Lactate gap and ethylene glycol poisoning.

EDITOR: We report a case in which we used the GlideScope to facilitate the successful insertion of nasogastric tube. A 66-yr-old male was scheduled for an elective left-sided hemi-mandibulectomy with radial free flap reconstruction for squamous cell carcinoma of the oral cavity. On assessment, the patient’s airway was Mallampati 2 and mouth opening was three fingerbreadths wide. We induced anaesthesia and intubated the trachea (Cormack & Lehane grade 2 on direct laryngoscopy). We attempted and failed to insert a nasogastric tube with digital manipulation as well as under direct vision with a MacIntosh blade. At this point, we inserted the video laryngoscope (GlideScope). The view was Cormack & Lehane grade 1 of the laryngeal inlet with an endotracheal tube in situ. We lifted the epiglottis with the GlideScope tip, which improved the view of entrance to the oesophagus. We could insert the nasogastric tube under direct vision with digital manipulation. The position was confirmed with gastric contents on aspiration and the appropriate pH of the aspirate. The GlideScope has been designed to facilitate tracheal intubation by achieving a clear view of the anterior segment of the glottis without the need for a direct line sight. Even in difficult intubations, the GlideScope achieves Cormack & Lehane view I and II in 99% of patients [1]. It requires less force than conventional laryngoscopy, hence it is less traumatic and minimizes the laryngoscopic stress response. Its slim blade provides a good working space not only for intubation, but also for nasogastric tube placement. It is easy to learn, use and master the technique. Even though there are no clinical trials available to support this use, it may be a useful technique to use the GlideScope to insert a nasogastric tube, especially in intubated patients. It may also theoretically reduce the stress response to laryngoscopy as it requires less force than the traditional laryngoscope.