Macintosh Laryngoscope For Tracheal Intubation Research Articles

Comparison of UESCOPE VL 400, I-View, Non-Channeled Airtraq Videolaryngoscopes and Macintosh Laryngoscope for Tracheal Intubation in Simulated Out-of-Hospital Conditions: A Randomized Crossover Manikin Study.

The aim of the study was to test the hypothesis that the results obtained with three different types of video laryngoscopes (UESCOPE VL-400, I-View, Non-Channeled Aitraq) with and without an endotracheal stylet should be better than the results obtained with a Macintosh laryngoscope in a simulated out-of-hospital scenario by a person without clinical experience. Primary outcome measures were the time taken to successfully achieve tracheal intubation (TI). Secondary outcomes included the grade of glottic view (Cormack and Lehane grades 1-4), the incidence of successful TI, the number of audible dental clicks indicating potential dental damage, the level of effort required to perform TI, and the operator's comfort during the procedure. The time required to achieve tracheal intubation successfully was significantly longer with the Macintosh laryngoscope and Airtraq than with the other video laryngoscopes. The use of the stylet significantly reduced the time required for tracheal intubation with the Macintosh laryngoscope (21.8 sec. vs. 24.0 sec., p = 0.026), UESCOPE VL 400 (18.1 sec. vs. 23.4 sec., p = 0.013), and Airtraq (22.7 sec. vs. 34.5 sec., p < 0.001). There were no significant differences in intubation time when using the I-View with or without stylets. No differences were observed in the Cormack-Lehane grading. The success rate of intubation was 100% for the Macintosh and I-View laryngoscopes used with or without stylets and for the UESCOPE VL 400 and Airtraq laryngoscopes used with stylets. Without stylets, the success rate of intubation was 96.6% for the UESCOPE VL 400 and 86.6% for the Airtraq. There were no significant differences in the risk of dental damage between the Macintosh, UESCOPE VL 400, I-View, and Airtraq laryngoscopes, regardless of the use of stylets (without and with stylets). The use of stylets significantly reduced dental damage only for the Airtraq laryngoscope: 8 (26.6%) vs. 2 (6.6%). Statistically significant differences in perceived exertion were observed between the mentioned laryngoscopes, both with and without stylets. However, there were no differences in the comfort of use between the laryngoscopes, regardless of the use of stylets (without and with stylets. The use of stylets led to better comfort in the case of the Macintosh (2.5 vs. 3, p = 0.043) and UESCOPE VL 400 (2 vs. 3, p = 0.008) laryngoscopes. In our study, the I-View and UESCOPE VL-400 video laryngoscopes provided better intubation results than the Macintosh laryngoscope in terms of time needed to intubate, glottis visibility, and reduction in dental damage. The use of the stylet did not significantly improve the intubation results compared to the results obtained in direct laryngoscopy. Due to the small study group and the manikin model, additional studies should be performed on a larger study group.

Comparison of McGrath Videolaryngoscope versus Macintosh Laryngoscope in Tracheal Intubation: An Updated Systematic Review.

(1) Background: In the last few years, many randomized controlled trials (RCTs) have compared direct Macintosh laryngoscopy with McGrath videolaryngoscopy in order to assess the potential benefits of the latter; the results were sometimes controversial. (2) Methods: We conducted a comprehensive literature search to identify our articles according to inclusion and exclusion criteria: to be included, each study had to be a prospective randomized trial or comparison between the McGrath videolaryngoscope and the Macintosh laryngoscope in an adult population. We did not include manikin trials or studies involving double-lumen tubes. (3) Results: 10 studies met the inclusion criteria necessary. In total, 655 patients were intubated with the McGrath and 629 with the Macintosh. In total, 1268 of 1284 patients were successfully intubated, showing equivalent results for the two devices: 648 of 655 patients with the McGrath videolaryngoscope and 620 of 629 patients with the Macintosh laryngoscope. No differences were noted in terms of hemodynamic changes or the incidence of adverse events. (4) Conclusions: We can assert that the McGrath videolaryngoscope and Macintosh laryngoscope, even if with equivalent tracheal intubation results, supplement each other.

Comparison of Airtraq™ video-laryngoscope and Macintosh laryngoscope for tracheal intubation in adults—a randomised study

BackgroundAirway management by intubation is considered a major responsibility and vital skill for anaesthesiologists. Direct laryngoscopy and endotracheal intubation under vision continues to be the gold standard for airway management. Though conventional laryngoscopy is done with Macintosh blade, it has its own drawbacks. The Airtraq™ is a tube/guide channelled video-laryngoscope and can be used in patients with normal as well as difficult airway. On literature review, studies comparing intubation time with Airtraq™ and Macintosh laryngoscopes have shown heterogeneous results. Therefore, the present study was designed to compare the Airtraq™ video-laryngoscope and Macintosh laryngoscope for tracheal intubation in adults.ResultsThe median time to intubation was significantly longer in group A [45 (27–77) s] than in group M [24 (21–26) s] (p < 0.001). In both groups, 96% patients had POGO score 75–100% and CL grade I. Intubation was noted to be easy in 88% cases in group A and 92% in group M (p > 0.05). Three cases in group A required a second attempt for successful intubation, whereas in group M, all cases were intubated in the first attempt (p > 0.05). Hemodynamic parameters and complications were comparable among the groups (p > 0.05).ConclusionsAirtraq™ video-laryngoscope took longer time for intubation than Macintosh laryngoscope. However, both the devices were similar in terms of glottic view, ease of intubation, number of intubation attempts, incidence of failed intubation, hemodynamic changes, and complications. The overall performance of Airtraq™ video-laryngoscope was similar to Macintosh laryngoscope in patients having normal airways.

Comparison of McGrath videolaryngoscope with conventional Macintosh laryngoscope for tracheal intubation in pediatric patients with normal airway

Background and Aims: Videolaryngoscopes have attained prime importance in securing the airway in children in the present era. McGrath videolaryngoscope is available with single-use non-channeled fog-free disposable blades of various sizes showing its efficacy for intubation in adults but still lacunae in data related to children.Materials and Methods: In this prospective randomized controlled trial, a total of 88 children of the American Society of Anesthesiologists Grade I and II aged 1–10 years, weighing 10–20 kg undergoing general anesthesia were enrolled. Using the sealed envelope technique, the children were randomly allocated between Group G, in whom McGrath videolaryngoscope and Group M, in whom Macintosh laryngoscope was used for intubation. The primary aim was to compare intubation time between the two videolaryngoscopes. The secondary outcomes included glottic exposure time, Cormack and Lehane grading, number of attempts of intubation, intubation difficulty scale and complications. Statistical analysis was done using MedCalc software. The Student's t-test and Chi-square test were used for quantitative and categorical data, respectively.Results: The mean intubation time was comparable in both the groups (18.14 ± 17.80 s in Group G vs. 17.30 ± 16.74 s in Group M, P = 0.821). The mean time to glottic exposure was shorter (5.66 ± 4.58 vs. 8.50 ± 5.59 s, P = 0.0108) with decreased number of attempts of tube insertion and less incidences of trauma observed in patients with Group G as opposed to Group M. The Cormack and Lehane grading showed better glottic view in Group G.Conclusion: McGrath videolaryngoscope is as useful as the Macintosh laryngoscope for intubation in children with the added advantages of a better view of the larynx, lesser attempts to intubation, and fewer incidence of trauma.

Comparison of the Airtraq video laryngoscope versus Macintosh laryngoscope for tracheal intubation in the pediatric patients

Securing a patent airway in patients undergoing general anesthesia is routinely done using gold standard methods of direct laryngoscopy with a Macintosh or Miller laryngoscope blade in children. However, this technique has several limitations. Video laryngoscopes provide the user with a better view of the larynx. We undertook this prospective, randomized, controlled trial to determine the intubation time of Airtraq compared with Macintosh laryngoscope in pediatric patients, number of intubation attempts, quality of visualization, optimization maneuvers, easiness of intubation, and cardiovascular changes during intubation. A total of 80 pediatric patients of either sex, between ages three to twelve years, belonging to American Society of Anesthesiologists (ASA) status I and II, who were divided equally into two groups using the sealed envelope technique. Patients were randomly assigned to be intubated with either Airtraq (Group A) or Macintosh laryngoscope (Group M). The difference between the time required for intubation within the two groups was significant (p &lt; 0.05), optimization maneuvers were more required for Group M than Group A (p &lt; 0.01). Quality of visualization was better in Group A compared with patients in Group M (p &lt; 0.05).

Comparison of C-MAC D-Blade with macintosh laryngoscope for endotracheal intubation in patients with cervical spine immobilization: A randomized controlled trial

BackgroundRecently, indirect laryngoscopes have emerged as an important tool in managing a difficult airway but the literature is insufficient on the comparison of C-MAC D-Blade with Macintosh for tracheal intubation during manual-in-line stabilization. We compared the efficacy of C-MAC D-blade with Macintosh laryngoscope for tracheal intubation in patients with manual-in-line stabilization. MethodsEighty adult patients undergoing elective surgery under general anesthesia were intubated after application of MILS using C-MAC D-Blade (n = 40) or Macintosh laryngoscope (n = 40) as per group allocation. Intubation Difficulty Scale was the primary outcome. We also recorded the duration of laryngoscopy, modified Cormack-Lehane grading, time taken for intubation, total intubation time, optimizing maneuvers required, number of attempts, and complications. ResultThe median intubation difficulty score (inter-quartile range) was significantly lower with C-MAC D-Blade[(0, 0–1) vs (3, 2–3)](P < 0.0001). C-MAC D-Blade provided significantly better glottic view in lesser time (10 s[7.5–13]vs9 [7–10]) (P = 0.02) without optimum external laryngeal manipulation(p = 0.0001). Time taken for tracheal intubation was longer in the C-MAC D-Blade, though, the total duration of tracheal intubation was comparable in both the groups (P = 0.069). ConclusionC-MAC D-Blade is superior to the Macintosh laryngoscope in terms of lower Intubation Difficulty Score in patients undergoing tracheal intubation with cervical spine immobilization.

Evaluation of the McGrath MAC™ and Macintosh laryngoscope for tracheal intubation

Evaluation of the McGrath MAC™ and Macintosh laryngoscope for tracheal intubation

Application of second-generation Shikani optical stylet in critically ill patients undergoing cerebral aneurysm embolization.

ObjectiveThis study was performed to compare the clinical value of the second-generation Shikani optical stylet with that of the Macintosh laryngoscope for tracheal intubation of patients undergoing cerebral aneurysm embolization.MethodsThirty-six patients who underwent cerebral aneurysm embolization were included. The intubation time, intubation success rate, blood oxygen saturation, heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured. Adverse reactions during tracheal intubation and the local tissue injury rate were recorded. Comparisons between the groups were performed with one-way analysis of variance.ResultsThe heart rate, SBP, and DBP upon tracheal intubation and at 1 and 3 minutes were significantly higher in the Macintosh laryngoscope group than in the Shikani optical stylet group. The time to completion of tracheal intubation was significantly shorter and the tissue injury rate was significantly lower in the Shikani optimal stylet group than in the Macintosh laryngoscope group.ConclusionsThe second-generation Shikani optical stylet is a simple, safe, and reliable tool for tracheal intubation in critically ill patients undergoing cerebral aneurysm embolization.

Comparison of King Vision video laryngoscope (channeled blade) with Macintosh laryngoscope for tracheal intubation using armored endotracheal tubes.

Background and Aims:During direct laryngoscopy (DL), intubation using armored endotracheal tubes (ETTs) requires help of bougies, stylets, or Magill's forceps, which leads to unnecessary prolongation in the intubation times. The channeled blade of King Vision (KV) video laryngoscope is likely to obviate the need of these equipments for a successful intubation using armored tubes.Material and Methods:After approval from Institutional Ethics Committee and informed consent, 100 patients were randomized to receive endotracheal intubation using armored ETTs either with KV video laryngoscope (VL) channeled blade or with Macintosh laryngoscope. Time to intubation, success rate, time for best glottis view, number of attempts, optimization maneuvers, or complications if any were recorded. Ease of device use was also assessed in terms of insertion, glottis visualization, and intubation. Continuous variables were tested using unpaired t-test and categorical variables with Pearson's Chi-square test. P ≤ 0.05 was considered significant.Result:First attempt success rate was 92% in group KV and 74% in group DL (P = 0.017). Time for successful intubation was less in group KV as compared with group DL (P < 0.0001). Optimization maneuvers such as “BURP” was needed in three patients of group KV and 11 patients of group DL (P = 0.0218). Bougie was needed in 13 patients of group DL and none from group KV (P = <0.001). Ease of device use was similar in the two groups.Conclusion:KVVL offers faster intubating conditions for tracheal intubation requiring armored ETTs in comparison to DL using Macintosh blade.

C-MAC videolaryngoscope versus Macintosh laryngoscope for tracheal intubation: A systematic review and meta-analysis with trial sequential analysis

Study objectiveThe C-MAC laryngoscope (C-MAC) is a videolaryngoscope that uses a modified Macintosh blade. Although several anecdotal reports exist, it remains unclear whether the C-MAC is superior to the Macintosh laryngoscope for tracheal intubation in the adult population. DesignSystematic review, meta-analysis. SettingOperating room, intensive care unit. MeasurementsFor inclusion in our analysis, studies had to be prospective randomised trials which compared the C-MAC with the Macintosh laryngoscope for tracheal intubation in the adult population. Data on success rates, intubation time, glottic visualisation and incidence of external laryngeal manipulations (ELM) during tracheal intubation were extracted from the identified studies. In subgroup analysis, we separated those parameters to assess the influence of the airway condition (normal or difficult) and laryngoscopists (novice or experienced). We conducted a trial sequential analysis (TSA). Main resultsSixteen articles with 18 trials met the inclusion criteria. The C-MAC provided better glottic visualisation compared to the Macintosh (RR, 1.08; 95% CI, 1.03–1.14). TSA corrected the CI to 1.01–1.19; thus, total sample size reached the required information size (RIS). Success rates and intubation time did not differ significantly between the laryngoscopes. TSA showed that total sample size reached the RIS for success rates. The TSA Z curve surpassed the futility boundary. The C-MAC required less ELM compared to the Macintosh (RR, 0.83; 95% CI, 0.72–0.96). TSA corrected the CI to 0.67–1.03; 52.3% of the RIS was achieved. In difficult airways, the C-MAC showed superior success rates, glottic visualisation, and less ELM compared to the Macintosh. Among experienced laryngoscopists, the C-MAC offered better glottic visualisation with less ELM than the Macintosh. ConclusionsThe C-MAC provided better glottic visualisation and less ELM (GRADE: Very Low or Moderate), with improved success rates, glottic visualisation, and less ELM in difficult airways.

McGrath videolaryngoscope versus Macintosh laryngoscope for tracheal intubation: A systematic review and meta-analysis with trial sequential analysis

Study objectiveThe McGrath laryngoscope is a novel self-contained videolaryngoscope with a single-use blade. There are several anecdotal reports that the McGrath is superior to the Macintosh laryngoscope for tracheal intubation. However this remains controversial. DesignMeta-analysis and systematic review. SettingOperating room or intensive care unit. MeasurementsA comprehensive literature search was conducted to identify clinical trials that met our inclusion criteria. To qualify, studies had to be prospective randomized trials comparing tracheal intubation between the McGrath and the Macintosh in an adult population. We extracted data on success rate, glottic visualization during intubation, and intubation time from the studies identified. In subgroup analysis, we assessed the influence on each of these parameters which included airway condition (normal or difficult) and operator (novice or experienced). We then conducted a trial sequential analysis (TSA). Main resultsFourteen articles met our inclusion criteria. The McGrath offered better glottic visualization than the Macintosh (risk ratio, 1.34; 95% confidence interval (CI), 1.25–1.45). However, the McGrath required longer intubation time (mean difference, 10.1s; CI, 2.74–17.5) and demonstrated similar success rate of tracheal intubation (risk ratio, 1.00; CI, 0.95–1.05) compared to the Macintosh. TSA showed that total sample size reached the required information size (RIS) in glottic visualization and success rate. However, only 15.1% of the RIS was achieved in intubation time. In the subgroup analysis for airway condition and operator experience level, there were no subgroup differences in both glottic visualization and intubation time. ConclusionsOur meta-analysis suggests that the McGrath is superior to the Macintosh in terms of glottic visualization (GRADE: moderate). However, it significantly extends intubation time (GRADE: very low) and its success rate (GRADE: very low) for tracheal intubation is not excellent. TSA suggests that further studies are necessary to confirm the results of intubation time.

Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis

Study objectiveVideolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity. DesignSystematic review, Meta-analysis SettingOperating room, Obesity patients MeasurementsData on success rate, intubation time, and glottic visualisation during tracheal intubation were extracted from the identified studies. In a subgroup analysis, we also compared the parameters for videolaryngoscopes with a tracheal tube guide channel and those without a tracheal tube guide channel. Data from individual trials were combined, and the DerSimonian and Laird random-effect model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) as well as the corresponding 95% confidence intervals (CI). Main resultsEleven articles describing 13 trials met the inclusion criteria. The performance of videolaryngoscopes was superior to that of the Macintosh laryngoscope for all outcomes. (Success rate; RR=1.11, 95% CI 1.04 to 1.18, p=0.001, I2=63%, Intubation time; WMD=−16.1, 95% CI −31.1 to −1.10, p=0.04, I2=97%, Glottic visualisation; RR=1.19, 95% CI 1.09 to 1.30, p<0.0001, I2=76%) In the subgroup analysis, the performance of both types of videolaryngoscopes (with and without a tracheal tube guide channel) was superior to that of the Macintosh laryngoscope, except for intubation time with the videolaryngoscopes without a tracheal tube guide channel. ConclusionsVideolaryngoscopes were superior to the Macintosh laryngoscope for tracheal intubation in adults with obesity. (GRADE score: low or very low.)

Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation in 2000 patients undergoing general anaesthesia: the randomised multicentre EMMA trial study protocol

IntroductionThe direct laryngoscopy technique using a Macintosh blade is the first choice globally for most anaesthetists. In case of an unanticipated difficult airway, the complication rate increases with the number...

Randomized Comparison of the Pentax AirWay Scope and Macintosh Laryngoscope for Tracheal Intubation in Patients With Obstructive Sleep Apnoea

Abstract Background Patients with obstructive sleep apnoea (OSA) can often present difficulties in intubation. This study aimed to compare the efficacy of the Pentax AirWay Scope (AWS) with that of the Macintosh laryngoscope for tracheal intubation in patients with OSA. Methods Forty-six patients undergoing uvulopalatopharyngoplasty were randomly allocated to tracheal intubation with either the Macintosh laryngoscope or the Pentax AWS. In all patients, intubation was performed by one of two anaesthetists experienced with both devices. The primary and secondary endpoints of this study were the intubation difficulty scale (IDS) score and success/failure and duration of the first successful intubation attempt. Results With the Pentax AWS, tracheal intubation was successful on the first attempt in all patients whereas four patients required repeated attempts at intubation with the Macintosh laryngoscope. The IDS score was significantly lower using the Pentax AWS and glottic exposure was better (the Cormack and Lehane grade 1 in all patients vs grade 2 or higher in all patients, P Conclusions In this study of patients with OSA, tracheal intubation by experienced anaesthetists was facilitated using the Pentax AWS compared with the Macintosh laryngoscope.

Randomized comparison of the Pentax AirWay Scope and Macintosh laryngoscope for tracheal intubation in patients with obstructive sleep apnoea

BackgroundPatients with obstructive sleep apnoea (OSA) can often present difficulties in intubation. This study aimed to compare the efficacy of the Pentax AirWay Scope (AWS) with that of the Macintosh laryngoscope for tracheal intubation in patients with OSA. MethodsForty-six patients undergoing uvulopalatopharyngoplasty were randomly allocated to tracheal intubation with either the Macintosh laryngoscope or the Pentax AWS. In all patients, intubation was performed by one of two anaesthetists experienced with both devices. The primary and secondary endpoints of this study were the intubation difficulty scale (IDS) score and success/failure and duration of the first successful intubation attempt. ResultsWith the Pentax AWS, tracheal intubation was successful on the first attempt in all patients whereas four patients required repeated attempts at intubation with the Macintosh laryngoscope. The IDS score was significantly lower using the Pentax AWS and glottic exposure was better (the Cormack and Lehane grade 1 in all patients vs grade 2 or higher in all patients, P<0.0001). Average duration of successful intubation was shorter (12.9 vs 29.9 s, P=0.0002), and fewer manoeuvres were needed to improve the glottic exposure (0 in all patients vs 1 or more in 16 patients, P<0.0001) with the Pentax AWS, compared with the Macintosh laryngoscope. ConclusionsIn this study of patients with OSA, tracheal intubation by experienced anaesthetists was facilitated using the Pentax AWS compared with the Macintosh laryngoscope.

A comparison of the Trachway intubating stylet and the Macintosh laryngoscope in tracheal intubation: a manikin study

The Trachway intubating stylet (Trachway(®)), when used by experienced anesthesiologists, has been shown to be effective for difficult airway management. We evaluated the efficacy of this intubating stylet for tracheal intubation in a manikin when used by experienced laryngoscopists with little experience using this device. