A Randomised Control Study Comparing C-MAC D-Blade Video Laryngoscope (Hyper Angulated Blade) and Macintosh Laryngoscope for Insertion of a Double-Lumen Tube in Patients Undergoing Elective Thoracotomy.

Abstract

The use of a double-lumen endotracheal tube is one of the common anesthetic techniques for operations in the thoracic cavity. However, when compared to a single-lumen tube, placement of a double-lumen tube is technically more difficult as a result of which it takes more time to insert and is associated with more complications such as mucosal injury, hoarseness, and sore throat, even in patients with no anticipated airway difficulty. The CMAC D-blade that is usually used in patients with anticipated airway difficulty, could assist in smooth and quick placement of double-lumen tube (DLT) even in patients with no anticipated airway difficulty. This study aimed to evaluate the effectiveness of the C-MAC D-blade in reducing the time taken to visualize the glottis and intubate patients with normal airway with a double-lumen tube. This was a prospective open-label randomized control trial in a tertiary hospital. Seventy-three consenting adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective thoracotomy, were randomly allocated to receive either C-MAC D-blade (Group D) or Macintosh blade (Group M). The primary objective was to compare the time taken for visualization of the glottis and intubation. Chi-square/Fisher's exact test and t-test were used for statistical analysis. Seventy-three patients were randomized (Group D = 36; Group M = 37). Time to visualize the glottic structures (4.56 ± 2.396 s vs. 7.27 ± 4.891 s, P = 0.01) was significantly better in Group D; however, the mean intubation time was comparable (55.92 ± 18.749 s vs. 51.08 ± 15.269 s, P = 0.61). C-MAC D-blade videolaryngoscope offers a better glottic view and lesser time to visualize glottis when compared with the Macintosh laryngoscope. However, the time taken to insert the DLT after visualization was longer. We infer that there is no advantage in the routine use of C-MAC D-blade for DLT insertion in patients with no anticipated airway difficulty.