C-MAC D-Blade Videolaryngoscope Research Articles

A prospective randomized comparative trial of pediatric C-MAC D-blade video laryngoscope with McCoy direct laryngoscope for intubation in children posted for elective surgical procedures under general anesthesia.

Pediatric airway management requires careful clinical evaluation and experienced execution due to anatomical, physiological, and developmental considerations. Video laryngoscopy in pediatric airways is a developing area of research, with recent data suggesting that video laryngoscopes are better than standard Macintosh blades. Specifically, there is a paucity of literature on the advantages of the C-MAC D-blade compared to the McCoy direct laryngoscope. After Ethics Committee approval, 70 American Society of Anesthesiologists physical status 1 and 2 children aged 4-12 years scheduled for elective surgery under general anesthesia were recruited. Patients were randomly allocated to intubation using a C-MAC video laryngoscope size 2 D-blade (Group 1) and a McCoy laryngoscope size 2 blade (Group 2). The Intubation Difficulty Scale (IDS) for ease of intubation was the primary outcome, while Cormack-Lehane grades, duration of laryngoscopy and intubation, hemodynamic responses, and incidence of any airway complications were secondary outcomes. Both groups were comparable in terms of patient characteristics. The median (IQR) Intubation Difficulty Scale (IDS) score was better but was statistically nonsignificant with C-MAC (0 [0-0] vs. 0 [0-2], p = .055). The glottic views were superior (CL grade I in 32/35 vs. 23/35, p = .002), and the time to best glottic view (6 s [5-7] vs. 8.0 s [6-10], p = .006) was lesser in the C-MAC D-blade group while the total duration of intubation was comparable (20 s [16-22] vs. 18 s [15-22], p = .374). All the patients could be successfully intubated on the first attempt. None of the patients had any complications. The C-MAC video laryngoscope size 2 D-blade provided faster and better glottic visualization but similar intubation difficulty compared to McCoy size 2 laryngoscope in children. The shorter time to achieve glottic view demonstrated with the C-MAC failed to translate into a shorter total duration of intubation when compared to the McCoy laryngoscope attributable to a pronounced curvature of the D-blade.

GlideScope versus C-MAC D-blade videolaryngoscope for double-lumen tube intubation in patients with anticipated difficult airways: A multi-center, prospective, randomized, controlled trial

Study objectiveVideolaryngoscopes are widely used to visualize difficult airways. Our aim was to compare the GlideScope and C-MAC D-blade videolaryngoscopes for double-lumen tube (DLT) intubation in patients with difficult airways. DesignA multi-center, prospective, randomized controlled trial. SettingThree comprehensive tertiary, high-volume hospitals from 5 December 2020 to 4 November 2021. PatientsWe included 348 adult patients with anticipated difficult airways who underwent elective thoracic surgery. InterventionsPatients were randomized into two groups: GlideScope and C-MAC D-blade. Following anesthesia induction, DLT intubation was performed using different videolaryngoscopes. MeasurementsThe primary outcome was the first-pass success rate of DLT intubation. All other results were recorded as secondary outcomes. Main resultsNo significant differences were observed in the first-pass success rate of DLT intubation between the GlideScope and C-MAC D-blade (86.21% and 89.66%, respectively; P = 0.323). However, compared with the GlideScope, the C-MAC D-blade provided a lower Cormack–Lehane grade (P < 0.001), lower rates of external laryngeal pressure (48 vs. 15, P < 0.001), and postprocedure sore throat (26 vs. 8, P < 0.001). The numerical rating score for difficulty of videolaryngoscope insertion into the oral cavity, delivery to the glottis, and intubation into the main bronchus were significantly lower when using the C-MAC D-blade (P < 0.001). Moreover, the duration of DLT intubation was shorter in the C-MAC D-blade group (81 s [70–97 s] vs. 95 s [78–115 s], P < 0.001). In each group, two patients underwent fiberoptic intubation after three attempts with a videolaryngoscope failed. ConclusionsIn patients with difficult airways, the GlideScope and C-MAC D-blade provided a similar success rate on the first DLT intubation attempt; however, the C-MAC D-blade offers a better glottic view, easier and faster intubation, and lower incidence of sore throat.

Comparison between C-MAC D-blade video laryngoscope and McCoy laryngoscope for nasotracheal intubation in traumatic cervical spine surgery - A randomised controlled trial.

