Laryngoscope Group Research Articles

A comparative evaluation of King Vision video laryngoscope (channelled blade), McCoy, and Macintosh laryngoscopes for tracheal intubation in patients with immobilized cervical spine

Background: Cervical spine immobilization results in a poor laryngeal view on direct laryngoscopy leading to difficulty in intubation. This randomized prospective study was designed to compare the laryngeal view and ease of intubation with the Macintosh, McCoy, and King Vision video laryngoscopes in patients with immobilized cervical spine. Method: Ninety adult patients of ASA grade I-II with immobilized cervical spine using manual inline axial cervical spine stabilization technique, undergoing elective cervical surgery were enrolled. The patients were randomly allocated into three groups to achieve tracheal intubation with Macintosh (MAC group n=30), McCoy (MCC group n=30), or King Vision video laryngoscopes (KVL group). When the best possible view of the glottis was obtained, the Cormack-Lehane laryngoscopy grade and the percentage of glottic opening (POGO) score were assessed. Other measurements included the intubation time, the intubation difficulty score, and the intubation success rate. Haemodynamic parameters and any airway complications were also recorded. Result: King Vision video laryngoscope reduced the intubation difficulty score, improved the Cormack and Lehane glottic view, and the POGO score compared with the McCoy and Macintosh laryngoscopes. The first attempt intubation success rate was also high in the King Vision video laryngoscope group. However, there were no statistically significant differences in the time required for successful intubation and the overall success rates between the devices tested. No dental injury or hypoxia occurred with either device. Conclusion: The use of a King Vision video laryngoscope resulted in better glottis visualization, easier tracheal intubation, and higher first attempt success rate as compared to Macintosh and McCoy laryngoscopes in immobilized cervical spine patients.

Clinical study of SMT-Ⅱ video laryngoscope with difficult airway intubation in emergency department

Objective: To observe the clinical feasibility and security of SMT-Ⅱ video laryngoscope in difficult airway intubation in emergency department. Methods: This study took 90 adults with difficult airway who were admitted to the rescue room of Jingxi court of Beijing Chao-Yang Hospital, Capital Medical University from January 2015 to December 2016.The patients were randomly divided into 2 groups(SMT-Ⅱ video laryngoscope group: n=45, Macintosh direct laryngoscope group: n=45), which were treated with endotracheal intubation and ventilator assisted ventilation.The evaluation of difficult mask ventilation(DMV) independent risk factor score, Wlison score, Cormack-Lehane grade, mouth opening, thyromental distance, visualization of the glottis, time for laryngoscopy, time for tracheal intubation, first-pass success rate of intubation, complications, mean arterial pressure(MAP) and heart rate(HR) before induction, after laryngoscopy, after induction, after intubation 5 minutes, 10 minutes were recorded.ANOVA, t-test, Chi-square test was used to analyze differences data, respectively. Results: There was no significant difference between the two groups in terms of gender, age, height, weight and other general data, mouth opening, DMV independent risk factor score, Wlison score, and thyromental distance(χ(2)=0.045, t=-0.367, t=0.684, t=0.511, t=0.330, t=-0.724, t=1.219, t=1.034, all P>0.05). A Cormack-Lehane grade Ⅰ or Ⅱ view were 44 cases in SMT-Ⅱ video laryngoscope group and 14 cases in Macintosh direct laryngoscope group. It significantly improved with the use of SMT- Ⅱ video laryngoscope, compared with Macintosh direct laryngoscope(χ(2)=52.096, P<0.01). The time to best view was shorter in SMT-Ⅱ video laryngoscope group compared to that in Macintosh direct laryngoscope group with (15.0±1.0) seconds vs. (24.2±3.4) seconds(t=-26.319, P<0.05). The tube passage time was shorter with SMT-Ⅱ video laryngoscope (31.6±4.3) seconds vs. (12.7±0.9) seconds(t=-21.698, P<0.05)). The first -pass success rates in SMT-Ⅱ video laryngoscope group and Macintosh direct laryngoscope group were 100% and 84.4%, respectively(χ(2)=5.577, P<0.05). For complications, pharyngorrhagia at intubation occurred in 1 case in SMT-Ⅱ video laryngoscope group and 9 cases in Macintosh direct laryngoscope group(χ(2)=5.513, P<0.05), dislocation of tooth at intubation occurred in 0 case in SMT- Ⅱ video laryngoscope group and 6 cases in Macintosh direct laryngoscope group (χ(2)=4.464, P<0.05). The mean arterial pressure values before induction, after laryngoscopy, after induction and after intubation 5 minutes, 10 minutes were (84.8±3.3), (89.2±3.6), (90.8±3.6), (86.6±3.4), (85.4±3.6) mmHg(1 mmHg=0.133 kPa) in SMT-Ⅱ video laryngoscope group and (85.8±3.1), (91.9±3.4), (96.1±2.9), (90.0±2.5), (86.5±2.9) mmHg in Macintosh direct laryngoscope group. There was a significant difference between the two groups at the 5-time points of MAP (F=16.619, P=0.000). The heart rate values before induction, after laryngoscopy, after induction and after intubation 5 minutes, 10 minutes were(77.4±4.3), (80.8±4.3), (83.3±4.9), (78.8±4.2), (76.9±4.2) rate/minutes in SMT-Ⅱ video laryngoscope group and (75.7±4.0), (85.3±4.4), (90.7±4.4), (84.3±4.1), (78.3±4.2) rate/minutes in the Macintosh direct laryngoscope group.There was a significant difference between the two groups at the 5-time points of HR(F=15.857, P=0.000). Conclusions: SMT-Ⅱ video laryngoscope uesd in difficult ariway enable better visualization of the glottic opening, short opertive time, enhance the success rate of intubation.It indicucates that SMT-Ⅱ video laryngoscope is safer than Macintosh direct laryngoscope in patients with difficult airway.

Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates).

Direct laryngoscopy is the method currently used for tracheal intubation in children. It occasionally offers unexpectedly poor laryngeal views. Indirect laryngoscopy involves visualizing the vocal cords by means other than obtaining a direct sight, with the potential to improve outcomes. We reviewed the current available literature and performed a meta-analysis to compare direct versus indirect laryngoscopy, or videolaryngoscopy, with regards to efficacy and adverse effects. To assess the efficacy of indirect laryngoscopy, or videolaryngoscopy, versus direct laryngoscopy for intubation of children with regards to intubation time, number of attempts at intubation, and adverse haemodynamic responses to endotracheal intubation. We also assessed other adverse responses to intubation, such as trauma to oral, pharyngeal, and laryngeal structures, and we assessed vocal cord view scores. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and trial registers (www.clinicaltrials.gov and www.controlledtrials) in November 2015. We reran the search in January 2017. We added new studies of potential interest to a list of 'Studies awaiting classification' and will incorporate them into formal review findings during the review update. We performed reference checking and citation searching and contacted the authors of unpublished data to ask for more information. We applied no language restrictions. We included only randomized controlled trials. Participants were children aged 28 days to 18 years. Investigators performed intubations using any type of indirect laryngoscopes, or videolaryngoscopes, versus direct laryngoscopes. We used Cochrane standard methodological procedures. Two review authors independently reviewed titles, extracted data, and assessed risk of bias. We included 12 studies (803 children) in this review and meta-analysis. We identified three studies that are awaiting classification and two ongoing studies.Trial results show that a longer intubation time was required when indirect laryngoscopy, or videolaryngoscopy, was used instead of direct laryngoscopy (12 trials; n = 798; mean difference (MD) 5.49 seconds, 95% confidence interval (CI) 1.37 to 9.60; I2 = 90%; very low-quality evidence). Researchers found no significant differences between direct and indirect laryngoscopy on assessment of success of the first attempt at intubation (11 trials; n = 749; risk ratio (RR) 0.96, 95% CI 0.91 to 1.02; I2 = 67%; low-quality evidence) and observed that unsuccessful intubation (five trials; n = 263) was significantly increased in the indirect laryngoscopy, or videolaryngoscopy, group (RR 4.93, 95% CI 1.33 to 18.31; I2 = 0%; low-quality evidence). Five studies reported the effect of intubation on oxygen saturation (n = 272; very low-quality evidence). Five children had desaturation during intubation: one from the direct laryngoscopy group and four from the indirect laryngoscopy, or videolaryngoscopy, group.Two studies (n = 100) reported other haemodynamic responses to intubation (very low-quality evidence). One study reported a significant increase in heart rate five minutes after intubation in the indirect laryngoscopy group (P = 0.007); the other study found that the heart rate change in the direct laryngoscopy group was significantly less than the heart rate change in the indirect laryngoscopy, or videolaryngoscopy, group (P < 0.001). A total of five studies (n = 244; very low-quality evidence) looked at evidence of trauma resulting from intubation. Investigators reported that only two children from the direct laryngoscopy group had trauma compared with no children in the indirect laryngoscopy, or videolaryngoscopy, group.Use of indirect laryngoscopy, or videolaryngoscopy, improved the percentage of glottic opening (five trials; n = 256). Studies noted no significant difference in Cormack and Lehane score (C&L) grade 1 (three trials; n = 190; RR 1.06, 95% CI 0.93 to 1.21; I2 = 59%). Evidence suggests that indirect laryngoscopy, or videolaryngoscopy, leads to prolonged intubation time with an increased rate of intubation failure when compared with direct laryngoscopy (very low-quality evidence due to imprecision, inconsistency, and study limitations). Review authors had difficulty reaching conclusions on adverse haemodynamic responses and other adverse effects of intubation, as only a few children were reported to have these outcomes. Use of indirect laryngoscopy, or videolaryngoscopy, might lead to improved vocal cord view, but marked heterogeneity between studies made it difficult for review authors to reach conclusions on this outcome.

Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients

In the intensive care unit (ICU), orotracheal intubation can be associated with increased risk of complications because the patient may be acutely unstable, requiring prompt intervention, often by a practitioner with nonexpert skills. Video laryngoscopy may decrease this risk by improving glottis visualization. To determine whether video laryngoscopy increases the frequency of successful first-pass orotracheal intubation compared with direct laryngoscopy in ICU patients. Randomized clinical trial of 371 adults requiring intubation while being treated at 7 ICUs in France between May 2015 and January 2016; there was 28 days of follow-up. Intubation using a video laryngoscope (n = 186) or direct laryngoscopy (n = 185). All patients received general anesthesia. The primary outcome was the proportion of patients with successful first-pass intubation. The secondary outcomes included time to successful intubation and mild to moderate and severe life-threatening complications. Among 371 randomized patients (mean [SD] age, 62.8 [15.8] years; 136 [36.7%] women), 371 completed the trial. The proportion of patients with successful first-pass intubation did not differ significantly between the video laryngoscopy and direct laryngoscopy groups (67.7% vs 70.3%; absolute difference, -2.5% [95% CI, -11.9% to 6.9%]; P = .60). The proportion of first-attempt intubations performed by nonexperts (primarily residents, n = 290) did not differ between the groups (84.4% with video laryngoscopy vs 83.2% with direct laryngoscopy; absolute difference 1.2% [95% CI, -6.3% to 8.6%]; P = .76). The median time to successful intubation was 3 minutes (range, 2 to 4 minutes) for both video laryngoscopy and direct laryngoscopy (absolute difference, 0 [95% CI, 0 to 0]; P = .95). Video laryngoscopy was not associated with life-threatening complications (24/180 [13.3%] vs 17/179 [9.5%] for direct laryngoscopy; absolute difference, 3.8% [95% CI, -2.7% to 10.4%]; P = .25). In post hoc analysis, video laryngoscopy was associated with severe life-threatening complications (17/179 [9.5%] vs 5/179 [2.8%] for direct laryngoscopy; absolute difference, 6.7% [95% CI, 1.8% to 11.6%]; P = .01) but not with mild to moderate life-threatening complications (10/181 [5.4%] vs 14/181 [7.7%]; absolute difference, -2.3% [95% CI, -7.4% to 2.8%]; P = .37). Among patients in the ICU requiring intubation, video laryngoscopy compared with direct laryngoscopy did not improve first-pass orotracheal intubation rates and was associated with higher rates of severe life-threatening complications. Further studies are needed to assess the comparative effectiveness of these 2 strategies in different clinical settings and among operators with diverse skill levels. clinicaltrials.gov Identifier: NCT02413723.

Comparative Evaluation of Performance of Videolaryngoscope vs Fastrach Intubating Laryngeal Mask Airway

ABSTRACTIntroductionThis prospective randomized study aimed to compare the effectiveness of the intubating laryngeal maskairway(ILMA) with the King Vision Video laryngoscope in aiding endotracheal intubation in Asian patients with normal airway. King Vision Video laryngoscope is a two-piece design. It has a reusable monitor that attaches to disposable blades. The ILMA is a device specifically designed to be an effective ventilatory device and blind intubating guide in patients with normal and abnormal airways.Materials and methodsAfter ethics committee approval and obtaining patient's written informed consent, 60 American Society of Anesthesiologists grade I and II adult patients undergoing elective surgery requiring intubation were randomly allocated into either the ILMA group (Group L) or the King Vision Video laryngoscope group (Group V).• Thorough preanesthetic checkup was done. Patient was premedicated. Induction was done with propofol 2.5 mg/kg and succinylcholine 1.5 mg/kg. In Group L, ILMA was inserted using a single-handed rotational technique. In the King Vision Video laryngoscope group, intubation was done with videolaryngoscope. Placement was confirmed with auscultation and capnography.• An independent observer recorded the following:– Time taken for successful intubation– Success or failure of the tracheal intubation– Number of attempts needed for successful tracheal intubation– Complication associated with tracheal intubation: bleeding or postoperative sore throat– Hemodynamic response to intubationResults and conclusionKing Vision Video laryngoscope is the more effective technique in aiding endotracheal intubation in patients with normal airways.How to cite this articleHanjura S, Agrawal AP, Agrawal M, Singh V, Vinay V, Ahmed R. Comparative Evaluation of Performance of VideolaryngoscopevsFastrach Intubating Laryngeal Mask Airway. Int J Adv Integ Med Sci 2017;2(1):1-7.

