Abstract
BackgroundThe double lumen endotracheal tube (DLT) is the most widely-used device for single lung ventilation in current thoracic anesthesia practice. In recent years, the routine application of the videolaryngoscope for single lumen endotracheal intubation has increased; nevertheless there are few studies of the use of the videolaryngoscope for DLT. We wondered whether there were benefits to using the videolaryngoscope for DLT placement in patients with predicted normal airways. Therefore, this study was designed to compare the performances of the GlideScope®, the C-MAC®(D) videolaryngoscope and the Macintosh laryngoscope in DLT intubation.MethodsThis was a randomized, controlled, prospective study. We randomly allocated 90 adult patients with predicted normal airways into three groups. All patients underwent routine anesthesia using different laryngoscopes according to group allocation. We compared DLT insertion times, first-pass success rates, numerical rating scales (NRS) of DLT delivery and DLT insertion, Cormack-Lehane degrees (C/L), hemodynamic changes and incidences of intubation complications. All outcomes were analyzed using SPSS13.0.ResultsCompared with the GlideScope, the Macintosh gave shorter times for DLT insertion (median: 96 (IQR: 51 [min–max: 62–376] s vs 73 (26 [48–419] s, p = 0.003); however, there was no difference between the Macintosh and C-MAC(D) (p = 0.610). The Macintosh had a significantly higher successful first attempt rate than did the GlideScope or C-MAC(D) (p = 0.001, p = 0.028, respectively). NRS of DLT delivery and insertion were significantly lower in the Macintosh than in the others (p < 0.001). However, the C/L degree in the Macintosh was significantly higher than in the others (p < 0.001). The incidences of oral bleeding, hoarseness, sore throat and dental trauma were low in all groups (p > 0.05). There were no significant differences in DLT misplacement, fiberoptic time or hemodynamic changes among the groups.ConclusionsCompared with the Macintosh laryngoscope, the GlideScope® and C-MAC®(D) videolaryngoscopes may not be recommended as the first choice for routine DLT intubation in patients with predicted normal airways.Trial registrationThe study was prospectively registered at the Chinese Clinical Trial Registry (no. ChiCTR1900025718); principal investigator: Z.L.H.; date of registration: September 6, 2019.
Highlights
The double lumen endotracheal tube (DLT) is the most widely-used device for single lung ventilation in current thoracic anesthesia practice
Compared with the Macintosh laryngoscope, the GlideScope® and C-MAC®(D) videolaryngoscopes may not be recommended as the first choice for routine DLT intubation in patients with predicted normal airways
In the present study, we compared the performances of the GlideScope®, C-MAC®(D) videolaryngoscope and the Macintosh laryngoscope in DLT intubation in normal airways
Summary
Approval for the study was granted by the Shanghai Renji Hospital Ethics Committee (Ethical number: 2016[036]). The computerized randomization was performed and the allocation results were placed in individual numbered and sealed envelopes. Ninety seconds after rocuronium administration, DLT intubation was performed using the allocated laryngoscope. DLT insertion time was defined as from the time the laryngoscope passed the patient’s lips until three complete end-tidal carbon dioxide cycles were displayed on the monitor. Hemodynamic parameters (mean arterial blood pressure and heart rate) were recorded 10 min before induction and 1, 3, and 5 min after intubation. The Kruskal–Wallis test was used to analyze independent samples (the success rate at the first attempt, the times of intubation attempts, the DLT insertion time, the number of external laryngeal pressure applications, C/L degree, and NRS of DLT delivery and insertion).
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