Comparison between C-MAC D-blade and McCoy laryngoscopes in intubating patients during cervical immobilization

Abstract

Aims This study was carried out to compare the efficacy of the C-MAC D-blade with the McCoy laryngoscope in intubating patients during cervical spine immobilization. Patients and methods This randomized controlled study was carried out in the Medical Research Institute Hospital, University of Alexandria, on 60 adult ASA I and II patients who were randomly categorized into two equal groups after written informed consent and approval of the ethics committee. All patients were subjected to the same anaesthetic protocol. Group I patients were intubated using the C-MAC D-blade laryngoscope, and group II patients were intubated using the McCoy laryngoscope. Haemodynamic measurements and oxygen saturation were recorded. The following intubation criteria were recorded for both groups: laryngeal view according to modified Cormack and Lehane grade at laryngoscopy, duration of the intubation procedure, number of intubation attempts and complications. Statistical analysis Data were statistically analysed with the SPSS software using t-test and χ2-test, and P value less than 0.05 was considered significant. Results Haemodynamic parameters (heart rate and mean arterial blood pressure) were significantly lower in the C-MAC D-blade group than in the McCoy group until 4 min after intubation. Oxygen saturation showed no significant difference between the two groups. The use of the C-MAC D-blade resulted in more appearance of modified C–L class 1, whereas the use of the McCoy laryngoscope resulted in more appearance of class 2b and class 3. Duration of intubation was statistically significantly longer in the C-MAC D-blade group than in the McCoy group, whereas for the number of intubation attempts C-MAC D-blade results in more successful intubation in the first attempt than the McCoy laryngoscope. Conclusion The C-MAC D-blade laryngoscope offers a new approach for the management of difficult airway, such as in patients in need for cervical immobilization. It causes less haemodynamic stress, it better intubates in the first trial and gives a better view of the larynx without moving the cervical spine, but it may be more time-consuming than direct laryngoscopes.