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Education  |   February 2015
GlideScope Cobalt Videolaryngoscope: Mirrors and Illusions
Author Notes
  • From the Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (J.E.F.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Fiadjoe: fiadjoej@email.chop.edu
Article Information
Education / Images in Anesthesiology / Airway Management / Technology / Equipment / Monitoring
Education   |   February 2015
GlideScope Cobalt Videolaryngoscope: Mirrors and Illusions
Anesthesiology 2 2015, Vol.122, 436. doi:10.1097/ALN.0000000000000209
Anesthesiology 2 2015, Vol.122, 436. doi:10.1097/ALN.0000000000000209
Abstract

Supplemental Digital Content is available in the text.

The GlideScope Cobalt videolaryngoscope (Verathon Medical, Bothell, WA) has become a popular teaching tool because of the ability of the instructor to share the same view as the trainee.1–3  During use of the GlideScope Cobalt videolaryngoscope size-2 blade, we noticed a reflected image of the vocal cords when the blade tip was used to lift the epiglottis. The figure shows the glottis with open vocal cord and a feeding tube entering the esophagus inferiorly. The epiglottis is elevated by the GlideScope blade and the faint horizontal white line seen within the glottic opening represents the blade tip. The image above the white line is a reflected (mirrored) image of the glottis below. Attempts to advance the breathing tube toward the mirrored (false) view of the glottis would fail and could lead to misplacement of the tracheal tube, multiple intubation attempts, and potential patient harm. The supplemental video demonstrates the reflected image on the blade tip above the real glottis (see Supplemental Digital Content 1, http://links.lww.com/ALN/B39).
The GlideScope Cobalt videolaryngoscope size-2 blade has a reflective surface which may cause confusion for novices during tracheal intubation. Many teachers of videolaryngoscopy instruct learners to direct the tube toward the anterior commissure of the glottis. With this blade, the tube would be directed toward the reflected image and not the actual glottis. Instructors of videolaryngoscopy should be aware of this unique artifact and instruct trainees accordingly.
Acknowledgments
The authors thank Lemuel White (Karl Storz Endoscopia America, Inc.; and The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania) and James McDaniels, B.S. (The Children’s Hospital of Philadelphia), for their technical assistance.
Competing Interests
The authors declare no competing interests.
References
Fiadjoe, JE, Gurnaney, H, Dalesio, N, Sussman, E, Zhao, H, Zhang, X, Stricker, PA A prospective randomized equivalence trial of the GlideScope Cobalt® video laryngoscope to traditional direct laryngoscopy in neonates and infants.. Anesthesiology. (2012). 116 622–8 [Article] [PubMed]
Howard-Quijano, KJ, Huang, YM, Matevosian, R, Kaplan, MB, Steadman, RH Video-assisted instruction improves the success rate for tracheal intubation by novices.. Br J Anaesth. (2008). 101 568–72 [Article] [PubMed]
Levitan, RM, Heitz, JW, Sweeney, M, Cooper, RM The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices.. Ann Emerg Med. (2011). 57 240–7 [Article] [PubMed]