The second piece of the puzzle with a hyperangulated video blade is getting the tube to drop into the trachea. One cannot merely advance the stylet, as the curvature used to get around the tongue creates a side-to-side dimension that exceeds the diameter of the human trachea. The trachea is only 15–20 mm in males and 14–16 mm in females. Additionally, if the hyperangulated stylet is simply rotated upward through the cords, the direction the tube and stylet points is upward, while the trachea has a downward inclination. Finally, there are the tracheal rings, which can prevent tube advancement when using a standard asymmetric left-beveled tracheal tube.
Verathon offers the GlideRite stylet to help with tube insertion. It is a rigid stylet with a 70-degree angle and a nifty proximal end, allowing the thumb to pop the stylet up (see Figure 3). A GlideRite stylet exceeds 2 inches in side-to-side dimension; this exceeds the dimensions of the human trachea. Accordingly, it is a tube delivery device (around the tongue and into the larynx), not a tracheal introducer. By partially removing the stylet after insertion through the cords, the tracheal tube can be advanced downward into the trachea. This maneuver, however, doesn’t address issues with the inclination of the trachea and the corrugation of the tracheal rings.
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About the Author
Richard M. Levitan, MD, FACEP, is an adjunct professor of emergency medicine at Dartmouth’s Geisel School of Medicine in Hanover, N.H., and a visiting professor of emergency medicine at the University of Maryland in Baltimore. He works clinically at a critical care access hospital in rural New Hampshire and teaches cadaveric and fiber-optic airway courses.