Comparison of Cormack Lehane grade, Head extension angle, Laryngoscope Blade Levering Motion angle and pressor response with Macintosh, McCoy and Balloon Laryngoscopy

Abstract

Balloon laryngoscopy was reported to improve glottic view. The authors studied Macintosh, McCoy's3 and Balloon laryngoscopy 7,8. They compared the Macintosh blade with optimal external laryngeal manipulation (OELM) 2 versus the McCoy's blade with lever activation and Balloon laryngoscope with Balloon inflation with 3 cc of air. Method: A series of 120 adult patients who underwent general anaesthesia and tracheal intubation in neutral position with Rigid Cervical neck collar was studied. Laryngoscopy was carried out using a Macintosh no.3 (15 patients) or 4 (15 patients) or McCoy's no. 3 (15 patients) or No. 4 (15 patients) or Balloon laryngoscope (R1L2) no. 3 (15 patients) or 4 (15 patients) or Balloon laryngoscope (L1R2) no. 3 (15 patients) or 4 (15 patients). The best glottic view was recorded for each approach with and without OELM in case of Macintosh or with and without lever activation in case of the McCoy's blade or with and without inflation of balloon in Balloon laryngoscopy. Head extension Angle and Laryngoscope Blade Levering Motion Angle were also measured with the help of Goniometer. Results: The McCoy's blade gives better glottic visualization on laryngoscopy than other laryngoscopes. The balloon laryngoscope blade proved better than the Macintosh laryngoscope blade in glottic visualization. In balloon laryngoscopy, L1R2 group performed slightly better than R1L2 in glottic visualization. Head extension angle and laryngoscopy blade levering motion angle were almost same in all types of laryngoscopy Conclusion: McCoy's blade was superior for glottic visualization followed by balloon laryngoscope blade pressure response was significant in all approaches of laryngoscopy. There was significant change in pulse rate, and systolic blood pressure in McCoy's laryngoscopy group as compared to other groups.