Endotracheal intubation using three different devices in patients with limited neck extension

Abstract

Background Direct laryngoscopes have been developed for many optical fiberscopes to provide a better view of the glottis without alignment of the oral, pharyngeal, and tracheal axes. Recently, video laryngoscopes have become increasingly important devices in difficult airway management. Purpose This study aimed to compare between direct laryngoscopy, C-MAC, and the C-MAC D-blade for orotracheal intubation in patients with limited neck extension and to assess the hemodynamics and the possible complications of orotracheal intubation in patients with limited neck extension using the three different devices. Patients and methods Thirty adult patients subjected to general anesthesia were randomly categorized into three equal groups: in group I, endotracheal intubation was performed using direct laryngoscopy with a conventional Macintosh blade, in group II C-MAC video laryngoscopy was performed with a conventional Macintosh blade, and in group III C-MAC video laryngoscopy was performed with a D-blade. Then, an assessment of the laryngoscopic view and the whole procedure of laryngoscopy and intubation was carried out. Conclusion This study validates the efficacy of the C-MAC Macintosh blade and the D-blade when compared with a direct laryngoscope in patients with limited neck extension. The D-blade has been found to be more effective in reducing hemodynamic responses to laryngoscopy and intubation, resulting in improvement of the laryngoscopic view with a high success rate; it facilitates the smooth performance of laryngoscopy and intubation from the first attempt with the least use of assisting maneuvers while achieving the shortest endotracheal tube (ETT) insertion time, with no occurrence of complications.