Comparison between C-MAC D-blade video laryngoscope and McCoy laryngoscope for nasotracheal intubation in traumatic cervical spine surgery - A randomised controlled trial.

Effectiveness of C-MAC video-stylet versus C-MAC D-blade video-laryngoscope for tracheal intubation in patients with predicted difficult airway: Randomized comparative study

ABSTRACT Background This prospective study was done on patients with suspected difficult airway to compare between C-MAC video-stylet (VS) and D-blade video-laryngoscope for tracheal intubation. Patients and methodology Randomization was done on 160 adult patients with anticipated difficulty in intubation for different causes to divide them into two equal groups (VS group and D group). Patients in each group were divided into five categories according to the cause of anticipated intubation difficulty. Duration of intubation, number of attempts, and success intubation rate were recorded. Hemodynamics parameters were measured before intubation as baseline, then after intubation at 1 and 5 min. Results In VS group, intubation time ranged between 23 and 166 s with mean of 53.2 ± 24.19 s and in D group it ranged between 30 and 279 s with mean of 65.5 ± 40.63 s (P-value 0.021). This shorter intubation time was not constant in different patient’s categories. The first attempt intubation was successfully done in 68 patients (85%) in VS group versus 61 patients (76.3%) in D group. Hemodynamically, HR and MABP showed significant increase in D group more than in VS group at 1 and 5 min after intubation (P-value = 0.001). Conclusion Both devices are helpful when there is a risk of difficult intubation. C-MAC VS is a better choice in cases of limited mouth opening and obesity, but in cases of limited cervical motility, the use of C-MAC D-blade is a better choice with a faster intubation time.

A comparative study of the C-MAC D-blade videolaryngoscope and McCoy laryngoscope for oro-tracheal intubation with manual in-line stabilization of neck in patients undergoing cervical spine surgery.

Airway management in cervical spine injury patients requires manual in-line stabilization (MILS) of the neck to avoid exacerbation of cord injury, which impedes visualization of glottis during laryngoscopy. Specially designed blades such as McCoy and C-MAC D-blades can improve laryngoscopic view in such patients. This study was performed to compare the efficacy of C-MAC D-blades and the McCoy laryngoscope for oro-tracheal intubation using MILS in patients undergoing cervical spine surgery. This randomized, prospective study was performed in 60 adult patients of American Society of Anesthesiologists grade I-III, either sex, 18 to 60 years of age undergoing elective cervical spine surgery. Patients were randomly categorized into two groups, group D and group M. Intubation was performed using a C-MAC D-blade videolaryngoscope in group D and a McCoy laryngoscope in group M using MILS. The intubation difficulty scale (IDS) score, laryngoscopy and intubation times, percentage of glottic opening (POGO) score, Cormack Lehane (CL) grading with and without external laryngeal pressure (ELP), need for bougie or change of blade or operator, and change in hemodynamics following intubation were recorded. Group D showed lower mean IDS scores than group M (P value < 0.0001). There were statistically significant differences found in duration of laryngoscopy (group D < group M), CL grading without ELP (group D: CL-1,2a >CL-2b, 3; group M: CL-1,2a <CL-2b, 3), mean POGO scores without ELP (group D > group M), need for ELP and lifting force (group D < group M), and hemodynamic responses after intubation (group D < group M). A C-MAC D-blade videolaryngoscope provides better and rapid visualization of glottis with less intubation difficulties than a McCoy laryngoscope during intubation using MILS in patients with cervical spine injury.

Standard and flexible tip bougie for tracheal intubation using a non‐channelled hyperangulated videolaryngoscope: a randomised comparison#

Bougie impingement during tracheal intubation can increases the likelihood of prolonged intubation time, failed intubation and airway trauma. A flexible tip bougie may overcome this problem, which can occur when using a non-channelled, hyperangulated videolaryngoscope with a standard bougie. This randomised controlled study compared standard and flexible tip bougies using a non-channelled videolaryngoscope (C-MAC® D-blade) in 160 patients. The primary outcome measure was the modified intubation difficulty scale score. Secondary outcome measures were: laryngoscopy time; total tracheal intubation time; first attempt success rate; and postoperative sore throat verbal rating score. The median (IQR [range]) modified intubation difficulty scale scores for standard bougie and flexible tip bougie were 1 (0-2[0-5]) and 0 (0-1[0-3]), respectively (p = 0.001). There was no significant differences in laryngoscopy time, total tracheal intubation time, first attempt success rate and postoperative sore throat between the two groups. Both the flexible tip and standard bougies can be used with a high first attempt success rate for tracheal intubation using a C-MAC D-blade videolaryngoscope. The flexible tip bougie demonstrated a significantly better modified intubation difficulty scale score and lower incidence of bougie impingement.

