Comparison of Laryngoscopic View and Hemodynamic Changes with Flexitip McCoy and Macintosh Laryngoscope Blade in Predicted Easy and Difficult Airway

Zia Arshad,Sulekha Saxena,Jaishree Bogra,Haider Abbas

doi:10.4236/ojanes.2013.35061

Abstract

Objective: To compare the laryngoscopic view and the hemodynamic changes by using flexitip McCoy laryngoscope with Macintosh laryngoscope. Method: Study design-Prospective randomized controlled study. A total of 220 patients were included in the study. Patients were allocated on the basis of their airway anatomy in to two groups, one is predicted easy group and the other one was predicted difficult airway group. Among each group, half of the patient intubation was performed with Macintosh blade and the other half was intubated with the help of McCoy blade. The airway prediction was done on the basis of Mallampati grade, thyromental distance, inter incisor gap, jaw protrusion and weight of the patient. Larygoscopic view and hemodynamic changes were recorded. Results: The change in pulse rate was significantly (p = 0.01) higher among the patients of Group B (85.02 ± 10.13) as compared to Group A (79.20 ± 13.11) after induction in predicted easy patients. Similar observation was found for pulse rate after laryngoscopy among both predicted easy and difficult patients. The diastolic blood pressure was significantly (p = 0.0001) higher in Group B (86.34 ± 9.78) than Group A (77.12 ± 11.66) after induction among predicted easy patients. However, diastolic blood pressure was significantly (p = 0.0004) higher in Group A (82.00 ± 10.98) compared with Group B (75.00 ± 9.06) after induction among predicted difficult patients. The average time taken during laryngoscopy was in-significantly (p > 0.05) higher in Group B (13.90 ± 5.95) compared with Group A (12.42 ± 3.58) among predicted easy patients. However, the time taken was significantly (p = 0.0001) higher in Group A (20.83 ± 2.47) than Group B (12.66 ± 3.0) in predicted difficult patients. A majority of the patients of both the groups were in Grade I (Group A = 61.8%, Group B = 81.8%) followed by Grade II (Group A = 38.2%, Group B = 18.2%) among predicted easy patients. Conclusion: It was concluded that the McCoy blade may be an answer to Macintosh blade in difficult airway cases, but not the substitute of Macintosh blade in every case. The McCoy blade improved laryngeal view in patients with limited neck extension.

Highlights

Airway management is the task with which an anaesthesiologist encounters routinely
Half of the patient intubation was performed with Macintosh blade and the other half was intubated with the help of McCoy blade
Similar observation was found for pulse rate after laryngoscopy among both predicted easy and difficult patients

Summary

Introduction

Adept airway management is an essential skill for an anaesthesiologist. Time to time different aids, devices and maneuvers are used to maintain the airway. Comparison of Laryngoscopic View and Hemodynamic Changes with Flexitip McCoy and Macintosh Laryngoscope 279 Blade in Predicted Easy and Difficult Airway easier tracheal intubation. The significant increase in heart rate and arterial blood pressure has been reported after laryngoscopy using the Macintosh blade, the use of McCoy blade has not been associated with any significant change in either heart rate or arterial blood pressure [2,3]. The present study was conducted to compare the difference of laryngoscopic view using McCoy’s and Macintosh laryngoscope and haemodynamic changes resulting during laryngoscopy and intubation with the two blades in predicted easy and difficult airway

Material & Method

Results

Discussion