Effect of awake tracheal intubation with intubating larynegeal mask airway on stress responses of hypertensive patients

Objective To evaluate the effect of awake tracheal intubation with intubating larynegeal mask airway(ILMA)on stress responses of hypertensive patients. Methods Sixty hypertensive patients, aged 45-64 yr, with body mass index of 20.3-27.5 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective abdominal surgery under general anesthesia, were divided into 2 groups(n=30 each)using a random number table: direct laryngoscope group(group D)and ILMA group(group I). At 3 min after topical anesthesia(T1), while epiglottis and glottis were exposed with direct laryngoscope in group D or during ILMA insertion in group I(T2), immediately after completion of intubation(T3), when the maximum change in hemodynamics after intubation appeared(at about 15 s after tracheal tubes were placed, T4), and at 5 min after completion of intubation(T5), mean arterial pressure(MAP)and heart rate(HR)were recorded, and blood samples were collected for determination of plasma epinephrine concentrations by radio-immunity method.Successful intubation at first attempt was recorded. Results Compared with the parameters at T1, the MAP, HR and plasma epinephrine concentrations were significantly increased at T2-4 in group D(P 0.05). Compared with group D, the MAP, HR and plasma epinephrine concentrations were significantly decreased at T2-4(P 0.05). Conclusion Awake tracheal intubation with ILMA does not induce strong stress responses and is helpful in avoiding the occurrence of cerebrovascular accidents, thus increasing the safty of awake tracheal intubation in hypertensive patients. Key words: Hypertension; Laryngeal masks; Intubation, intratracheal

A study of laryngeal mask airway aided fiberoptic bronchoscopy-guided tracheal intubation in anticipated difficult airways patients

Objective To estimate the clinical value of fiberoptic bronchoscopy(FOB)-guided tracheal intubation with laryngeal mask airway in anticipated difficult airways patients. Methods Twenty four ASA Ⅰ or Ⅱ patients scheduled for elective general anesthesia surgery with one or several difficult intubation criterion (thyromental distance<6 cm, 1.5 cm<interincisor distance<3 cm, head extension and neck movement limited <80 degree and Mallampati class Ⅲ or Ⅳ) were randomly allocated into 2 groups, 12 cases in each group. Patients in the LMA with FOB group (F group) underwent intubation with laryngeal mask airway with fiberoptic bronchoscope and patients in the direct laryngoscope group (L group) underwent direct intubation with laryngeal scope orally. If failed three times using direct laryngeal scope, intubate according to the F group method. Record patients airway assessment and the MAP and heart rate before(basement) and 3 min after intubation, the intubation time and the times of intubation successful. All the patients were followed up postoperatively for adverse effects like sore throat or hoarseness. Results Airway assessments of the patients in the two groups before intubation had no difference(P>0.05). Compared with the value of basement, the MAP and HR increased significantly in the patients of the L group(P 0.05). There is significant difference between L group and F group(P< 0.05). The first intubation attempt succeeded in 75% of the patients in the F group and the total success rate was 100%, though the success rate was only 25% at the first attempt in the L group and the total rate of success was 50% after three attempts. Six cases failed with direct laryngeal scope after three attempts, then two of them intubated successfully with FOB aided by LMA at the first attempt and four of them succeeded at the second time. The rate of success of first attempt and the total rate of three attempts in the F group were higher than the L group. There was significant difference between the two groups (P<0.05). The duration of intubation in the F group was shorter significantly than that in the L group [(81±9) s vs (161±26) s ](P<0.05). There were two cases in the F group who had mild sore throat. Six cases had moderate to severe sore throat and mild hoarseness and two cases had mild sore throat in the L group. Conclusions Laryngeal mask airway combining with fiberoptic bronchoscope intubation in anticipated difficult airways was effective to improve the success rate of intubation and reduce adverse effects of direct laryngoscope intubation postoperatively. It is worthy of clinical application. Key words: Difficult airway; Intubation, Intratracheal; Laryngeal mask; Fiberoptic bronchoscope

Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients

BackgroundNasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. Material and methods200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. ResultsSuccess rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. ConclusionUse of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.

