Are we glorifying the use of video laryngoscopes? A randomized control study comparing C-MAC(R) laryngoscope and McCoy blade for tracheal intubation in patients undergoing general anaesthesia with simulated immobilization of cervical spine

Abstract

Objective: Intubating patients with cervical spine injury is a challenge as the cervical spine is immobilized to prevent neurological damage. Although Fibre optic intubation is gold standard, many anaesthetist’s use video laryngoscope or McCoy blade for intubation. The purpose of this study was to compare the efficacy of C-MAC(R) video laryngoscope and direct laryngoscope with McCoy blade in intubating patients with cervical spine immobilization simulating cervical spine injuries. Materials and Methods: A total of 60 patients undergoing general anaesthesia were randomized into two groups. Intubation was attempted using C-MAC(R) video laryngoscope and McCoy blade after cervical immobilization using hard collar. Time to intubate, hemodynamic parameters and Intubation difficulty score was used to compare the groups. Result: The laryngoscopic views and success of intubation was comparable in both video laryngoscope and Mc Coy group (30/30; 100% success in both the groups). The time to intubate was found to be less in McCoy group (29.83 ± 1.46 s and 25.67 ± 2.04 s) when compared to C-MAC (R) video laryngoscope. The intubation response was lesser in C-MAC compared to McCoy blade (82.97±7.23 s and 88.30±6 s). Time taken for the hemodynamic to return to baseline was the same in the groups (8.67±1.52 s and 9.13±1.25 s). Conclusion: Direct laryngoscopy and intubation with McCoy blade is faster when compared to C-MAC(R) video laryngoscope; but with exaggerated intubation response]. Keywords: Laryngoscopy, Intubation, Cervical spine immobilization, Hemodynamics.