Glidescope videolaryngoscopy vs Frova endotracheal introducer in difficult unexpected airway management

Background and Goal of Study: In unpredicted difficult orotracheal intuba- tion (OTI), both national and international guidelines suggest to avoiding more than three attempts in order to reduce the risk of “cannot intubate - cannot ventilate” situation. The second attempt should be performed with some mod- ified elements such as laryngoscope blades, position of the patient’s head, BURP, etc., but the third one should be performed using alternative devices. The guidelines don’t provide any precise indications about videolaryngo- scopes as alternative to fibrobroncoscopy. The aim of this study is comparing the ef ficacy of the Frova and Glidescope in the unpredicted dif ficult OTI in pa- tients admit ted to elective inter ventions and the evaluation of stress by the maneuver per formed using the t wo devices, through hemodynamic monitoring. Materials and methods: A randomized controlled trial was performed on 40 consecutive patients, through the ages of 18 to 70, under general anesthe- sia with more than one attempts of the OTI maneuver. A Frova Introducer or Glidescope were used while comparing the duration of the first attempt to the duration of the OTI using Frova Introducer or Glidescope. Cardiorespira- tory monitoring predicted the registration of the following parameters: BP, HR, SaO2 and EtCO2,at T0= before induction;T1=before direct laryngoscopy with a Macintosh laryngoscope,T2=during direct laryngoscopy,T3= OTI with Frova or Glidescope,T4=10 minutes later. Results and discussion: There were 40 randomized consecutive patients with unpredicted dif ficult OTI in the Frova group (FI) (n=20) and in the Glides- cope group (GS) (n=20).Most of the patients of both groups were intubated at the first attempt using Frova (n=13) patients and patients with Glide (n=12); the rest of the patients at the second attempt. The overall time needed for the correct placement of the endotracheal tube was significantly briefer (P< 0.001) in the FI group (12.1±4.1 sec) compared to the GS group (39.9±11.8 sec). Monitoring BP and HR in various times has shown a significant increase in both groups corresponding to T2 and T3 (P < 0.001) corresponding to direct laryngoscopyConclusions: All patients in this study were successfully intubated; already in the first attempt with Frova or Glidescope in most cases. The SaO2 values were always above the security levels (< 97%). The OTI with Frova was faster and less traumatic compared to the one with glidescope