GLIDESCOPE VERSUS DIRECT LARYNGOSCOPE FOR NASOTRACHEAL INTUBATION IN ORAL AND MAXILLOFACIAL SURGERY PATIENTS WITH ANTICIPATED DIFFICULT AIRWAYS

General anesthesia for oral and maxillofacial surgery is one of the most challenging tasks for an anesthetist. Nasotracheal intubation is usually required in these patients to allow an unrestricted surgical approach. The GlideScope video-laryngoscopy (GVL) appears to provide better glottic visualization than direct laryngoscopy. However, the effectiveness of GlideScope for nasotracheal intubation in patients for oral or maxillofacial surgery with difficult airways needs more investigation. The purpose of this study is to evaluate the usefulness of GVL vs. direct laryngoscope for nasotracheal intubation in adult patients with difficult airways presenting for oral or maxillofacial surgery. Patients and Methods: The Macintosh laryngscope and the Glidescope were compared for nasotracheal intubation in 40 patients ASA I-III with difficult airway undergoing oral or maxillofacial surgery. The patients were randomly assigned to laryngoscopic group (DL group) or the Glidescope group (GV group). Prior to nasotracheal intubation all patients were given a Cormack and Lehane (C L) grade by a separate anesthetist using a Macintosh laryngoscope. The patients were then intubated, using direct laryngoscopy or the GlideScope. Outcome measures included grading of view, intubation success or failure, numbers of intubation attempts, time to intubation, usage of Magill forceps, and complications. Results: There were no differences between groups with respect to hemodynamic and oxygen saturation during the study period P 0.05. There was a significant difference in laryngoscopic views according to the Cormack and Lehane classification. The Cormack and Lehane I II views obtained by conventional laryngoscope rose from 70% and 95% of cases with GlideScope (P 0.05) , while C L III and IV decline from 40 to 5 % with GlideScope P 0.05. The intubation was successful in 95% of the cases in (GV) group vs. 85% in (DL) group .The nasotracheal intubation performed with the direct laryngoscope (45.1±7.8) s was significantly faster than that with the GlideScope (53.5±14.7) s, P 0.033. Magill forceps were used in 25% in the GV group, but were employed 60% of the time in the DL group, P = 0.02. The intubation failure rate was higher using the direct laryngoscope 15% vs. 5% in GlideScope P= 0. 49. The incidence of post-operative sore throat was significantly reduced in the GV group 15% versus 40% in DL group, P = 0.07. Conclusions: Oral and maxillofacial surgery has a potentially difficult airway, but if managed properly the morbidity and mortality can be reduced or avoided. The Glidescope (VL) can be used successfully for nasotracheal intubation in difficult airway in oral and maxillofacial surgery.