Abstract
Background Manual in line axial stabilization (MIAS) technique is recommended for stabilizing the cervical spine in suspected cervical spine injuries, but creates special challenges in airway management. The present study compares two different video laryngoscope (VL) namely CMAC D blade (CMAC) and glidescope blade 4 (GL) for intubation in patients with a simulated difficult airway by applying MIAS. Methodology This was a hospital based prospective, single blind, randomized comparative pilot study. A total of 60 patients, having no predictors of difficult airway and scheduled for elective surgery were recruited and randomized into 2 equal sized groups based on a software generated random sequence. The Primary outcome was Intubation Difficulty Score (IDS), whereas the time taken to secure the airway and obtain a capnographic wave, Cormack Lehane Grade (CL) and hemodynamic parameter comprised the secondary outcomes. The following tests- Fischer’s exact test, Chi-square test and Student ‘t’ test used for analysis. Results GL group had an IDS score of zero in 46.7% patients compared to 26.7% in CMAC group, IDS score of 0-5 was found to be 50 % in GL group while CMAC group scored 66.6%. This was found to be statistically insignificant (p=0.18). Time taken for successful intubation was 43.70±9.91 and 54.60±20.47 seconds (p=0.011) in GL and CMAC group respectively. Conclusions VL is a vital tool in the management of difficult airway. The superiority of one over the other device tested here could not be established, although GL showed slightly better scores but were statistically insignificant.
Highlights
The Video-laryngoscopes (VL) have become an airway by measuring Intubation difficulty score (IDS) and time required for intubation
glidescope blade 4 (GL) group had an IDS score of zero in 46.7% patients compared to 26.7% in CMAC group, IDS score of 0-5 was found to be 50 % in GL group while CMAC group scored 66.6%
Time taken for successful intubation was 43.70±9.91 and 54.60±20.47 seconds (p=0.011) in GL and CMAC group respectively
Summary
This was a hospital based prospective, single blind, randomized comparative pilot study. A total of 60 patients, having no predictors of difficult airway and scheduled for elective surgery were recruited and randomized into 2 equal sized groups based on a software generated random sequence. The following tests- Fischer’s exact test, Chi-square test and Student ‘t’ test used for analysis This was a prospective, single blind, randomized comparative pilot study, conducted after obtaining institution ethics committee approval. This particular study compared CMAC- D blade with glidescope blade 4 in patients with simulated difficult airway created using MIAS maneuver. The inclusion criteria for this study comprised of patients admitted for elective surgery requiring general anesthesia with endotracheal intubation. The exclusion criteria involved trauma patients, emergency surgery, any clinical predictors of difficult airway, burn patients, bronchial asthma, COPD, bronchiectasis, and recent history of chest infection
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