Similar to their flexible counterparts, rigid fiberoptic scopes are devices that permit indirect observation of the glottis and allow the operator to visualize passage of the endotracheal tube (ETT) into the airway. Newer devices, called videolaryngosopes, resemble conventional laryngoscopes but allow visualization of the airway on a video screen mounted nearby or attached to the handle of the device. Currently, the most commonly used of these devices is the GlideScope videolaryngoscope or GVL (Verathon Inc., Bothell, WA, USA; Figs. 24-1 and 24-2). Other promising videolaryngoscopes are the Pentax AWS (Hoya Corp., Tokyo, Japan; Figs. 24-3 and 24-4) and the C-MAC Storz (Karl Storz, Tuttlingen, Germany; Fig. 24-5). Older, but well-described devices include the Bullard laryngoscope (Gyrus ACMI, Southborough, MA, USA; Fig. 24-6), the Upsherscope (Mercury Medical, Clearwater, FL, USA; Fig. 24-7), and the WuScope (Achi Corp. San Jose, CA, USA; Fig. 24-8). Rigid fiberoptic scopes are inserted into the hypopharynx to obtain a view of the glottis rather than into the airway like flexible fiberoptic scopes. The ETT is then inserted into the airway while visualizing its progress with the scope. Some types have a stylet onto which the ETT is loaded, whereas others require freehand insertion.

Rigid fiberoptic scopes may be used routinely in airway management, but they have proven to be very useful in placement of the ETT when there is difficulty in aligning the oral, pharyngeal, and laryngeal axes, such as in patients with cervical spine immobilization or atlanto-occipital joint disease.¹,² Rigid videolaryngoscopes have also proven to be invaluable as a teaching tool. These devices allow the apprentice to visualize airway anatomy such as the epiglottis and glottis by looking at the video screen. The teacher is able to look at the video screen and help to guide the process of intubation using real-time visualization.

The GVL is a commonly used and well-studied rigid scope. This device features a blade similar to a Macintosh blade, but the GVL blade is made of durable plastic and has a more acute distal curvature (60°). There is an accompanying video camera at the distal end of the blade that serves to project an image of the glottis on a liquid crystal display (LCD) monitor.³ Insertion of the GVL classically follows a midline approach. After visualization of the uvula, the GVL blade is inserted in the vallecula or alternatively passed beyond the epiglottis if the epiglottis obstructs viewing the glottis.³ With the glottis in view on the monitor, the ETT is then passed into the airway with visual confirmation of ETT placement. Achieving an adequate view of the glottis with the GVL appears routine, although placement of the ETT can remain difficult due to the curvature of the GVL blade; thus, use of a rigid sylet is recommended during ETT placement.³,⁴

One of the newest additions to the rigid fiberoptic scope collection is the Pentax AWS. This innovative device consists of a 2.4″ LCD full color monitor, a 12-cm cable with a charge-coupled device camera, and a disposable clear blade (PBlade, Hoya Corp., Tokyo, Japan). The disposable PBlade is placed over the image cable leaving the camera approximately 3 cm from the tip of the blade. The PBlade allows an ETT to be attached to the right side of the blade to facilitate ETT placement (compatible with ETT sized 6.5 to 8.0). The PBlade also houses a port through which a suction catheter can be passed. The entire device is powered by two AA alkaline batteries that allows continuous operation for up to 1 hour. Insertion of the Pentax AWS is similar to the insertion of a Miller blade, with the distal end of the blade placed on the glottic side of the epiglottis. There is a sighting device on the LCD monitor that allows the user to align the tip of the ETT with the glottic opening to assist with ease of intubation.⁵,⁶

The original model for the rigid fiberoptic scope is the Bullard laryngoscope. This device features a blade contour designed to match the anatomy of the upper airway. The blade then mounts onto a standard laryngoscope handle. The Bullard laryngoscope encompasses a fiberoptic bundle that lies on the posterior aspect of the blade and is located near the end of the blade. It also possesses a working channel that runs the entire length of the blade for introduction of medications, suction, or oxygen insufflation. Intubation with the Bullard is achieved by the operator inserting the scope in a midline pathway into the hypopharynx in an anesthetized patient. The operator then advances the blade into position cephalad to the glottis. This yields an excellent view of the larynx. The ETT can then be pushed forward off the stylet (or placed freehand), into the glottis, while observing placement through the instrument.