Glidescope Video Laryngoscopy in Patients with Severely Restricted Mouth Opening-A Pilot Study

Background: An inter-incisor gap <3 cm is considered critical for videolaryngoscopy. It is unknown if new generation GlideScope SpectrumT videolaryngoscopes with low-profile hyperangulated blades might facilitate safe tracheal intubation in these patients. This prospective pilot study aims to evaluate feasibility and safety of GlideScope(TM) videolaryngoscopes in severely restricted mouth opening. Methods: Feasibility study in 30 adults with inter-incisor gaps between 1.0 and 3.0 cm scheduled for ENT or maxillofacial surgery. Individuals at risk for aspiration or rapid desaturation were excluded. Results: The mean mouth opening was 2.2 +/- 0.5 cm (range 1.1-3.0 cm). First attempt success rate was 90% and overall success was 100%. A glottis view grade 1 or 2a was achieved in all patients. Nasotracheal intubation was particularly difficult if Magill forceps were required (n = 4). Intubation time differed between orotracheal (n = 9; 33 (25; 39) s) and nasotracheal (n = 21; 55 (38; 94) s); p = 0.049 intubations. The airway operator's subjective ratings on visual analogue scales (0-100) revealed that tube placement was more difficult in individuals with an inter-incisor gap <2.0 cm (n = 10; 35 (29; 54)) versus >= 2.0 cm (n = 20; 20 (10; 30)), p = 0.007, while quality of glottis exposure did not differ. Conclusions: Glidescope(TM) videolaryngoscopy is feasible and safe in patients with severely restricted mouth opening if given limitations are respected.

Automated summary

This study evaluated the feasibility and safety of GlideScope(TM) videolaryngoscopes in patients with severely restricted mouth opening. The results showed that GlideScope(TM) successfully achieved tracheal intubation, with more difficulty in patients with an inter-incisor gap < 2.0 cm. The study concluded that GlideScope(TM) videolaryngoscopy is feasible and safe in patients with restricted mouth opening if given limitations are respected.