Intubating a difficult airway, such as a trauma patient, or a patient with anterior larynx, or an individual who is status post radiation therapy to the neck, often presents a life and death challenge. To offer an alternative to the popular McGrath Series laryngoscopes, marketed by LMA, a couple nurse anesthetists decided to develop their own video device, the CoPilot VL that offers a few novel features, such as a patent-pending Bougie Port. According to Magaw LLC., the company making the device, disposable cover sheaths can be released with a push of a button and the video screen can stand on its own or be clamped to a pole for easy access. The $3,000 device should be available for purchase this summer, and you can get in line by filling out a pre-order form.
From the product page:
Most practitioners are amazed by the ease of achieving good laryngeal views provided with VL devices, particularly those with angulated blades. However, actually getting the ETT through the glottis and into the trachea can pose a challenge, particularly in patients with an anterior airway. One simple method of facilitating intubation is to use our patent-pending Bougie Port. It solves the problem many VL devices can’t address — getting the ETT "around the corner" and into the trachea.
A common mistake many new VL users will make is placing the end of the scope too close to the glottis. When this happens, the end of the scope will actually get in the way of the tip of the ETT as you try to navigate it into the glottis. Instead, back the scope away from the glottis. With VL, it can be preferential to have a grade 2 view over a grade 1 view. This allows a wider field of view and more room to maneuver the tip of the ETT.
A few other things to keep in mind when learning VL:
• Keep your eyes on the patient as you introduce the scope into the mouth until it reaches the oropharynx.
• A midline introduction is usually recommended, but if your patient has a small mouth, try introducing the sheath further left. Once you have a good laryngeal view, watch the patient as you insert the endotracheal tube into the patient’s mouth, or a bougie into the bougie port.
• If you’re having difficulty passing the tube, reduce your upward lifting force while maintaining good laryngeal view. If you are using a stylet instead of a bougie, slide the stylet back a few centimeters which can straighten the end of the ETT. Also, you may try withdrawing the sheath a centimeter or two. These techniques can bring the axis of the ETT into better alignment with the axis of the trachea.