Comparison of Macintosh, McCoy and Miller Laryngoscope Blades for Intubation- A Prospective Randomised Study

Maintenance of airway during anaesthesia is very important to anaesthesiologist. A prospective, randomized study was conducted in300 patients posted for various surgeries under general anaesthesia with endotracheal intubation to evaluate differences in glottic view, attempts of laryngoscopy and intubation attempts associated with the three blades- Macintosh, McCoy and Miller laryngoscope blade. They were allocated in three groups. In first group laryngoscopy was done with Macintosh blade, in second group with McCoy blade, in third group with Miller blade. In this study it was found that Cormack LehaneGrade III view was more with Macintosh and McCoy blade which was more in comparison to Miller blade. Degree of difficulty in intubation was more with Miller blade in comparison to Macintosh and McCoy blade which is statistically significant ( p value < 0.05).

Comparison of clinical efficacy of Talwalkar fibrelite stylet (TFS) versus direct laryngoscopic technique for orotracheal intubation in adult patients undergoing general anaesthesia

Direct laryngoscopy is well proven and most commonly used technique of orotracheal intubation. Lighted stylet device is also an established technique of orotracheal intubation. Talwalkars fibrelite stylet is a type of lighted stylet deviced for orotracheal intubation. This study compares the clinical efficacy of TFS versus direct laryngoscopic technique for orotracheal intubation. Materials & Methods:Hundred patients were randomized to undergo tracheal intubation with either the Talwalkar fibrelite stylet (TFS group, n = 50) or the direct laryngoscope (LS group, n=50). Intubation was attempted with the assigned airway device. The data collected included the rate of successful endotracheal intubation, the number of attempts required, the duration of the intubation, as well as adverse effects. Statistical Analysis:The statistical analysis of the study was carried out by using ANOVA application, Chi square test, (Pearson Chai square test) wherever applicable. Results: In laryngoscopy group 45(95%) intubations were successful in first attempt, while 5(10%) required second attempt. In TFS group 30(60%) intubations were successful in first attempt and 20 (40%) required second attempt. The duration of successful intubation for the first tracheal intubation attempt was comparable in both groups. All intubations were completed successfully within two intubation attempt. Conclusions: As compared to conventional direct laryngoscopy, TFS is associated with fewer complications and correct positioning of endotracheal tube, hence it can be safe & effective device of intubation. Keywords: laryngoscopy, intubation, Talawalkarfibrelite Stylet, efficacy, general anaesthesia

Degree of cervical mobility differs or not when using alternative way of intubation: Intubating laryngeal mask or classic laryngoscope

BackgroundSpine surgery needs a special consideration as regards minimizing the movement during intubation to avoid the hazards to spinal cord. The present study aims to highlight the preferable technique for cervical intubation. The Intubating Laryngeal Mask Airway (ILMA, Fastrach™ laryngeal mask company, Henle-on-Thomes, U.K.) is a supraglottic device specially designed to be an effective ventilator device and blind intubation guide in patient with normal and abnormal airways.Methods40 patients were involved and randomly assigned to two equal groups according to the used technique of endotracheal intubation: (Group 1): Intubating Laryngeal Mask technique and (Group 2): Direct laryngoscopy technique. Anesthesia was induced using a combination of 1 μg/kg fentanyl, 5 mg/kg thiopental sodium (sleeping dose) and atracurium 0.5 mg/kg (Intubating laryngeal Mask or the Macintosh blade) was used to secure the airway according to the patient group. Meanwhile a continuous videofluoroscopy was recorded. The radiographs were analyzed for movements in the cervical segments C1/2 and C2/3. A reference line was drawn following the dorsal alignment of C2. Another two lines, one connecting the anterior and posterior arch of C1, and one through the basal plate of C3, were drawn to transect the above mentioned reference line.ResultsThe mean cervical spine extension at C1/C2 was 77.2 ± 3.5 before intubation, 74.8 ± 4.3 during intubation, and 75.9 ± 4.2 after intubation for group 1, while it was 74.95 ± 4 before, 65.9 ± 4.4 during, and 68.75 ± 3.9 after intubation for group 2 there was statistically significant difference between LMA group (group 1) and direct laryngoscopy group (group 2) in the motion of cervical spine extension at C1/C2 during and after intubation where the p-value was <0.05.ConclusionThe ILM (Fastrach) is a satisfactory alternative to the currently used methods of airway management in cervical spine injuries and reduces movement of the cervical spine.

