Comparison of C-MAC D-Blade with macintosh laryngoscope for endotracheal intubation in patients with cervical spine immobilization: A randomized controlled trial

Abstract

BackgroundRecently, indirect laryngoscopes have emerged as an important tool in managing a difficult airway but the literature is insufficient on the comparison of C-MAC D-Blade with Macintosh for tracheal intubation during manual-in-line stabilization. We compared the efficacy of C-MAC D-blade with Macintosh laryngoscope for tracheal intubation in patients with manual-in-line stabilization. MethodsEighty adult patients undergoing elective surgery under general anesthesia were intubated after application of MILS using C-MAC D-Blade (n = 40) or Macintosh laryngoscope (n = 40) as per group allocation. Intubation Difficulty Scale was the primary outcome. We also recorded the duration of laryngoscopy, modified Cormack-Lehane grading, time taken for intubation, total intubation time, optimizing maneuvers required, number of attempts, and complications. ResultThe median intubation difficulty score (inter-quartile range) was significantly lower with C-MAC D-Blade[(0, 0–1) vs (3, 2–3)](P < 0.0001). C-MAC D-Blade provided significantly better glottic view in lesser time (10 s[7.5–13]vs9 [7–10]) (P = 0.02) without optimum external laryngeal manipulation(p = 0.0001). Time taken for tracheal intubation was longer in the C-MAC D-Blade, though, the total duration of tracheal intubation was comparable in both the groups (P = 0.069). ConclusionC-MAC D-Blade is superior to the Macintosh laryngoscope in terms of lower Intubation Difficulty Score in patients undergoing tracheal intubation with cervical spine immobilization.