title: Children with challenging airways: What about GlideScope®video-laryngoscopy?
abstract: BACKGROUND
  GlideScope®video-laryngoscopy is becoming increasingly used, including in paediatrics. However, to date, very few data are available on efficiency during situations involving difficult intubation. Our objective was to describe the usefulness of the GlideScope®in children with presumed challenging airway criteria.
  
  
  METHODS
  In this observational study, all children with predicted criteria of potential difficult intubation and requiring general anaesthesia with tracheal intubation were prospectively enrolled over a 12-month period. The Cormack and Lehane (CMK) grade was first assessed by direct laryngoscopy. In case of a CMK≥3, the same experienced anaesthesiologist scored the CMK scale under GlideScope®videoscopy. Data related to GlideScope®use under difficult intubation conditions were analysed.
  
  
  RESULTS
  Out of the sixty-one patients (median [25th-75thinterquartile range] age of 12 [4-37] months) included, 37 (62%) patients have confirmed a high probability of difficult intubation. Compared to direct laryngoscopy, GlideScope®video-laryngoscopy was significantly associated with an improved CMK grade (P<0.001). Tracheal intubation with the GlideScope®was successful after the first attempt in almost one half of cases and ultimately in 100% of patients. The median time required for successful GlideScope®intubation was 42.5 [30-60] s. No per procedure complications were recorded.
  
  
  CONCLUSIONS
  In children with challenging airways, GlideScope®video-laryngoscopy resulted in a significant improvement of the glottic view with an excellent success rate and satisfactory time to intubation. How these devices are to be positioned in difficult airway management algorithms and guidelines remain to be defined.
authors.affiliation: Department of Paediatric Anaesthesia and Critical Care Medicine, Montpellier University, Lapeyronie Hospital, CHU Montpellier, 34295 Montpellier cedex 5, France. Electronic address: c-sola@chu-montpellier.fr.
authors.forename: Chrystelle
authors.initials: C
authors.lastname: Sola
authors.affiliation: Department of Paediatric Anaesthesia and Critical Care Medicine, Montpellier University, Lapeyronie Hospital, CHU Montpellier, 34295 Montpellier cedex 5, France.
authors.forename: Anne-Charlotte
authors.initials: AC
authors.lastname: Saour
authors.affiliation: Department of Paediatric Anaesthesia and Critical Care Medicine, Montpellier University, Lapeyronie Hospital, CHU Montpellier, 34295 Montpellier cedex 5, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Macq
authors.affiliation: Biostatistics and Clinical Research Consultant, Department of Anaesthesiology and Critical Care Medicine, Montpellier University, Lapeyronie Hospital, CHU Montpellier, 34295 Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bringuier
authors.affiliation: Department of Paediatric Anaesthesia and Critical Care Medicine, Montpellier University, Lapeyronie Hospital, CHU Montpellier, 34295 Montpellier cedex 5, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Raux
authors.affiliation: Department of Paediatric Anaesthesia and Critical Care Medicine, Montpellier University, Lapeyronie Hospital, CHU Montpellier, 34295 Montpellier cedex 5, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Dadure
mesh_terms: D058109:Airway Management / Q000295:instrumentation*; D000768:Anesthesia, General; D002675:Child, Preschool; D005260:Female; D005931:Glottis / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation*; D008297:Male; D011446:Prospective Studies
keywords: Difficult airway; GlideScope; Paediatric anaesthesia; Video-laryngoscopy