Endotracheal Tube Replacement in the Prone Position With Intubating Laryngeal Mask Airway/Flexible Fiberoptic Scope Combination or Glidescope® Video Laryngoscope: A Manikin-Based Study.

Abstract

Placing patients in the prone position is required for many surgical procedures. However, once in this position, the endotracheal tube (ETT) is often inaccessible to providers and accidental removal in an anesthetized, surgical patient can pose a life-threatening emergency. This experimental study aimed to examine the effectiveness of endotracheal reintubation in the prone position using a video laryngoscope (Glidescope®) compared with an intubating laryngeal mask airway (LMA) with ETT placement assisted by fiberoptic scope on a manikin. This study was conducted using 30 anesthesia providers with varying degrees of experience. The median times to intubation were lower using the Glidescope (73.5 s vs 130 s; P < .001). Moreover, the use of the Glidescope resulted in no esophageal intubations as well as fewer attempts than when using the LMA. Most anesthesia providers found that the Glidescope was the easiest technique to perform and learn. Despite these positive outcomes for the Glidescope, most of the participants reported the use of the LMA as a safer choice because of its capability to ventilate the manikin quickly (mean time to ventilation 12.13 s). The Glidescope method was found to be more likely to cause dental damage. The most important strategy is development of a plan prior to the emergent need.