The GlideScope Video Laryngoscope and the Macintosh Laryngoscope Compared in a Simulated Difficult Airway with Immobilization and Bleeding—A Randomized, Prospective, Crossover Study

Background: This study assesses the effectiveness of the GlideScope Videolaryngoscope (GS) in comparison with the Macintosh laryngoscope in a simulated difficult airway with blood in the airway and restricted range of motion of the neck. 39 participants experienced with the GS and the Macintosh laryngoscope were used. Methods: This analysis is a prospective, randomized, crossover study. Our study was performed on an intubation simulation model with artificial blood in the airway and restricted range of motion. The intubation time was recorded from picking up the laryngoscope to advancing the endotracheal tube through the glottic opening. Secondary endpoints were the Cormack & Lehane score, the percentage of the glottis seen, the subjective difficulty of the procedure on a scale of 0 to 10, the number of adjustment maneuvers, the number of attempts, and the number of failed intubations. Attempts were defined as removal of instruments from the airway and reinsertion. Failed intubations were defined as esophageal intubations or intubations lasting longer than 120 seconds. Results: The mean intubation time was 47.6 seconds with the GS and 21.4 seconds with the Macintosh laryngoscope. There were 3 failed intubations with the Macintosh laryngoscope and 4 failed intubations with the GS. The failed intubations with the Macintosh laryngoscope were all esophageal intubations. The failed intubations with the GS were due to exceeding the time limit of 120 seconds. Both devices had a mean Cormack & Lehane score of 1.8 and the mean percentage of the Glottis seen was 58% for both devices. The average subjective difficulty on a scale from 0 to 10 was ranked 4.16 for the Macintosh and 5.14 for the GS. Participants needed an average of 1 adjustment maneuvers with the Macintosh laryngoscope and 2.7 adjustments with the GS. Conclusion: The GS, used by experienced anesthesiologists in a simulated difficult airway, had an inferior performance compared to the Macintosh laryngoscope in terms of intubation time, number of intubation attempts, number of adjustment maneuvers, and number of failed intubations.