The effectiveness of GlideScope video laryngoscopy in the management of pediatric difficult airways
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The aim of this thesis is to quantify the intubation success rates and complication rates associated with GlideScope® video laryngoscopy in pediatric difficult airway patients. Difficult intubation is a major source of anesthesia-related morbidity and mortality in both adults and children (1-3). A number of studies have demonstrated that video laryngoscopy has helped to address this problem in adults, producing high intubation success rates with minimal complications (4-6). However, the literature on the use of videoscopes in children with difficult airways is sparse. We therefore sought to examine success and complication rates with the GlideScope®, a common type of video laryngoscope. To do so, we examined patient data from the Pediatric Difficult Intubation Registry, a collection of information on difficult airway incidents at fourteen pediatric teaching hospitals in the United States. From these data we calculated overall, first-pass, and rescue success rates on a per-attempt and per-patient basis, comparing them to success rates that resulted from using direct laryngoscopy. We also examined success rates for smaller groups of patients divided by Cormack-Lehane airway grade, weight, and muscle relaxant use. Finally, we assessed complication rates for patients undergoing GlideScope® intubation attempts and direct laryngoscopy. The GlideScope® produced lower success rates in our sample than those documented in adult difficult airway patients. This was particularly the case among smaller children and those with poor glottis visualization. However, the GlideScope® was superior to direct laryngoscopy by all measures and in all patient subgroups. We also found lower rates of hypoxemia and overall complications among patients receiving intubation attempts with only the GlideScope® versus only direct laryngoscopy. We believe this result may be related to the greater number of intubation attempts among patients receiving direct laryngoscopy.