Intraocular pressure changes: the McGrath video laryngoscope vs the Macintosh laryngoscope; a randomized trial

Study ObjectiveTo determine the effects of the McGrath Series 5 video laryngoscope on intraocular pressure (IOP) during laryngoscopy. DesignProspective, randomized, double blind. SettingOperating room. PatientsEighty adult patients of American Society of Anesthesiologist physical status 1 scheduled for nonophthalmic elective surgery under general anesthesia. InterventionsThe endotracheal intubation was provided using McGrath series 5 video laryngoscope in MG group (n=40) or Macintosh laryngoscope in M group (n=40). MeasurementsThe IOP of the right and left eyes was measured before and after the laryngoscopic process. Main ResultsThe mean arterial blood pressure values just before laryngoscopy and intubation and after intubation were 77.38±6.18 and 97.38±12.77 in the McGrath video laryngoscope group and 75.85±7.88 and 99.12±14.30 in the Macintosh laryngoscope group, respectively. The IOP values of the left eye after intubation and at the 5th and the 10th minutes in the Macintosh laryngoscope group were found to be significantly higher than those in the McGrath video laryngoscope group (P=.019, P=.019, and P=.007, respectively). In addition, the IOP values of the right eye were found to be higher after intubation and at the 5th and the 10th minutes in the Macintosh laryngoscope group, compared to the McGrath video laryngoscope group (P=.009, P=.021, and P=.011, respectively). The mean IOP values for the left eye just before laryngoscopy and intubation and after intubation were 10.65±2.52 and 15.57±3.62 in the McGrath video laryngoscope group, and for the right eye, they were 10.60±1.64 and 17.17±2.38 in the Macintosh laryngoscope group, respectively. ConclusionThe McGrath Series 5 video laryngoscope may provide a lower IOP level compared to the Macintosh laryngoscope in an otherwise healthy, young patient population.

TotalTrack video intubating laryngeal mask in super-obese patients - series of cases.

BackgroundSuper-obese patients are at increased risk of difficult mask ventilation and difficult intubation. Therefore, devices that allow for simultaneous ventilation/oxygenation during attempts to visualize the entrance to the larynx, increase patient safety. TotalTrack video intubating laryngeal mask is a new device that allows for ventilation during intubation efforts.Patients and methodsTwenty-four super-obese patients (body mass index >50 kg/m2) were divided into two subgroups: intubation efforts using 1) TotalTrack and 2) Macintosh blade standard laryngoscope in induction of general anesthesia. Visualization and successful intubation was evaluated for both groups with ventilation and post-mask complications additionally evaluated for TotalTrack.ResultsIn all cases in the TotalTrack group, the Cormack-Lehane score was 1, ventilation and intubation was successful in 11/12 patients. No hypoxia during intubation efforts was recorded. No serious complications of use of TotalTrack were observed. In the Macintosh blade laryngoscope group, all patients were intubated, but the Cormack-Lehane score was 2 in four cases, and 3 in three cases.ConclusionTotalTrack video intubating laryngeal mask is a device that allows for better visualization of the larynx compared to the standard Macintosh blade laryngoscope, it provides effective ventilation/oxygenation and intubation in super-obese patients.

Comparison of Cormack Lehane Grading System and Intubation Difficulty Score in Patients Intubated by D-Blade Video and Direct Macintosh Laryngoscope: A Randomized Controlled Study

D-blade is a relatively new device in the field of videolaryngoscopy, designed for airway management by enabling indirectoscopic glottic view. In our study, we investigated efficiency of D-blade in comparison with direct Macintosh laryngoscope (gold standard). Fifty-two adult patients with normal airway scheduled for elective surgery in general anesthesia were randomly assigned in D-blade video or direct Macintosh group. In the first video group, patients were laryngo-scoped and intubated by D-blade, and in the second group laryngoscopy and intubation were performed by Macintosh laryngoscope. Glottic view was evaluated according to Cormack Lehane grading system (C-L), while duration of intubation and easiness of intubation were evaluated according to the intubation difficulty score (IDS). Additionally, hemodynamic parameters were recorded before and after induction. There were no statistically significant between-group differences in time to intubation, easiness of endotracheal tube insertion, C-L, and IDS. In comparison with direct Macintosh laryngoscope, D-blade showed similar but still favorable characteristics. In our opinion, D-blade is a useful device in airway management and should be used in daily anesthesiologist work.

A Comparison of Cervical Spine Movement during Tracheal Intubation when Using a Pentax Airway Scope or the GlideScope Video Laryngoscopy with Fluoroscopy

Background: Cervical spine movement does occur during intubation and in patients with cervical spine injuries; the result can have devastating neurologic outcomes. Video laryngoscopes provide a better view of the glottis and less cervical spine movement. Objective: The purpose of this study is a comparison of cervical spine motion during tracheal intubation between the GlideScope video laryngoscopy and the Pentax Airway Scope. The primary outcome is the difference in cervical spine motion. The cervical spine motion was recorded using fluoroscopic video and the angular displacement of the spine was measured by a radiologist. The secondary outcome is the hemodynamic changes after intubation. Methods: Into Pentax Airway Scope and GlideScope video laryngoscopy groups, we randomly allocated two hundred and one patients who underwent elective non-cardiac surgery and require general anesthesia with tracheal intubation. All patients underwent general anesthesia with the same induction medications, muscle relaxant and narcotics. During airway maneuvers, a fluoroscopy was used to record cervical spine movements from the occiput down to C5 level. Vital signs were recorded after successful intubation. All images were measured by the radiologist consultant. Using the classic AutoCAD program and the angles between adjacent levels were calculated and shown as a number. Results: The Pentax Airway Scope and GlideScope induced the greatest cervical spine movement in the C1-C2 segments, during each stage of the laryngoscopies. Cervical spine motion was not statistically different using either video laryngoscope at the five segments studied. The hemodynamic changes after intubation showed after the first and second minutes and there were significantly less systolic blood pressure and diastolic blood pressure changes in the Pentax group. Conclusion: Cervical spine movement during tracheal intubation is not significant difference between the Pentax Airway Scope and the GlideScope.

Comparison of three intubation methods in patients with restricted cervical movement

The clinical data of 96 intubated inpatients with restricted cervical movement from June 2012 to June 2014 were retrospectively reviewed.They were divided into fiberoptic bronchoscope, Shikani optical stylet and McCoy laryngoscope groups (n=32 each). Identical anesthesia induction was applied.Compared with McCoy laryngoscope group, the total success rate and one-time success rate of tracheal intubation was higher in Shikani optical stylet group, tracheal intubation time was shorter and postoperative complications were fewer (P 0.05). Shikani optical stylet intubation has a less impact on hemodynamics and intubation time is short so that it is ideal for surgical patients with restricted cervical spine. Key words: Intubation, intratracheal; Spondylosis, cervical vertebrae

Multimodal imaging using optical coherence tomography and endolaryngeal ultrasonography in a new rabbit VX2 laryngeal cancer model.

Optical coherence tomography (OCT) provides ultrahigh-resolution imaging of tissues within a depth of a few millimeters, whereas ultrasonography provides good imaging further below the surface. We aimed to develop a minimally invasive rabbit model of VX2 laryngeal cancer, suitable for these two imaging modalities through a transoral approach. We also sought to study the utility of combined OCT and endolaryngeal ultrasonography (EUS) for evaluation of early and advanced laryngeal cancer, using this model. VX2 tumor suspension was inoculated into the vocal folds of ten rabbits by injection through the trans-thyrohyoid membrane. The tumor model was characterized by rigid laryngoscopy and the tumor generation rate was 80% (8/10). Correlation between frequency-domain OCT and high-frequency EUS were used to visualize laryngeal tumors in the area of protruding mass formation in four rabbits, one week after injection (group A) and the remaining four rabbits two weeks after injection (group B). A small submucosal tumor was observed with rigid laryngoscopy in group A, and pathologic evaluation showed that the tumor was close to the basement membrane of the vocal fold mucosa, but had not invaded. OCT confirmed that the lining of the mucosa and basement membrane of the vocal fold was not broken, but the mucosa had thinned at the most elevated ridge. However, these lesions were not detected by EUS, and the overall shape of the tumor could not be clearly identified by EUS. A large tumor filling the laryngeal lumen was observed with rigid laryngoscopy in group B, and nearly the entire vocal fold, including the paraglottic space, was found to be involved on pathologic analysis. Distinguishing between normal structures and tumor was difficult using OCT; however, EUS confirmed the overall shape, size, and extent of the tumor, and the paraglottic space and thyroid cartilage were shown to be intact. This study is the first experimental trial, assessing the value of multimodal imaging using OCT and EUS in a rabbit VX2 laryngeal tumor model. Combining OCT and EUS helped to identify changes in laryngeal mucous membranes, and could potentially be used to identify laryngeal tumors and predict how tumors progress. This combined modality could help in determining tumor extent, assisting in diagnosis, and establishing a treatment plan for laryngeal cancer.

