Glidescope Video Laryngoscopy in Patients with Severely Restricted Mouth Opening-A Pilot Study.

Background: An inter-incisor gap <3 cm is considered critical for videolaryngoscopy. It is unknown if new generation GlideScope Spectrum™ videolaryngoscopes with low-profile hyperangulated blades might facilitate safe tracheal intubation in these patients. This prospective pilot study aims to evaluate feasibility and safety of GlideScope videolaryngoscopes in severely restricted mouth opening.

Methods: Feasibility study in 30 adults with inter-incisor gaps between 1.0 and 3.0 cm scheduled for ENT or maxillofacial surgery. Individuals at risk for aspiration or rapid desaturation were excluded.

Results: The mean mouth opening was 2.2 ± 0.5 cm (range 1.1-3.0 cm). First attempt success rate was 90% and overall success was 100%. A glottis view grade 1 or 2a was achieved in all patients. Nasotracheal intubation was particularly difficult if Magill forceps were required ( = 4). Intubation time differed between orotracheal ( = 9; 33 (25; 39) s) and nasotracheal ( = 21; 55 (38; 94) s); = 0.049 intubations. The airway operator's subjective ratings on visual analogue scales (0-100) revealed that tube placement was more difficult in individuals with an inter-incisor gap <2.0 cm ( = 10; 35 (29; 54)) versus ≥2.0 cm ( = 20; 20 (10; 30)), = 0.007, while quality of glottis exposure did not differ.

Conclusions: Glidescope videolaryngoscopy is feasible and safe in patients with severely restricted mouth opening if given limitations are respected.