Comparisons of Videolaryngoscopes for Intubation Undergoing General Anesthesia: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Juncheol Lee,Youngsuk Cho,Bo-Hyoung Jang,Hyungoo Shin,Dong Won Kim,Tae Ho Lim,Kyu-Sun Choi,Chiwon Ahn,Jae Guk Kim,Min Kyun Na,Wonhee Kim

doi:10.3390/jpm12030363

Abstract

Background: The efficacy and safety of videolaryngoscopes (VLs) for tracheal intubation is still conflicting and changeable according to airway circumstances. This study aimed to compare the efficacy and safety of several VLs in patients undergoing general anesthesia. Methods: Medline, EMBASE, and the Cochrane Library were searched until 13 January 2020. The following VLs were evaluated compared to the Macintosh laryngoscope (MCL) by network meta-analysis for randomized controlled trials (RCTs): Airtraq, Airwayscope, C-MAC, C-MAC D-blade (CMD), GlideScope, King Vision, and McGrath. Outcome measures were the success and time (speed) of intubation, glottic view, and sore throat (safety). Results: A total of 9315 patients in 96 RCTs were included. The highest-ranked VLs for first-pass intubation success were CMD (90.6 % in all airway; 92.7% in difficult airway) and King Vision (92% in normal airway). In the rank analysis for secondary outcomes, the following VLs showed the highest efficacy or safety: Airtraq (safety), Airwayscope (speed and view), C-MAC (speed), CMD (safety), and McGrath (view). These VLs, except McGrath, were more effective or safer than MCL in moderate evidence level, whereas there was low certainty of evidence in the intercomparisons of VLs. Conclusions: CMD and King Vision could be relatively successful than MCL and other VLs for tracheal intubation under general anesthesia. The comparisons of intubation success between VLs and MCL showed moderate certainty of evidence level, whereas the intercomparisons of VLs showed low certainty evidence.

Highlights

The tracheal intubation during general anesthesia can be often unsuccessful
This systematic review and network meta-analysis demonstrated that the C-MAC D-blade (CMD) was relatively successful compared with other VLs and Macintosh laryngoscope (MCL) for the tracheal intubation undergoing general anesthesia in all airway circumstances
While the KV was more successful in normal airway circumstances, the CMD was more successful in difficult airway circumstances compared with other VLs and MCL

Summary

Introduction

The tracheal intubation during general anesthesia can be often unsuccessful. the intubation is successful, it can cause several complications. Channeled VLs include Airtraq, Airwayscope and King Vision, whereas non-channeled VLs include GlideScope, C-MAC, C-MAC Dblade (CMD), and McGrath It appears that the mechanism of VL is helpful in increasing success rates, several randomized controlled trials (RCTs) have suggested that VLs are surprisingly not more effective than MCL [8–14]. In the rank analysis for secondary outcomes, the following VLs showed the highest efficacy or safety: Airtraq (safety), Airwayscope (speed and view), C-MAC (speed), CMD (safety), and McGrath (view) These VLs, except McGrath, were more effective or safer than MCL in moderate evidence level, whereas there was low certainty of evidence in the intercomparisons of VLs. Conclusions: CMD and King Vision could be relatively successful than MCL and other VLs for tracheal intubation under general anesthesia. The comparisons of intubation success between VLs and MCL showed moderate certainty of evidence level, whereas the intercomparisons of VLs showed low certainty evidence

Objectives

Methods

Results

Conclusion