why not guide channel in Glidescope?

[cdk270]

There are many cases in which glidescope provides beautiful view of vocal cord but ETT can't be reached in the visual field. Why don't they provide guide channel for ETT as in many other video laryngo such as King's vision? Any idea?
Also, there are two models of Kin'gs vision video laryngo, one is with guide channel, the other is standard. Wouldn't it be always safe to use guide channeled laryngoscope? Why use standard? Is there any problem or disadvantages with the guide channel in intubation process?

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[Robotic Wis-Hipple]

There are many cases in which glidescope provides beautiful view of vocal cord but ETT can't be reached in the visual field. Why don't they provide guide channel for ETT as in many other video laryngo such as King's vision? Any idea?
Also, there are two models of Kin'gs vision video laryngo, one is with guide channel, the other is standard. Wouldn't it be always safe to use guide channeled laryngoscope? Why use standard? Is there any problem or disadvantages with the guide channel in intubation process?

The axis that gives you the view from a videolaryngoscope may not be the same angle/axis that permits advancement of an ETT thru the cords. I myself like the ability to manipulate the ETT as needed. In addition to that, many instances where you use a glidescope are small mouth/poor mouth opening scenarios and IMO some of the videolaryngoscope blades are already too bulky.

 

[Mman]

There are many cases in which glidescope provides beautiful view of vocal cord but ETT can't be reached in the visual field. Why don't they provide guide channel for ETT as in many other video laryngo such as King's vision? Any idea?
Also, there are two models of Kin'gs vision video laryngo, one is with guide channel, the other is standard. Wouldn't it be always safe to use guide channeled laryngoscope? Why use standard? Is there any problem or disadvantages with the guide channel in intubation process?

Not having to put the tube through a guide channel is a good thing as it permits me more different paths to getting the endotracheal tube in place than only when the vocal cords are centered in the middle of the screen. You can aim the tube up, down, left, or right depending on what you see on the screen.

 

[dhb]

Use a fiberoptic scope with the glide

 

[chocomorsel]

Manipulate the styler on the ETT to create a more steeped curve or lesser curve. Use the stylet provided by the Glidescope. Others are too flimsy for the angle of the scope. Watch the ETT goes through the mouth first before turning your head back to the screen.

You just need experience. Glidescope and McGrath are the best ones out there.

I have never had this problem. However like Robotic His Whipple I find the King way too bulky and difficult to place in smaller mouths.

 

[Consigliere]

McGrath is better.

 

[cdk270]

The axis that gives you the view from a videolaryngoscope may not be the same angle/axis that permits advancement of an ETT thru the cords. I myself like the ability to manipulate the ETT as needed. In addition to that, many instances where you use a glidescope are small mouth/poor mouth opening scenarios and IMO some of the videolaryngoscope blades are already too bulky.

Don't you use a styler to conform the shape of ETT to that of the glidescope and follow the axis/path made by glidescope blade? Do you find much difference between this and guide channel (except the bulkiness) ?

 

[cleansocks]

Another trick you wouldn't be able to do with a channel: guide ETT with rigid stylet and park tip at glottic entrance. If can't quite get through (a bit too anteriorly pointed, for example), remove stylet and alligator roll (tm) it in

 

[Mman]

Don't you use a styler to conform the shape of ETT to that of the glidescope and follow the axis/path made by glidescope blade? Do you find much difference between this and guide channel (except the bulkiness) ?

Sort of, but if it isn't right I can take the stylet out and bend it to a different angle to facilitate aiming the tube away from the center of the glidescope screen.

 

[Robotic Wis-Hipple]

Don't you use a styler to conform the shape of ETT to that of the glidescope and follow the axis/path made by glidescope blade? Do you find much difference between this and guide channel (except the bulkiness) ?

Sometimes.... but more often I'd say I approach the glottis with the styletted tube near 90 degrees perpendicular to the blade, that way small rolling movements from the connector end of the tube produce relatively large anterior/posterior movements of the distal tip of the ETT which allows you to get the tip where you need it. This wouldn't be possible with a tube guide channel.

In the end, tools are made to make things easier or to facilitate successful completion of a job but they aren't always a one size fits all easy mode. A guide channel may make things easy and perfectly guide the ETT thru the cords some of the time, but restricting a skilled laryngoscopist from being able to make adjustments in the technique would be counterproductive in many cases.

 

[deleted682700]

McGrath is better.

The picture qualty and their service is poor. This forced us to buy glidescope

 

[deleted171991]

Sometimes.... but more often I'd say I approach the glottis with the styletted tube near 90 degrees perpendicular to the blade, that way small rolling movements from the connector end of the tube produce relatively large anterior/posterior movements of the distal tip of the ETT which allows you to get the tip where you need it. This wouldn't be possible with a tube guide channel.

In the end, tools are made to make things easier or to facilitate successful completion of a job but they aren't always a one size fits all easy mode. A guide channel may make things easy and perfectly guide the ETT thru the cords some of the time, but restricting a skilled laryngoscopist from being able to make adjustments in the technique would be counterproductive in many cases.

+1. Once you've done 20-25 intubations with a glidescope, it's piece of cake. I actually tend to grab the connector end with my hand (make a fist), not just with my fingertips, and guide it with wrist movements.

 

[psychbender]

I actually tend to grab the connector end with my hand (make a fist), not just with my fingertips, and guide it with wrist movements.

That's what she said.

 

[deleted171991]

That's what she said.

My mistake then. I missed that part. Can you please quote it?

 

[dhb]

 

[deleted162650]

My mistake then. I missed that part. Can you please quote it?

Nurse! We need a sense of humor over here STAT. It appears FFP is suffering from an acute case of Can't Recognize a Joke-itis.

 

[deleted171991]

Nurse! We need a sense of humor over here STAT. It appears FFP is suffering from an acute case of Can't Recognize a Joke-itis.

I didn't know that expression. You forget I am not a native speaker.

Now that I looked it up... really, @psychbender?

 

[psychbender]

I didn't know that expression. You forget I am not a native speaker.

Now that I looked it up... really, @psychbender?

I felt that the forum needed a little low-brow humor to bring us all back down.

Also, you totally opened yourself up for that.

 

[deleted171991]

I felt that the forum needed a little low-brow humor to bring us all back down.

Also, you totally opened yourself up for that.

I am trying to explain, in my best broken English, one of the best tricks when intubating with a glide, and I get this. Seriously?

 

[Psai]

I felt that the forum needed a little low-brow humor to bring us all back down.

Also, you totally opened yourself up for that.

Are you sure he opened himself up? Sounds like an outside job to me

Or maybe it was an inside job.

 

[psychbender]

*rimshot*

 

[Psai]

*rimshot*

Yes it was.