title: Early Endotracheal Tube Insertion with the GlideScope: A Randomized Controlled Trial.
abstract: BACKGROUND
  The GlideScope videolaryngoscope is an intubating device routinely used by anesthesiologists for tracheal intubation. It is occasionally difficult to advance the endotracheal tube (ETT) into the trachea, despite a good view of the glottis. One technique that may be used when difficulty is encountered is to remove the GlideScope from the pharynx and introduce the ETT into the pharynx first, leaving it in place posteriorly while the GlideScope is inserted. Frequently, when the GlideScope is subsequently inserted, the ETT tip will then be in good view, resting near the glottis, and will easily advance into the trachea. In this randomized, single-blinded trial, we assessed whether orotracheal intubation with the GlideScope is faster and/or easier with the ETT-first technique as a primary technique in elective patients.
  
  
  METHODS
  One hundred sixty patients with normal-appearing airways who required elective orotracheal intubation were allocated randomly to intubation with insertion of the ETT or GlideScope into the oropharynx first. The primary outcome was time to intubation. The secondary outcomes were subjective ease of intubation (100-mm visual analog scale, 0 = easy; 100 = difficult), number of attempts/failures, incidence of oropharyngeal bleeding, and postoperative sore throat and/or vocal changes.
  
  
  RESULTS
  Baseline demographics were similar between the 2 groups. Mean time to intubation was 48.2 ± 17.1 seconds with the ETT-first technique and 51.5 ± 21.8 seconds with the GlideScope-first technique (P = 0.30). The mean difference was 3.3 seconds in favor of the ETT-first technique (95% confidence interval, -2.9 to 9.6). The median ease of intubation using the visual analog scale was 13.3 mm (interquartile range, 5.3 to 21) with the ETT-first technique and 13.5 mm (interquartile range, 5.6 to 29.5) with the GlideScope-first technique (P = 0.30). The difference between the medians was -2.0 mm in favor of the ETT-first group (95% confidence interval, -1.5 to 6.0). There was no difference between groups for number of intubation attempts, incidence of oropharyngeal bleeding, laryngoscopic grade, sore throat, or vocal changes.
  
  
  CONCLUSIONS
  In this study of GlideScope laryngoscopy, no statistically significant difference was observed in the time to intubate or the subjective ease of intubation whether the ETT or GlideScope was inserted into the oropharynx first.
authors.affiliation: From the Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Turkstra
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Cusano
authors.forename: Jason A
authors.initials: JA
authors.lastname: Fridfinnson
authors.forename: Pravin
authors.initials: P
authors.lastname: Batohi
authors.forename: Maxim
authors.initials: M
authors.lastname: Rachinsky
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D053208:Kaplan-Meier Estimate; D020704:Laryngoscopes; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D017211:Treatment Failure; D016896:Treatment Outcome; D014741:Video Recording