A Randomised Control Study Comparing C-MAC D-Blade Video Laryngoscope (Hyper Angulated Blade) and Macintosh Laryngoscope for Insertion of a Double-Lumen Tube in Patients Undergoing Elective Thoracotomy.

The use of a double-lumen endotracheal tube is one of the common anesthetic techniques for operations in the thoracic cavity. However, when compared to a single-lumen tube, placement of a double-lumen tube is technically more difficult as a result of which it takes more time to insert and is associated with more complications such as mucosal injury, hoarseness, and sore throat, even in patients with no anticipated airway difficulty. The CMAC D-blade that is usually used in patients with anticipated airway difficulty, could assist in smooth and quick placement of double-lumen tube (DLT) even in patients with no anticipated airway difficulty. This study aimed to evaluate the effectiveness of the C-MAC D-blade in reducing the time taken to visualize the glottis and intubate patients with normal airway with a double-lumen tube. This was a prospective open-label randomized control trial in a tertiary hospital. Seventy-three consenting adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective thoracotomy, were randomly allocated to receive either C-MAC D-blade (Group D) or Macintosh blade (Group M). The primary objective was to compare the time taken for visualization of the glottis and intubation. Chi-square/Fisher's exact test and t-test were used for statistical analysis. Seventy-three patients were randomized (Group D = 36; Group M = 37). Time to visualize the glottic structures (4.56 ± 2.396 s vs. 7.27 ± 4.891 s, P = 0.01) was significantly better in Group D; however, the mean intubation time was comparable (55.92 ± 18.749 s vs. 51.08 ± 15.269 s, P = 0.61). C-MAC D-blade videolaryngoscope offers a better glottic view and lesser time to visualize glottis when compared with the Macintosh laryngoscope. However, the time taken to insert the DLT after visualization was longer. We infer that there is no advantage in the routine use of C-MAC D-blade for DLT insertion in patients with no anticipated airway difficulty.

Comparison of different types of stylets with no-stylet technique for intubation with C-MAC D-Blade® videolaryngoscope in simulated difficult airway: A prospective randomized study.

Objective: The angulated C-MAC D-Blade videolaryngoscope (VL) is designed for difficult intubation and may not be compatible with standard PVC endotracheal tubes (ETTs). This study was planned to compare efficacy of C-MAC, D-Blade VL using ETT with three different stylets versus no-stylet in patients undergoing tracheal intubation with simulated difficult airway. Methods: After obtaining written informed consent and IEC approval, a total of 144 adult patients were allocated to four groups of 36 each using no-stylet or different types of stylets. The four groups were as follows: Group NS: no-stylet; Group CS: C-MAC stylet; Group DS: D-Blade-type stylet; Group HS: hockey-stick shaped stylet. A rigid appropriate-sized Philadelphia cervical collar was placed around the neck to simulate difficult airway, and C-MAC D-Blade VL was used for intubation. The duration of each intubation stage and attempts were evaluated. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM SPSS Corp.; Armonk, NY, USA), and appropriate tests for different variables were applied. Appropriately, Student’s t test, Chi-square test, Mann–Whitney U test, and one-way ANOVA test were applied. Results: Similar Cormack Lehane grade glottic view was observed in all groups. The number of attempts and duration of intubation were significantly greater using NS group than for other groups. Additional laryngeal manipulation was required in all cases in Group NS, compared to one, zero, and two cases in Groups CS, DS, and HS, respectively (P < .001). Conclusion: Use of Hockey stick shaped stylet, D-Blade-shaped stylet, and C-MAC stylet decreased the total intubation duration in patients with simulated difficult airway.

Awake intubation with C-MAC videolaryngoscope in a patient with difficult airway.

Sir, The role of videolaryngoscopy has increased in the management of the difficult airway in recent times. We report a case where C-MAC D-blade videolaryngoscope (VL) was used in the airway management of a patient with cervico-facial necrotising fasciitis scheduled for surgical debridement. A 28-year-old male patient was posted for surgical debridement of cervico-facial necrotising fasciitis with multi-organ dysfunction. He was a known case of type 1 diabetes mellitus (DM). On examination, the patient was irritable and disoriented due to sepsis-induced encephalopathy (GCS-E3V3M5). He had a swollen and blackened right cheek due to necrosis with extension to the neck [Figure 1]. The mouth opening of the patient was around 1.6cm with restricted neck mobility, eliminating the possibility of neck extension. Our primary airway management plan was awake intubation via C-MAC VL (Karl Storz) blade D. A fibre-optic bronchoscope with an endoscopic mask was readily available as an alternative airway management plan. A skilled ear-nose-throat (ENT) surgeon was also requested to be standby for the emergency tracheostomy.Figure 1: Cervico-facial necrotising fasciitis involving the entire right cheek and extending to the neckIn the preoperative room, the patient's airway was prepared by nebulisation with 4mL of 4% lignocaine. In the operating room, standard American Society of Anesthesiologists (ASA) monitors such as electrocardiogram, non-invasive blood pressure and pulse oximeter were attached to the patient. The patient was sedated with 50 μg fentanyl and dexmedetomidine (loading dose of 1 μg/kg, followed by the infusion of 0.5 μg/kg/h). The patient received continuous oxygen via a nasal catheter with a flow of 3 L.min−1. Topical anaesthesia was supplemented with two puffs of lidocaine 10% metered spray applied directly on the surface of the tongue and oropharynx. Videolaryngoscopy was done using an adult D-blade of C-MAC and the percentage of glottic opening (POGO) score was found to be zero. Simultaneously, the posterior pharyngeal wall was anaesthetised with two puffs of 10% lignocaine spray to blunt the reflexes during insertion of the endotracheal tube (ETT). The patient was then intubated with a 7.5 mm internal diameter (ID) ETT with the aid of Eschmann stylet (Portex; Smiths Medical). After confirmation of the capnography waveform, general anaesthesia was induced with propofol and rocuronium. The surgery lasted uneventfully for around 100 min after which the patient was shifted to the intensive care unit, and was extubated the same day. Cervico-facial necrotising fasciitis is a soft tissue infection that spreads along with the superficial musculoaponeurotic system and early aggressive surgical debridement is the mainstay in achieving a successful outcome.[1] Anaesthetic management of such patients is challenging as the pain, swelling and oedema due to inflammatory processes restrict the facial and cervical movements, making the airway potentially difficult. Awake fibre-optic intubation (AFOI) is considered the technique of choice in predicted difficult airway. AFOI has a steep learning curve and requires patient cooperation. Recently, VLs have gained immense popularity as the first-line devices in adult and paediatric difficult airways due to feasibility of orotracheal intubation in a restricted mouth opening.[23] Karmer et al. described C-MAC VL as superior to fibre-optic intubation (FOI) in terms of faster intubation time in limited mouth opening patients(>1.3cm).[4] Alhomary in a systematic review also confirmed that awake video laryngoscopy has a shorter intubation time compared to AFOI.[5] In our institute, we frequently use D-blade of C-MAC for difficult intubations and so are well versed with it. Hence, C-MAC was chosen as a primary airway management plan to quickly secure the airway. Since the D-blade has a thickness of around 1 cm, it can be easily accommodated in the limited mouth opening patient and has a better field of vision (60 degrees angle of view) with the requirement of less lifting force to visualise the glottis, especially in patients who are not fully anaesthetised.[6] To conclude, we suggest that awake videolaryngoscopy using D-blade of C-MAC VL can be considered as an alternative for tracheal intubation in difficult airway scenarios where AFOI is difficult or not possible. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement We would like to acknowledge the support and guidance of Dr Rakesh Kumar, M.D, Associate Professor, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur in helping me write this article.

Randomized crossover trial comparing cervical spine motion during tracheal intubation with a Macintosh laryngoscope versus a C-MAC D-blade videolaryngoscope in a simulated immobilized cervical spine

BackgroundMaintaining cervical immobilization is essential during tracheal intubation in patients with unstable cervical spines. When using the Macintosh laryngoscope for intubation in patients with cervical immobilization, substantial neck extension is required for visualization of the glottis. However, the C-MAC D-Blade videolaryngoscope may require less neck extension due to its acute angulation. We hypothesized that C-MAC D-Blade videolaryngoscopic intubation would result in less cervical spine movement than Macintosh laryngoscopic intubation. We compared the effects of C-MAC D-Blade videolaryngoscopic intubation and Macintosh laryngoscopic intubation in terms of cervical spine motion during intubation in patients with simulated cervical immobilization.MethodsIn this randomized crossover study, the cervical spine angle was measured at the occiput–C1, C1–C2, and C2–C5 segments before and during tracheal intubation with either a C-MAC D-Blade videolaryngoscope or Macintosh laryngoscope in 20 patients, with application of a neck collar for simulated cervical immobilization. Cervical spine motion was defined as the change in angle measured before and during tracheal intubation.ResultsThe cervical spine motion at the occiput–C1 segment was measured at 12.1 ± 4.2° and 6.8 ± 5.0° during Macintosh laryngoscopic and C-MAC D-blade videolaryngoscopic intubation, respectively, corresponding to a 44% reduction in cervical spine motion when using the latter device (mean difference, − 5.3; 98.33% CI: − 8.8 to − 1.8; p = 0.001). However, there was no significant difference between the two intubation devices at the C1–C2 segment (− 0.6; 98.33% CI: − 3.4 to 2.2; p = 0.639) or C2–C5 segment (0.2; 98.33% CI: − 6.0 to 6.4; p = 0.929).ConclusionsThe C-MAC D-Blade videolaryngoscope causes less upper cervical spine motion than the Macintosh laryngoscope during tracheal intubation of patients with simulated cervical immobilization.Trial registrationThis study was registered at ClinicalTrials.gov on June 26, 2018 (NCT03567902).

Comparison of C-MAC D-blade videolaryngoscope and McCoy laryngoscope efficacy for nasotracheal intubation in simulated cervical spinal injury: a prospective randomized comparative study

BackgroundImmobilization with cervical spine worsens endotracheal intubation condition. Though various intubation devices have been demonstrated to perform well in oral endotracheal intubation, limited information is available concerning nasotracheal intubation (NTI) in patients with cervical spine immobilization. The present study compared the performance of the C-MAC D-Blade videolaryngoscope with the McCoy laryngoscope for NTI in patients with simulated cervical spine injuries.MethodsThis was a prospective, randomized, controlled, study done in a tertiary hospital. Ninety-five patients requiring NTI were included in data analysis: McCoy group (group M, n = 47) or C-MAC D-Blade videolaryngoscope group (group C, n = 48). A Philadelphia neck collar was applied before anesthetic induction to immobilize the cervical spine. Single experienced anesthesiologist performed NTI. The primary outcome was duration of intubation divided by three steps: nose to oropharynx; oropharynx into glottic inlet; and glottic inlet to trachea. Secondary outcomes included glottic view as percentage of glottis opening (POGO) score and Cormack-Lehance (CL) grade, modified nasal intubation-difficulty scale (NIDS) rating, hemodynamic changes before and after intubation, and complications.ResultsTotal intubation duration was significantly shorter in group C (39.5 ± 11.4 s) compared to group M (48.1 ± 13.9 s). Group C required significantly less time for glottic visualization and endotracheal tube placement in the trachea. More patients in group C had CL grade I and higher POGO scores (P < 0.001, for both measures). No difficulty in NTI (modified NIDS = 0) was more in group C than group M. Hemodynamic changes and incidence of complications were comparable between groups.ConclusionThe C-MAC D-Blade videolaryngoscope is an effective tool for NTI in a simulated difficult airway, which improves glottic visualization and shortens intubation time relative to those with McCoy laryngoscope.Trial registrationClinical Research Information Service of the Korea National Institute of Health, Identification number: KCT 0004535, Registered December 10, 2019, Retrospectively registered, http://cris.nih.go.kr.

Comparison of the C-MAC D-Blade videolaryngoscope and direct laryngoscope in pediatric patients: Randomized controlled trial.

Endotracheal intubation is a key skill for clinicians and may be challenging in some patients due to various reasons. Nowadays, various kinds of videolaryngoscopes are available and usually used as a rescue device when direct laryngoscopy failed. Pediatric airway has some differences when compared with adults and may be challenging. This study aims to compare and evaluate C Mac D-Blade and commonly used Macintosh laryngoscope in pediatric patients. In this study, 56 pediatric patients, 5-10 years old (10-40 kgs) who had undergone elective surgery and need endotracheal intubation were included after obtaining ethical board approval and informed consent from parents. The patients were randomized into two equal groups for laryngoscopy and intubation by either with Macintosh laryngoscope or C Mac D-Blade videolaryngoscope. Glottic view, number of attempts, intubation time, any complications and hemodynamic variables were recorded. A value of p<0.05 was considered significant. In pediatric patients with unanticipated difficult airway, the mean intubation time was significantly shorter with C Mac D-Blade (21±9 and 41±7 seconds, respectively (p<0.001). The results of the two groups were similar concerning the remaining parameters. C Mac D-Blade videolaryngoscope shortened intubation time about twice when compared to Macintosh blade C Mac D-Blade videolaryngoscope, Videolaryngoscopes may be a good alternative for routine intubation, education and a rescue device for difficult intubation.

Cervical spine motion during intubation: a fluoroscopic comparison between three intubation techniques

Background Anaesthetists are responsible for the management of the airway in patients with unstable cervical spine (C spine). The optimal tracheal intubation technique for patients with potential C spine injury remains controversial. Videolaryngoscopes are used in an attempt to balance the need to limit cervical motion and overcome the difficulty of obtaining laryngeal views especially with manual in-line stabilization or cervical collar. Aim The current study aimed to compare the degree of C spine movement during intubation using different devices, Macintosh direct laryngoscope, C-MAC D-Blade videolaryngoscope and flexible intubation video endoscope (FIVE), in anaesthetized patients with normal airway and simulated C spine immobilization. Patients and methods This study was carried out on 45 adult patients scheduled for radiographic procedures under general anaesthesia with endotracheal intubation (ETT). Patients were randomly divided into three equal groups (15 patients each) using the sealed envelope technique: group M (Macintosh direct laryngoscope), group D (C-MAC D-Blade) and group F (FIVE). C spine movement was recorded with continuous fluoroscopy at 3–8 frames/s using a digital videofluoroscopy unit during both laryngoscopy and intubation to capture the maximal extent of C spine movement. The following parameters were evaluated: age, BMI, airway score, haemodynamic parameters, glottic view grade (Cormack and Lehane), time to successful ETT insertion and maximum segmental spine motion. Results The three studied groups were matching as regards age, BMI and airway score. Heart rate and mean arterial blood pressure observed after insertion of the ETT were statistically higher in group M compared with groups D and F. However, there were no significant differences in mean observed HR and mean arterial blood pressure between groups D and F at all time intervals. The Macintosh (group M) had significantly higher C and L grades than the two other devices in groups D and F. There was no significant difference in C and L grades attainted by the D-Blade in group D and the FIVE in group F. D-Blade had significantly shorter intubation time compared with Macintosh and FIVE. Macintosh direct laryngoscope resulted in significantly greater cervical movement at all measured motion segments compared with D-Blade and FIVE. Meanwhile, FIVE caused significantly less motion compared with D-Blade. Conclusion In patients with potential C spine injury and cervical immobilization, D-Blade results in less cervical motion, better glottic views and shorter intubation time compared with Macintosh laryngoscope. Flexible intubation scope causes the least cervical motion but with the longest intubation time.

C-MAC D-Blade video laryngoscope for awake double lumen tube placement: A case report

Awake intubation for double lumen tube placement is a challenging task even for experienced clinicians, for smooth intubation different techniques and equipment are always desired. We report the successful use of C-MAC videolayrngoscope as a tool for awake intubation and double lumen tube placement.

Comparative Study of Intubation Performance between Macintosh, the Channeled King Vision and the C-MAC D-Blade Videolaryngoscope in Controlled Hypertensive Patients

Background: The common cause of anesthesia related injury is inability to intubate the trachea. Video laryngoscopes present an enlarged video image of glottis while intubating the trachea. The aim of this study is to compare efficacy of intubation by Macintosh with C-MAC D-Blade and King Vision video laryngoscope (VL) in controlled hypertensive patients. Patients and methods: 105 ASA II T2: just before intubation; T3: 2 min after intubation; T4: 5 min after intubation. Primary outcome: time and number of attempts required to successful intubation. Secondary outcomes: ease of laryngoscope insertion, Quality of view, Assist maneuvers, Intubation difficulty, Complications. Results: Differences in heart rate and mean blood pressure between all groups were statistically significant at T3&T4. Differences in duration of successful intubation were statistically significant between group (M) and group(C), also between group (M) and group (K). Statistically significant differences were obtained between all groups regarding quality of view of glottis, ease of insertion of laryngoscope, and use of assist maneuvers for intubation. Conclusion: Video laryngoscopes provide hemodynamic stability and better view of glottis than Macintosh during intubation. King Vision VL has advantages of ease of insertion, less need of assist maneuvers for intubation, with less complication. Thus, it is beneficial to use King Vision for intubation in hypertensive patients.

A Randomized Prospective Study Comparing C-Mac D-Blade, Airtraq, and Fiberoptic Bronchoscope for Intubating Patients with Anticipated Difficult Airway

Background: Several complications may be correlated with difficult airway up to death. Fiberoptic bronchoscope is the gold stander to deal with difficult intubation. Airtraq laryngoscope and C-MAC® video laryngoscope are new devices that are used successfully for tracheal intubation. We compared using C-MAC D-blade video laryngoscope, Airtraq laryngoscope, and Fiberoptic bronchoscope for intubation of patient likely to have difficult intubation. Patients and methods: Ethical committee permission was obtained before 120 adult patients (ASA I-III) with expected difficult intubation were incorporated in this prospective study. Participants were randomly distributed to 3 equal groups to be intubated using either C-MAC D-blade (group 1), Airtraq (group 2), or Fiberoptic technique (group 3) after anesthesia was induced. Our primary outcome was time to tracheal intubation. Intubation data, hemodynamics, and SpO2 were evaluated. Results: Time to visualize the vocal cords (T1) and time to tracheal intubation (T2) were significantly shorter in CMAC D-blade group (group 1) and Airtraq group (group 2) than Fiberoptic group (group 3) and there was insignificant variance between group 1 and group 2. All participants were intubated in the 1st attempt except one in C-MAC Dblade group who needed 2 intubation attempts. There were insignificant variances between the 3 groups regarding number of successful trial (success rate), and manipulation used to improve vocal cord visualization or intubation. Sore throat grades were significantly lower in group 2 and 3 than group 1. Lowest SpO2 was significantly lower in group 3 than the other 2 groups. Mean arterial blood pressure and heart rate measured at 1 min and 3 min after intubation were significantly higher in group 1 than group 2 and 3. Conclusion: When compared to Fiberoptic bronchoscope both C-mac D-blade and Airtraq comparably showed shorter time to visualize vocal cords and intubate patients with anticipated difficult intubation.

Comparison of Macintosh, McCoy and C-MAC D-Blade video laryngoscope intubation by prehospital emergency health workers: a simulation study.

The aim of the this study is to evaluate the intubation success rates of emergency medical technicians using a Macintosh laryngoscope (ML), McCoy laryngoscope (MCL), and C MAC D-Blade (CMDB) video laryngoscope on manikin models with immobilized cervical spines. This randomized crossover study included 40 EMTs with at least 2 years' active service in ambulances. All participating technicians completed intubations in three scenarios-a normal airway model, a rigid cervical collar model, and a manual in-line cervical stabilization model-with three different laryngoscopes. The scenario and laryngoscope model were determined randomly. We recorded the scenario, laryngoscope method, intubation time in seconds, tooth pressure, and intubation on a previously prepared study form. We performed Friedman tests to determine whether there is a significant change in the intubation success rate, duration of tracheal intubation, tooth pressure, and visual analog scale scores due to violations of parametric test assumptions. We performed the Wilcoxon test to determine the significance of pairwise differences for multiple comparisons. An overall 5% type I error level was used to infer statistical significance. We considered a p value of less than 0.05 statistically significant. The CMDB and MCL success rates were significantly higher than the ML rates in all scenario models (p<0.05). The CMDB intubation duration was significantly shorter when compared with ML and MCL in all models. CMDB and MCL may provide an easier, faster intubation by prehospital emergency health care workers in patients with immobilized cervical spines.

Comparison of Tracheal Intubation Using the Storz's C-Mac D-blade(TM) Video-Laryngoscope Aided by Truflex(TM) Articulating Stylet and the Portex(TM) Intubating Stylet.

Background:Tracheal intubation using Storz’s C-Mac D-bladeTM videolaryngoscope is associated with difficult negotiation of the tracheal tube into the glottis due to steep angulation of its blade.Objectives:In this study, we hypothesized that TruflexTM articulating stylet with its ability to dynamically tailor the ETT shape to patients’ oropharyngeal anatomy would be better suited to the D-blade angulation and ease tracheal intubation compared to PortexTM intubation stylet.Patients and Methods:Following approval by the Ethical Issues Committee and informed consent, 218 ASA I and II patients of either sex were enrolled in this interventional, single-blind, randomized controlled trial. Tracheal intubation was performed following a uniform general anesthetic technique using the Storz’s C-Mac D-bladeTM videolaryngoscope aided by either TruflexTM articulating stylet or the PortexTM intubation stylet by an experienced anesthesiologist. The outcome measures included success or failure to intubate in the first attempt, total intubation time, hemodynamic disturbances, trauma if any and user satisfaction.Results:The number of patients in whom intubation was successful in the first attempt was significantly higher by using Truflex™ articulating stylet (99.1%) compared to PortexTM intubation stylet (90.0%; P-Value = 0.003). User satisfaction grade was significantly better while using TruflexTM articulating stylet (8.5 ± 0.88) compared to the PortexTM intubation stylet (8.23 ± 0.99; P-Value = 0.035). We did not observe any significant difference in total intubation time, hemodynamic disturbances or trauma.Conclusions:Storz’s C-Mac D-bladeTM videolaryngoscope provides grade I Cormack and Lehane’s glottic view in 99.1% patients. First attempt successful tracheal intubation and user satisfaction significantly improved by TruflexTM articulating stylet compared to the PortexTM intubation stylet.

Comparison between bougies and stylets for simulated tracheal intubation with the C-MAC D-blade videolaryngoscope

The C-MAC D-blade is a new, highly angulated, videolaryngoscope blade designed for use in patients with difficult airways. Directing a tracheal tube into the trachea with any indirect viewing laryngoscope can be difficult, even with a good view of the laryngeal inlet. To determine which introducing strategy is most suitable for use with the C-MAC D-blade videolaryngoscope. Observational manikin study. Centre for Simulation and Patient Safety. Twenty-four anaesthetists of at least 12 months' of experience. Six tracheal tube introducer strategies (no tracheal tube introducer (TX); hockey stick stylet (SH); Gliderite stylet (SG); bougie with tube loaded distally, near its curved tip (BD); bougie with tube loaded proximally (BP); bougie unloaded until tracheal placement (BU)) for each of two laryngoscopy settings (easy and difficult) in a SimMan 3G manikin. Two intubation attempts, with a maximum time allowance of 60 s each, were allowed for all laryngoscopy setting/introducer combinations. Time to intubate in seconds. Secondary outcome was overall subjective difficulty using a visual analogue scale. In the easy laryngoscopy setting, time to intubation was [median (interquartile range): SH 8.5 sec (7 to 11); SG 10 (8 to 11.5); BD 11 (10 to 12.5); TX 11 (7 to 31.5); BP 12 (11 to 13.5); BU 13 (11 to 14.5). There was no evidence of an overall difference in introducer strategies for time to intubate (P < .025) with SG and SH found to be favourable when compared with BU, and SH was also favourable when compared with BP. In the difficult laryngoscopy setting, time to intubation was: SG 11.5 (10 to 17.5); SH 14 (12 to 22); BD 15.5 (12 to 23.5); BU 16.5 (14 to 21); BP 16.5 (15.5 to 20.5); TX 60 (26.5 to 60). There was evidence of an overall difference in introducer strategies for time to intubate (P < 0.025) with all introducers found to be favourable compared with TX. SG was found to be favourable when compared with BU and BP. In groups TX and SH, anaesthetists failed to intubate in 13 of 24 cases and 1 of 24 cases, respectively. The visual analogue scores tended to reflect intubation times, more so in the difficult setting. The differences in time to intubate in both the easy and difficult laryngoscopy settings were minor for the different introducer strategies studied. The stylet introducers tended to take less time, but this did not result in important statistical differences. When using the C-MAC D-blade videolaryngoscope for simulated tracheal intubation, stylets and bougies performed in a similar fashion.

Inhaled induction and topical anesthesia of the airway guided with C-MAC d-Blade videolaryngoscope in a myasthenia gravis patient and difficult airway

This is a case of a patient diagnosed with myasthenia gravis and clinical predictors of difficult intubation and ventilation undergoing emergency surgery for eventroplasty and bowel resection. The patient was successfully intubated asleep, with no neuromuscular relaxation, using a C-MAC videolaryngoscope and difficult intubation d-Blade, following inhaled induction and topical anesthesia of the airway.We do want to stress the clinical value of videolaryngoscopy in patients with positive predictors of difficult intubation, the applicability of Sevoflurane for the maintenance of spontaneous ventilation in a patient asleep, as well as the use of Sugammadex for reversal of neuromuscular block in a myasthenia patient.