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

BackgroundEvidence to predict difficult intubation remains scarce in the emergency department (ED) setting. A previously defined clinical decision rule, the modified LEMON criteria, may provide a reliable and reproducible means of identifying difficult intubations. We aimed to prospectively evaluate the external validity of the modified LEMON criteria in the EDs. MethodsWe conducted a 13-center prospective observational study, the second Japanese Emergency Airway Network study. We prospectively collected data on all patients undergoing intubations in the ED from February 2012 through September 2014. The primary outcomes were sensitivity, specificity, and predictive values of the modified LEMON criteria for predicting difficult intubation (≥2 attempts by emergency attending physicians or anesthesiologists). ResultsThe database recorded a total of 4034 encounters (capture rate, 96%) in the EDs. Of these, 3313 patients (84%) underwent the intubation attempt with a direct laryngoscope and 610 patients (16%) with a video laryngoscope. The proportion of difficult intubation was 5.4% (95% confidence interval [CI], 4.7%-6.2%) in the direct laryngoscope group and 7.4% (95% CI, 5.6%-9.7%) in the video laryngoscope group. The sensitivity was 85.7% (95% CI, 79.3%-90.4%) with direct laryngoscope and 94.9% (95% CI, 83.5%-98.6%) with video laryngoscope. The specificity was 47.6% (95% CI, 47.2%-47.9%) and 40.3% (95% CI, 39.4%-40.6%), respectively. The negative predictive value was 98.2% (95% CI, 97.5%-98.8%) and 99.0% (95% CI, 96.6%-99.7%), respectively. ConclusionsIn this multicenter prospective study, we found a high sensitivity and a negative predictive value of the modified LEMON criteria for predicting difficult intubation. The modified LEMON might assist ED providers in better identifying difficult intubations.

Laryngoscopy facilitates successful i-gel insertion by novice doctors: a prospective randomized controlled trial

This study investigated the hypothesis that the efficacy of insertion of the supraglottic device i-gel(®) (i-gel) can be improved by laryngoscopy and can provide better sealing pressure in anesthetized patients by novice doctors. Eighty-four adult patients were assigned to the laryngoscopy group (L group, 42 patients) or control group (i.e., conventional blind insertion; C group, 42 patients). Anesthesia was induced with propofol and remifentanil, and rocuronium 0.6-0.9 mg/kg was administered. The number of attempts until successful insertion, sealing pressure, vital sign changes upon insertion, and subjective difficulty of insertion by novice doctors were compared between the groups. The total number of insertion attempts was one (L group 36 cases, C group 23 cases), two (L group 6 cases, C group 18 cases), and three (L group 0 case, C group 1 case), with significant differences between groups (P = 0.007). The sealing pressure was significantly higher in the L group than in the C group (L group 22.3 ± 2.6 cmH2O, C group 19.5 ± 2.7 cmH2O, P < 0.001). Vital sign changes (heart rate and blood pressure) did not differ between the two groups. The subjective difficulty of insertion was significantly lower in the L group than in the C group (L group 26.8 ± 11.8 mm, C group 47.0 ± 15.1 mm, P < 0.001). The incidence of postoperative pharyngeal pain was significantly lower in the L group than in the C group (P < 0.001), while the incidence of hoarseness did not differ between the two groups (P = 1.00). Our results suggest that laryngoscopy facilitates i-gel insertion by novice doctors, as reflected in the rate of successful insertions, higher sealing pressure, and lower subjective difficulty of insertion in anesthetized patients.

Comparison of video laryngoscopy versus direct laryngoscopy during urgent endotracheal intubation: a randomized controlled trial.

In the critically ill undergoing urgent endotracheal intubation by direct laryngoscopy, multiple attempts are often required with a higher complication rate due to the urgency, uncontrolled setting, comorbidities, and variability in expertise of operators. We hypothesized that Glidescope video laryngoscopy would be superior to direct laryngoscopy during urgent endotracheal intubation. Single-center prospective randomized controlled trial. Beth Israel Medical Center, an 856-bed urban teaching hospital with a 16-bed closed medical ICU. Of 153 consecutive patients undergoing urgent endotracheal intubation by pulmonary and critical care medicine fellows, 117 met inclusion criteria. Patients undergoing urgent endotracheal intubation were randomized to Glidescope video laryngoscopy or direct laryngoscopy as the primary intubation device. The primary outcome measure was the rate of first-attempt success. Acute Physiology and Chronic Health Evaluation II scores were similar between groups (20.9 ± 8.2 vs 19.9 ± 7.9). First-attempt success was achieved in 74% of the Glidescope video laryngoscopy group compared with 40% in the direct laryngoscopy group (p < 0.001). All unsuccessful direct laryngoscopy patients were successfully intubated with Glidescope video laryngoscopy, 82% on the first attempt. There was no significant difference in rates of complications between direct laryngoscopy and Glidescope video laryngoscopy: esophageal intubations (7% vs 0%; p = 0.05), aspiration events (7% vs 9%; p = 0.69), desaturation (8% vs 4%; p = 0.27), and hypotension (13% vs 11%; p = 0.64). Glidescope video laryngoscopy improves the first-attempt success rate during urgent endotracheal intubation performed by pulmonary and critical care medicine fellows when compared with direct laryngoscopy.