title: GlideScope versus flexible fiber optic for awake upright laryngoscopy.
abstract: OBJECTIVE
  We compare laryngoscopic quality and time to highest-grade view between a face-to-face approach with the GlideScope and traditional flexible fiber-optic laryngoscopy in awake, upright volunteers.
  
  
  METHODS
  This was a prospective, randomized, crossover study in which we performed awake laryngoscopy under local anesthesia on 23 healthy volunteers, using both a GlideScope video laryngoscopy face-to-face technique with the blade held upside down and flexible fiber-optic laryngoscopy. Operator reports of Cormack-Lehane laryngoscopic views and video-reviewed time to highest-grade view, as well as number of attempts, were recorded.
  
  
  RESULTS
  Ten women and 13 men participated. A grade II or better view was obtained with GlideScope video laryngoscopy in 22 of 23 (95.6%) participants and in 23 of 23 (100%) participants with flexible fiber-optic laryngoscopy (relative risk GlideScope video laryngoscopy versus flexible fiber-optic laryngoscopy 0.96; 95% confidence interval 0.88 to 1.04). Median time to highest-grade view for GlideScope video laryngoscopy was 16 seconds (interquartile range 9 to 34) versus 51 seconds (interquartile range 35 to 96) for flexible fiber-optic laryngoscopy. A distribution of interindividual differences demonstrated that GlideScope video laryngoscopy was, on average, 39 seconds faster than flexible fiber-optic laryngoscopy (95% confidence interval 0.2 to 76.9 seconds).
  
  
  CONCLUSIONS
  GlideScope video laryngoscopy can be used to obtain a Cormack-Lehane grade II or better view in the majority of awake, healthy volunteers when an upright face-to-face approach is used and was slightly faster than traditional flexible fiber-optic laryngoscopy. However, flexible fiber-optic laryngoscopy may be more reliable at obtaining high-grade views of the larynx. Awake, face-to-face GlideScope use may offer an alternative approach to the difficulty airway, particularly among providers uncomfortable with flexible fiber-optic laryngoscopy.
authors.affiliation: Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA. natalie.silverton@hsc.utah.edu
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Silverton
authors.forename: Scott T
authors.initials: ST
authors.lastname: Youngquist
authors.forename: Michael P
authors.initials: MP
authors.lastname: Mallin
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Bledsoe
authors.forename: Erik D
authors.initials: ED
authors.lastname: Barton
authors.forename: Erika D
authors.initials: ED
authors.lastname: Schroeder
authors.forename: Amber D
authors.initials: AD
authors.lastname: Bledsoe
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Axelrod
mesh_terms: D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D055100:Optical Fibers; D011187:Posture; D013997:Time Factors; D014741:Video Recording; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods