Induction Of Intubation Research Articles

Ketamine versus etomidate for induction of intubation in critically ill patients.

Ketamine versus etomidate for induction of intubation in critically ill patients.

Analgesic effect of thoracic paravertebral block on patients undergoing thoracoscopic lobectomy under general anesthesia.

To investigate the analgesic effect of thoracic paravertebral block (TPVB) in patients undergoing thoracoscopic lobectomy under general anesthesia (GA). Clinical records of 82 patients who underwent thoracoscopic lobectomy under GA from October 2021 to October 2022 in the General Hospital of Southern Theater Command were retrospectively analyzed. The patients were divided into two groups according to the method of anesthesia used: general anesthesia group (Group-G, n=37), and TPVB plus GA group (Group-T, n=45). The analgesic effect, mean arterial pressure (MAP), heart rate (HR) and the rate of adverse events in both groups were compared. Visual analogue scale (VAS) scores of patients in Group-T at 12h, 24h and 48h after the operation were significantly lower compared to Group-G (P<0.05). MAP and HR the time of tracheal intubation induction (T1), single lung ventilation (T2), skin incision (T3), operation completion (T4), and 20 minutes after the extubation (T5) were lower in both groups compared to T0, and were significantly higher in Group-T compared to Group-G (P<0.05). The rate of adverse events in Group-T was 6.67%, significantly lower compared to Group-G (24.32%) (P<0.05). TPVB combined with GA can improve the analgesic effect, improve MAP and HR during the operation, and reduce the incidence of adverse events in patients undergoing thoracoscopic lobectomy.

Impact of immediate general anesthesia in the emergency room on prevention of rebleeding after subarachnoid hemorrhage.

Aneurysm rebleeding is fatal in patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate whether immediate general anesthesia (iGA) management in the emergency room, upon arrival, prevents rebleeding after admission and reduces mortality following aSAH. The clinical data of 3033 patients with World Federation of Neurosurgical Societies (WFNS) grade 1, 2, or 3 aSAH from the Nagasaki SAH Registry Study between 2001 and 2018 were retrospectively analyzed. iGA was defined as sedation and analgesia using intravenous anesthetics and opioids combined with intubation induction. We calculated crude and adjusted odds ratios to evaluate the associations between iGA and the risk of rebleeding/death using multivariable logistic regression models with fully conditional specification for multiple imputations. In the analysis of the relationship between iGA and death, we excluded patients with aSAH who died within 3days after the onset of symptoms. Of the 3033 patients with aSAH who met the eligibility criteria, 175 patients (5.8%) received iGA (mean age, 62.4years; 49 were male). Heart disease, WFNS grade, and lack of iGA were independently associated with rebleeding in the multivariable analysis with multiple imputations. Among the 3033 patients, 15 were excluded due to death within 3days after the onset of symptoms. After excluding these cases, our analysis revealed that age, diabetes mellitus, history of cerebrovascular disease, WFNS grade, Fisher grade, lack of iGA, rebleeding, postoperative rebleeding, no shunt operation, and symptomatic spasm were independently associated with mortality. Management by iGA was associated with a 0.28-fold decrease in the risks of both rebleeding and mortality in patients with aSAH, even after adjusting for the patient's history of diseases, comorbidities, and aSAH status. Thus, iGA can be a treatment for the prevention of rebleeding before aneurysmal obliteration treatment.

Comparison of Intubation Conditions Between Airtraq, McGrath Video Laryngoscopes, and Macintosh Under Conditions of Simulated Trauma Airway and Rapid Sequence Induction Intubation

BackgroundPatients arriving at the emergency department with a potential cervical spine injury and immobilized in a rigid cervical collar often require emergency airway management and rapid sequence induction intubation (RSII). There have been several advances in airway management with the advent of channeled (AirtraqⓇ; Prodol Meditec) and nonchanneled (McGrathⓇ; Meditronics) video laryngoscopes, which enable intubation without the removal of the cervical collar, but their efficacy and superiority over conventional laryngoscopy (Macintosh) in the presence of a rigid cervical collar and cricoid pressure have not been evaluated. ObjectiveOur aim was to compare the channeled (Airtraq [group A]) and nonchanneled (McGrath [Group M]) video laryngoscopes with a conventional laryngoscope (Macintosh [Group C]) in a simulated trauma airway. MethodsA prospective randomized controlled study was conducted in a tertiary care center. Participants were 300 patients requiring general anesthesia (American Society of Anesthesiologists class I or II), of both sexes, and aged 18–60 years. Airway management was simulated without removal of a rigid cervical collar and using cricoid pressure during intubation. After RSI, patients were intubated with one of the study techniques according to randomization. Intubation time and intubation difficulty scale (IDS) score were noted. ResultsMean intubation time was 42.2 s in group C, 35.7 s in group M, and 21.8 s in group A (p = 0.001). Intubation was easy in group M and group A (median IDS score of 0; interquartile range [IQR] 0–1 for group M and median IDS score of 1; IQR 0–2 for group A and group C; p < 0.001). A higher proportion (95.1%) of patients had an IDS score of < 1 in group A. ConclusionsThe performance of RSII with cricoid pressure in the presence of a cervical collar was easier and more rapid with channeled video laryngoscope than with other techniques.

Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care.

Recent data indicated a high incidence of inappropriate management of neuromuscular block, with a high rate of residual paralysis and relaxant-associated postoperative complications. These data are alarming in that the available neuromuscular monitoring, as well as myorelaxants and their antagonists basically allow well tolerated management of neuromuscular blockade. In this first European Society of Anaesthesiology and Intensive Care (ESAIC) guideline on peri-operative management of neuromuscular block, we aim to present aggregated and evidence-based recommendations to assist clinicians provide best medical care and ensure patient safety. We identified three main clinical questions: Are myorelaxants necessary to facilitate tracheal intubation in adults? Does the intensity of neuromuscular blockade influence a patient's outcome in abdominal surgery? What are the strategies for the diagnosis and treatment of residual paralysis? On the basis of this, PICO (patient, intervention, comparator, outcome) questions were derived that guided a structured literature search. A stepwise approach was used to reduce the number of trials of the initial research ( n = 24 000) to the finally relevant clinical studies ( n = 88). GRADE methodology (Grading of Recommendations, Assessment, Development and Evaluation) was used for formulating the recommendations based on the findings of the included studies in conjunction with their methodological quality. A two-step Delphi process was used to determine the agreement of the panel members with the recommendations: R1 We recommend using a muscle relaxant to facilitate tracheal intubation (1A). R2 We recommend the use of muscle relaxants to reduce pharyngeal and/or laryngeal injury following endotracheal intubation (1C). R3 We recommend the use of a fast-acting muscle relaxant for rapid sequence induction intubation (RSII) such as succinylcholine 1 mg kg -1 or rocuronium 0.9 to 1.2 mg kg -1 (1B). R4 We recommend deepening neuromuscular blockade if surgical conditions need to be improved (1B). R5 There is insufficient evidence to recommend deep neuromuscular blockade in general to reduce postoperative pain or decrease the incidence of peri-operative complications. (2C). R6 We recommend the use of ulnar nerve stimulation and quantitative neuromuscular monitoring at the adductor pollicis muscle to exclude residual paralysis (1B). R7 We recommend using sugammadex to antagonise deep, moderate and shallow neuromuscular blockade induced by aminosteroidal agents (rocuronium, vecuronium) (1A). R8 We recommend advanced spontaneous recovery (i.e. TOF ratio >0.2) before starting neostigmine-based reversal and to continue quantitative monitoring of neuromuscular blockade until a TOF ratio of more than 0.9 has been attained. (1C).

STUDY OF THE EFFECT OF PROPOFOL &amp; ETOMIDATE AS AN INDUCTION AGENT ON HAEMODYNAMIC CHANGES DURING INDUCTION &amp; ENDOTRACHEAL INTUBATION

Introduction: Laryngoscopy and subsequent tracheal intubation cause a fugitive tachycardia and hypertension as a result of sympathoadrenal stimulation. Careful selection of anestheshetic is thus required, as cardiovascular reserve is decreased in certain patients, so as to avoid undue depressions of cardiac and circulatory function Aims And Objectives: This randomized double blind prospective study had been designed for comparative evaluation of inj propofol 2.5 mg/kg, inj Etomidate 0.3 mg/kg an induction agent on haemodynamic changes such as HR, SBP, DBP, MAP and oxygen saturation during induction and tracheal intubation and also to study the adverse effects the two drugs under study Material And Methods: After approval from medical ethics committee, Dr D Y Patil Medical College and Hospital, Pune, the study was carried out on sixty (60) patients undergoing elective surgeries under standard general anesthesia. ? All patients were premedicated with Ondansetron 0.1mg/kg i.v., inj midazolam 0.02mg/kg and inj fentanyl 2 mcg/kg i.v. ? All patients pre-oxygenated with 100% oxygen for 3 min, all vital parameters recorded (T1) ? Group P received inj. propofol 2.5 mg/kg i.v. and group E received Etomidate 0.3mg/kg i.v. over 30 sec and vital parameters recorded as (T2) ? Inj succinylcholine as muscle relaxant given after administering induction agent, laryngoscopy and tracheal intubation attempted with appropriate sized endotracheal tube. All vital parameters recorded during laryngoscopy(T3), periodic monitoring of vital parameters carried out at 1,2,3,5 and 10 minutes intervals post intubation ? Further the patient was maintained on O2 /N2O / Isoflurane and Vecuronium i.v. top-ups as and when required ? At the end of surgery, patient reversed with inj. Glycopyrrolate 0.008mg/kg i.v. along with inj. Neostigmine 0.05mg/kg intravenously and extubated after gaining consciousness and adequate power ? Patient shifted to recovery room observed for any side effects such as nausea, vomiting, Result: The demographic profile was comparable. There was no statistically considerable difference between the two study groups with respect to baseline parameters of HR, SBP, DBP, MAP and SpO2. There was decrease in mean heart rate seen in group P compared to group E at post induction (T2), after intubation 1 min, 2min, the values were statistically significant with P value &lt;0.05,.and decrease in mean SBP, mean DBP AND MAP in group P compared to group E at post induction (T2), after intubation 1,2 3, 5 min values were statistically significant with p value &lt;0.05 Pain on injection was more in group P 26 out of 30(86.7%) than group E, which was statistically significant with p value &lt;0.05 Incidence of myoclonus was more in group E 23 patients out of 30(76.7%) compared to group P which was statistically significant with p value &lt;0.05. In group P 2 out of 30 patients (6.7%) had vomiting and in group E 3 out of 30 patients (10%) had vomiting, difference was statistically insignificant with p value &gt;0.05 Conclusion: A• Both, Propofol and etomidate are safe induction agents A• Etomidate maintains better haemodynamic stability than propofol as induction agent A• Pain on injection was more with propofol. However, myoclonus was more with etomidate A• Both drugs were associated with no significant side effects/complication.

Response to letter to the editor: Hemodynamic effects of trauma rapid sequence intubation induction agents are not only related to the medication used.

Response to letter to the editor: Hemodynamic effects of trauma rapid sequence intubation induction agents are not only related to the medication used.

Letter to the editor: Hemodynamic effects of trauma rapid sequence intubation induction agents are not only related to the medication used.

Letter to the editor: Hemodynamic effects of trauma rapid sequence intubation induction agents are not only related to the medication used.

Preoperative Gastric Ultrasound in Surgical Patients who Undergo Rapid Sequence Induction Intubation

BackgroundThe evaluation of preoperative aspiration risk in surgical patients is mainly based on clinical judgement. The aim of this study was to estimate the proportion of surgical patients who undergo rapid sequence induction intubation that have gastric contents and volume which might give a hint that the patient could be at low or high risk of aspiration assessed by gastric ultrasound, and the feasibility of this approach in the clinical setting. MethodsIn this prospective observational study, seventy-two adult surgical patients who underwent rapid sequence induction intubation underwent gastric ultrasound before induction of anaesthesia. Based on gastric contents and volumes measured in the antrum of the stomach, the findings were categorised into low and high risk of aspiration. ResultsEvaluation of the gastric contents was possible in 63/72 patients (88% [95% CI: 80–95%]). Among these, the number of patients with indicators for low aspiration risk was 32/63 (51% [95% CI: 38–63%]). The mean examination time was 2 min 50 s (SD ±1 min 16 s [95% CI 2 min 32 s to 3 min 8 s]). ConclusionsThis small observational study provides hints that half of the patients undergoing rapid sequence induction intubation have, according to gastric ultrasound assessment, not an elevated risk of aspiration. We also showed that a transcutaneous gastric ultrasound examination is easy, fast without time delay and doable immediately before induction of anaesthesia in the operating theatre.

Transnasal humidified rapid-insufflation ventilatory exchange during rapid sequence induction in children

BackgroundThe objective of this study was to measure the incidence of arterial oxygen desaturation during rapid sequence induction intubation in children following apnoeic oxygenation via transnasal humidified rapid-insufflation ventilatory exchange (THRIVE). MethodsIn this prospective observational study, arterial desaturation < 95% SaO2 before intubation was recorded following apnoeic RSI combining an intravenous hypnotic agent, suxamethonium and THRIVE (used during the apnoeic period). The incidence of desaturation was calculated in the whole cohort and according to patients’ age (older or younger than 1 year). ResultsComplete data were collected for 79 patients, 1 day to 15 years of age. Nine patients (11.4%) exhibited arterial desaturation before tracheal intubation and received active facemask ventilation. Patients exhibiting desaturation were more likely to be less than 1 year of age (9/9, (100%) versus 37/70, (52.9%); P = 0.005), to be reported as difficult intubations (5/9, (55.6%) versus 1/70, (1.4%), p < 0.001), and to have regurgitation at induction (2/9, (22.2%) versus 0/70, (0%), p = 0.01). ConclusionsResults of the current study indicated that almost 91% of RSI can be performed without desaturation when THRIVE is used. A comparative controlled study is required to confirm these findings. Specific situations and conditions limiting the efficacy of THRIVE during RSI should also be investigated.

Comparing two different doses of propofol after sevoflurane induction for intubation in paediatric patients without use of neuromuscular blocking agents

In the practice of paediatric anaesthesia, intubation of trachea without using neuromuscular blocking agents is becoming commoner more so in conditions in which muscle relaxants are not preferred. Different combinations of drugs including opioids, intravenous agents and inhalational agents are being used for facilitating endotracheal intubation when muscle relaxants are not used. In this study we compared intubating conditions in paediatric patients after sevoflurane induction and propofol in two different doses.80 children of 2 to 12 years age undergoing elective surgeries were divided into two groups P2 and P3 of 40 each. After sevoflurane induction and fentanyl 2mcg/kg I.V. group P2 received propofol 2mg/kg and group P3 received propofol 3mg/kg I.V. The two groups were compared with respect to intubating conditions and haemodynamic parameters.Clinically acceptable intubating conditions were seen in all patients in both groups. Excellent intubating conditions were more in group P3 (87.5%) than group P2 (80%). Haemodynamic parameters showed no significant difference between the two groups.In paediatric patients, endotracheal intubation can be comfortably performed without muscle relaxantsby using propofol and fentanyl with sevoflurane induction with no respiratory or haemodynamic adverse events. Propofol in a dose of 3mg/kg gives better intubating conditions than 2mg/kg without adverse haemodynamic effects, although 2mg/kg propofol also gives acceptable intubating conditions.

Prolonged Intraoperative Cardiac Arrest in a Young Patient with Successful Precordial Thump

Cardiac arrest during surgery is rare but is one of the most dreaded complications. Precordial thump (PT) had been used for a long time, but in the present day it has become obsolete. In regard to the witnessed onset of asystole, there is insufficient evidence to recommend for or against the use of the PT. This case report is of a 17-year-old male who presented to hospital with a congenital haemangioma on the right calf. He had no other significant medical conditions and was on no other medications. The patient history, clinical examination, and investigations were normal. He had undergone an operation 3 weeks previously where a section of his haemangioma was excised, and an appointment was made for excision of the remaining haemangioma. Anaesthesia induction and endotracheal intubation were smooth and uneventful. Following lifting and exsanguination of the patient’s leg by Esmarch bandage, he developed ventricular fibrillation and arrested with asystole. Cardiopulmonary resuscitation was performed, with no good response, for approximately 50 minutes. Lastly, a PT was performed, and the patient’s heart rate immediately returned. The operation was postponed. Postresuscitation care was conducted in an intensive care unit. The patient was later discharged without complications.

Regulation of left atrial fibrosis induced by mitral regurgitation by SIRT1

SIRT1 (silent information regulator 1) is a histone deacetylase. It can sense the energy level in cells and delay cell senescence, leading to resistance to external stress and improving metabolism. Mitral regurgitation (MR) is a common disease in cardiac surgery. However, there are no previous studies on SIRT1 and left atrial fibrosis caused by MR. In this study, we aimed to explore the regulatory effect of SIRT1 on left atrial fibrosis induced by MR. We used Guizhou miniature pigs to establish an MR model and a sham operation model after anaesthesia induction and respiratory intubation, and these model animals were followed for 30 months after the surgery. The differential distribution and expression of SIRT1 and collagen I in the left atrium was determined by immunofluorescence and Western blotting. Furthermore, we treated NIH3T3 fibroblasts (CFs) with resveratrol and Angiotensin II (Ang II) to analyse the specific mechanism involved in the development of myocardial fibrosis. The results showed that the MR model was successfully constructed. There were 8 pigs in the MR group and 6 pigs in the control group. In both the animal experiments and the cell experiments, the expression of collagen I in the MR group was increased significantly compared to that in the control group, while the expression of SIRT1 was decreased.

Comparison of rapid sequence induction intubation conditions with Suxamethonium verses Rocuronium.

Objectives: To compare endotracheal intubating conditions in rapid sequence induction using Suxamethonium and Rocuronium. Study Design: Randomized Controlled Trial. Setting: Allied Hospital Faisalabad. Period: From 02-07-2015 to 01-07-2016. Material &amp; Methods: After taking approval from hospital ethical committee, cases of emergency surgery fulfilling the inclusion criteria were enrolled and informed consent was taken after explaining all the procedure to the patient. All the patients were randomly divided into 2 groups by using computer generated random number table. Both groups were induced with thiopentone sodium 5mg/kg, analgesia was given with nalbuphine 0.1mg/kg. Group A was given Suxamethonium in a dose of 1 mg/kg body weight after induction agent. Group B was given 0.6 mg/kg Rocuronium after induction. Intubation was performed after 60 sec in both groups with cricoid pressure. Anesthesia was maintained with O2/N2O in a ratio of 50:50 and isoflurane (0.6-1.0%) in both groups. Anesthesia was stopped at the end of surgery in all the patients. Results: Mean age of the patients was 40.49+11.47 and 43.43+12.88 years, 51.43% and 45.71% were male while 48.57% and 54.29% were females, Comparison of intubation conditions was recorded as 97.14% excellent and 2.86% good in patients received suxamethonium and 82.86% and 17.14% in Rocuronium Group had good conditions. Conclusion: It was found that Suxamethonium is significantly better when compared to Rocuronium for endotracheal intubation conditions in rapid sequence induction.

THE COMPARISON OF ETOMIDATE AND PROPOFOL FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO INDUCTION AND ENDOTRACHEAL INTUBATION

Background: This study is designed to compare the degree of attenuation of hemodynamic response to induction, laryngoscopy and endotracheal intubation of etomidate with those of propofol in patients undergoing noncardiac surgical procedures.&#x0D; Methods: The present study conducted in Non Cardiac Surgeries in the Department of Anaesthesiology, Jhalawar Medical College &amp; Associated Hospitals, Jhalawar, Rajasthan.After institutional ethical committee’s approval and written informed consent from the patient’s attendant in the format as per proforma, the present study was conducted on 60 patients of ASA Grade I and II of either sex, aged 18 to 60 years, scheduled for a variety of non-cardiac surgical procedures requiring general anaesthesia.&#x0D; Results: The findings of the study suggest that use of etomidate as inducing agent provides more hemodynamic stability as compared to propofol and can be preffered in patients prone to hemodynamic instability, cardiovascular abnormalities, hypovolemia, prone to renal failure due to hypotension. Propofol may be preffered for induction where hypertension is contraindicated or hypotension is preffered and myoclonus is to be avoided.&#x0D; Conclusion: Etomidate provides a more stable hemodynamics during general anesthesia as compared to propofol.&#x0D; Keyword:- Etomidate, Propofol, Hemodynamic.

Application of rapid induction of intubation by sedatives combined with cis-atracurium in the emergency department

Objective To study the effect of sedative combined with cis-atracurium in rapid induction intubation in emergency department. Methods From October 15, 2017 to April 15, 2019, 52 critically ill patients who needed tracheal intubation in emergency department of the People's Hospital of Changzhi were selected.And the patients were numbered according to the time sequence of enrollment, and then randomly divided into group A and group B according to the random number table, with 26 cases in each group.Group A was given sedatives combined with cis-atracurium to induce rapid intubation.Group B only received sedatives to induce intubation.The success rate of intubation, successful intubation time were compared between the two groups.Before and after endotracheal intubation, the heart rate, mean arterial blood pressure, pulse oxygen concentration and the change of catecholamine concentration were compared. Results The success rate of intubation in group A was 100.0%, which in group B was 76.9%, the difference between the two groups was statistically significant (χ2=12.15, P 0.05). The serum adrenaline level was higher compared with before intubation, but there was no statistically significant difference (t=-1.03, P>0.05). In group B, the pulse oxygen concentration was significantly increased after intubation compared with before intubation (t=5.74, P 0.05). Conclusion In the airway management of critically ill patients in emergency department, the application of sedatives combined with cis-atracurium to rapidly induce intubation can improve the hypoxia symptoms of patients more rapidly and can keep patients' hemodynamics, catecholamine concentration is relatively stable, it has the characteristics of safety and efficiency. Key words: Emergency service, hospital; Emergencies; Critical illness; Airway management; Intubation, intratracheal; Atracurium; Hypnotics and sedatives; Hemodynamics

