A comparison of the GlideScope with the Macintosh laryngoscope for nasotracheal intubation in patients with ankylosing spondylitis.

PURPOSE: The GlideScope (GS) video laryngoscope has been proven to be a suitable intubating device for a predicted difficult intubation. Patients with ankylosing spondylitis (AS) presented with particularly challenging airway management problems to the anesthesiologists. The benefits of using a GS in these patients have not been fully explored. The aim of this study was to evaluate the effectiveness of the GS, in comparison with the Macintosh laryngoscope, when performing nasotracheal intubation in patients with AS under general anesthesia.

METHODS

A total of 60 ASA I-II patients with AS were randomly assigned to undergo nasotracheal intubation using either the GS or the Macintosh laryngoscope. Preoperative airway assessments were performed in an attempt to predict the difficulty of tracheal intubation. Duration and number of intubation attempts, success rates, number of optimization maneuvers, Cormack and Lehane grades, Percentage of Glottic Opening (POGO) scores for each attempt, and difficulty of device use (VAS difficulty scores) were recorded. Complications associated with intubation were also recorded.

RESULTS

The rate of successful nasotracheal intubation was lower with the Macintosh laryngoscope (70%) compared with the GS (96.7%). In comparison with the Macintosh laryngoscope, the GS significantly reduced the intubation difficulty score, duration of tracheal intubation attempts, need for optimization maneuvers, and improved the Cormack and Lehane grade obtained during laryngoscopy.

CONCLUSIONS

The GS reduced the difficulty of tracheal intubation and provided a better laryngoscopic view with higher overall success rates and shorter duration of intubation attempts than the Macintosh laryngoscope. In our study, the GS proved to be a better alternative in most cases, compared with the Macintosh laryngoscope, for intubating AS patients who preferred their airway management under general anesthesia.