0 ML, which
went is this time because it was a “straight shot”. There was no problem with
desaturation, thanks to generous preoxygenation. In retrospect, a bougie or other
device might have been helpful, with the ETT then being passed over it.
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