Abstract
Objective:In obstetric patients’ airway, guidelines have recommended the availability of advanced airway equipment. Our aim was to compare the larynx visualization provided by the Macintosh direct laryngoscope and McGrath video laryngoscope and the intubation time of patients undergoing cesarean section.Methods:This study was conducted at a private obstetrics and gynecology hospital during one month between June and July 2018. A hundred patients scheduled for elective cesarean section under general anesthesia were randomized into two different group’s as intubated using either McGrath VL or Macintosh DL. The intubation times, Cormack–Lehane grade, percentage of glottic opening, mean arterial blood pressure, and heart rates before and after intubation were compared among the groups.Results:The McGrath VL significantly reduced the intubation time compared to the Macintosh DL. In the McGrath VL group, better glottic view set the time of tracheal intubation as assessed using the Cormack-Lehane classification system and POGO scores were recorded. After intubation, hemodynamic parameters were significantly higher in the Macintosh DL group than in the McGrath VL group.Conclusion:The McGrath VL significantly lowered intubation time relative to the Macintosh DL, which may be a critical finding considering the importance of maintaining the mother’s airway for the health of both mother and baby.
Highlights
In the United States, preliminary research on anesthesia-related maternal death indicated that more than 52% of maternal mortalities were caused by complications of general anesthesia, largely connected with airway management.[1]
#Independent t-test results are expressed as mean ± standard deviation DL: direct laryngoscope, VL: video laryngoscope
Higher Cormack-Lehane and POGO scores were achieved using the McGrath VL compared to the Macintosh DL, meaning that video laryngoscopy resulted in better glottic view than direct laryngoscopy in this study
Summary
In the United States, preliminary research on anesthesia-related maternal death indicated that more than 52% of maternal mortalities were caused by complications of general anesthesia, largely connected with airway management.[1]. A recent study showed that the incidence of difficulties during intubation and subsequent complications have increased.[2] In addition, research has suggested that airway difficulties occur eight times more frequently in obstetric patients than in the general population.[3]. Guidelines have provided recommendations for the availability of advanced airway equipment, and neuraxial anesthesia has been encouraged.[4] A recent publication argued that video laryngoscopy was superior to direct laryngoscopy for the intubation of obstetric patients with normal airways.[5] Unlike a standard laryngoscope using a Macintosh blade, the McGrath video laryngoscope (VL) results in a glottic view even without bringing into alignment the oral, laryngeal, and pharyngeal axes. The McGrath VL results in a clear picture of the nearby airway anatomy and vocal cords on a liquid crystal display screen mounted on the handle.[6]
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