Abstract
We evaluated the performance of the McGrath video laryngoscope and Pentax Airway Scope in comparison with the Macintosh laryngoscope for nasotracheal intubation in paediatric patients. For this, 108 patients were enrolled in an open-label, randomized controlled trial. Patients were randomly allocated to one of three groups based on use of the Macintosh laryngoscope, McGrath video laryngoscope, or Pentax Airway Scope. Time to intubation, the intubation difficulty, and the quality of navigation were compared among groups. The median nasotracheal intubation time [interquartile range] in the Macintosh group (33.5 [28.3–39.8] s) was significantly shorter than those of the McGrath (39.0 [32.0–43.0] s) and Pentax groups (43.0 [35.0–52.0] s). The difficulty of nasotracheal intubation was similar among all groups. When navigating and aligning the tube from the oropharynx into the glottic inlet, the cuff inflation method was required in significantly fewer patients for the Macintosh group (11.1%) than for the McGrath (48.6%) and Pentax (51.4%) groups. Thus, compared to the McGrath video laryngoscope and Pentax Airway Scope, the Macintosh laryngoscope allowed shorter nasotracheal intubation times and better facilitated tracheal navigation, requiring less use of the cuff inflation method to navigate the tracheal tube into the glottic inlet.
Highlights
Increasing evidence suggests that use of a video laryngoscope in nasotracheal intubations can offer several advantages over a direct laryngoscope[1,2,3]
Nasotracheal intubation was completed within 120 s in all patients, but two patients were categorized as a failed intubation because they were intubated with a Macintosh laryngoscope instead of the assigned device
We demonstrated that the Macintosh laryngoscope required shorter intubation times than did the McGrath video laryngoscope or Pentax Airway Scope
Summary
Increasing evidence suggests that use of a video laryngoscope in nasotracheal intubations can offer several advantages over a direct laryngoscope[1,2,3]. Unlike conventional laryngoscopes, which provide direct line-of-sight, video laryngoscopes provide a non-line-of-sight view through a screen display, providing greater visibility when advancing the tracheal tube into the trachea[2,5,6] This decreases distortion of the oropharyngeal structure, and minimizes the need for Magill forceps to insert the tracheal tube and reduces the time needed to intubate. No comparative studies have been performed using the Macintosh-shaped and channelled blade in paediatric patients The objective of this investigation was to compare the intubation time, difficulty of nasotracheal intubation, and quality of navigation at each stage of tube insertion of the Macintosh laryngoscope, McGrath video laryngoscope, and Pentax Airway Scope for nasotracheal intubation in paediatric patients
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