OP06 - A comparison of three videolaryngoscopes for double-lumen tubes intubation in humans by users with mixed experience. A randomized controlled study

Abstract

A recent manikin study demonstrated that the Airtraq® and non-channelled King Vision™ videolaryngoscopes (VL) took longer times for double-lumen tube (DLT) intubation than the Macintosh by less experienced providers. [1] We hypothesized that the use of the King Vision™ and Airtraq® VLs by users with mixed experience might reduce the time to DLT intubation in patients undergoing thoracic surgery. One hundred-thirty-three patients scheduled for elective thoracic surgery using the DLT for one-lung ventilation were assigned randomly to place the DLT using the Macintosh (n=32), GlideScope® (n=34), Airtraq® (n=35) or King Vision™ (n=32). Time to DLT intubation, first-pass success rate, percentage of glottic opening score, intubation difficulty using a Likert scale, optimisation manoeuvers, failure to intubation, defined as an attempt taking longer than 150 s. or if peripheral oxygen saturation decreased <92%, and postoperative sore throat and hoarseness of voice, were recorded. Compared with the GlideScope®, the Macintosh, Airtraq®, and KVL took shorter times to DLT intubation (median times: GlideScope®111.5 s. [95% confidence interval (CI) 89.3 s. to 136.6 s.]; Macintosh 64 s. [95% CI 59.3 s. to 76.6 s.]; Airtraq® 67 s. [95% CI 49.5 s. to 86.2 s.]; KVL 91 s. [95% CI 39.2 to 80.4], P=0.004) and had comparable first-pass success rate (100%, 100%, 94.4%, and 100%, respectively, P=0.522), glottis view, and postoperative sore throat and hoarseness of voice. Compared with the GlideScope®, the Airtraq® and KVL required less frequent optimising manoeuvres (P< 0.001). The Airtraq® was easier to use than the GlideScope® [1.1 ± 1.53 vs. 2.4 ± 1.60; P=0.023] and associated with two failures due to the inability to advance the DLT through the glottis opening because the blade was placed too deep in the airway and not midline. Duration of DLT intubation had a significant negative correlation with the prior experience of using the device tested (r =−0.392, P=0.001). The channeled Airtraq® required less time for DLT intubation and was easier to use than the GlideScope® when used by users with mixed experience. It was registered with www.clinicaltrials.gov [NCT NCT02305667] 1. El-Tahan MR, Al׳ghamdi AA, Khidr AM, Gaarour IS. Comparison of three videolaryngoscopes for double-lumen tubes intubation in simulated easy and difficult airways: a randomized trial. Minerva Anestesiol. 2016; 82:1050-1058.