Modified Nasal Tse-PAP Mask Provides Continuous Active Oxygenation during Sedation, GA Induction and Difficult Intubation

Modified Nasal Tse-PAP Mask Provides Continuous Active Oxygenation during Sedation, GA Induction and Difficult Intubation

Bag-Valve-Mask Ventilation After Induction for Intubation: PreVenting Hypoxemia?: July 2019 Annals of Emergency Medicine Journal Club

Bag-Valve-Mask Ventilation After Induction for Intubation: PreVenting Hypoxemia?: July 2019 Annals of Emergency Medicine Journal Club

Effect of hypothermia on endotracheal tube cuff pressure during cardiopulmonary bypass in pediatric patients with congenital heart disease

Objective To evaluate the effect of hypothermia on the endotracheal tube cuff pressure during cardiopulmonary bypass in the pediatric patients with congenital heart disease. Methods Forty pediatric patients of both sexes, of American Society of Anesthesiologists physical status Ⅱ–Ⅳ, aged 1 months–14 yr, weighing 3–58 kg, scheduled for elective surgery for congenital heart disease using cardiopulmonary bypass, were included in this study. All the pediatric patients were intubated with a cuffed endotracheal tube. After anesthesia induction and endotracheal intubation, the air was injected into the cuff to make the cuff pressure reach 20 cm H2O (baseline). The endotracheal tube cuff pressure was recorded when the esophageal temperature was reduced to 34, 32, 30, 28 and below 28 ℃ and returned to 28, 30, 32, 34 and 36 ℃. Results The cuff pressure was significantly decreased when the esophageal temperature was reduced to 30 and 28 ℃ and below 28 ℃ and returned to 28, 30, 32 and 34 ℃ as compared with the baseline(P<0.05). Conclusion Hypothermia can reduce the endotracheal tube cuff pressure during cardiopulmonary bypass, and it is recommended to routinely monitor the cuff pressure in the pediatric patients with congenital heart disease. Key words: Hypothermia; Cardiopulmonary bypass; Intubation, intratracheal; Children

The Clarus Video System (Trachway) and direct laryngoscope for endotracheal intubation with cricoid pressure in simulated rapid sequence induction intubation: a prospective randomized controlled trial

BackgroundDuring an emergency endotracheal intubation, rapid sequence induction intubation (RSII) with cricoid pressure (CP) is frequently implemented to prevent aspiration pneumonia. We evaluated the CVS in endotracheal intubation in RSII with CP, in comparison with a direct laryngoscope (DL).MethodsOne hundred fifty patients were randomly assigned to one of three groups: the CVS as a video stylet (CVS-V) group, the CVS as a lightwand (CVS-L) group and DL group. Primary outcomes were to assess the power of the CVS, compared with DL, regarding the first attempt success rate and intubation time in simulated RSII with CP. Secondary outcomes were to examine hemodynamic stress response and the incidence of complications.ResultsThe first attempt success rates within 30 s and within 60 s were higher in CVS-V and DL group than those in CVS-L group (p = 0.006 and 0.037, respectively). The intergroup difference for intubation success rate within 30 s was nonsignificant and almost all the patients were successfully intubated within 60 s (98% for CVS-L and DL group, 96% for CVS-L group). Kaplan-Meier estimator demonstrated the median intubation time was 10.6 s [95% CI, 7.5 to 13.7] in CVS-V group, 14.6 s [95% CI, 11.1 to 18.0] in CVS-L group and 16.5 s [95% CI, 15.7 to 17.3] in DL group (p = 0.023 by the log-rank test). However, the difference was nonsignificant after Sidak’s adjustment. The intergroup differences for hemodynamic stress response, sore throat and mucosa injury incidence were also nonsignificant.ConclusionsThe CVS-D and DL provide a higher first attempt intubation success rate within 30 and 60 s in intubation with CP; the intubation time for the CVS-V was nonsignificantly shorter than that for the other two intubation methods. Almost all the patients can be successfully intubated with any of the three intubation methods within 60 s.Trial registrationClinicalTrials.gov identifier: NCT03841890, registered on February 15, 2019 (retrospectively registered).