A Prospective, Longitudinal Study on Effectiveness of King Vision® Video Assisted Laryngoscope and McCoy Laryngoscope in Patients with Simulated Restricted Neck Mobility

Abstract

Introduction: Successful airway management in patients with restricted cervical spine movement is always very challenging as there is no consensus regarding management of difficult airway in such patients with limited or no cervical spine mobility. Aim: To assess whether the King Vision® Video Laryngoscope (KVVL) provides a better view of the glottis and has higher success rate of tracheal intubation than McCoy laryngoscope in patients with simulated difficult airway. Materials and Methods: A prospective, longitudinal, comparative study was conducted with prior approval from Institutional Ethics Committee, 100 patients were divided equally (n=50) into group V {Video Laryngoscope (VL)} and group M (McCoy laryngoscope). Time required for laryngoscopy and intubation, any damage to teeth or soft tissue injury was noted and view of the glottis was graded using a modified classification reported by Cormack and Lehane. Qualitative data (sex, American Society of Anesthesiologists (ASA) physical status, Mallampati classification, Cormack and Lehane glottis view grade, number of laryngoscopic attempts, number of optimisation maneuver required etc.,) were compared between the groups. Chi-square test (χ2) and Fisher-exact test were used. Results: The success on first attempt of laryngoscopy was significantly greater (p=0.014), time taken to do the procedure of laryngoscopy (p<0.001) and duration of intubation (p<0.001) was significantly lesser in the group V patients as compared to group M. Incidence of procedural dental injury was totally absent in group V, whereas four cases were recorded in group M. Optimisation maneuver was required in 50% of the group M patients as compared to 10% of group V (p<0.001). Changes in baseline parameters like pulse, Blood Pressure (BP) was noted more in group M (p<0.01) probably owing to the greater mean duration of intubation. Conclusion: KVVL appears to possess more advantages over the McCoy laryngoscope in respect to ease of viewing glottis, reduced duration of laryngoscopy and intubation, lesser complications and haemodynamic instability.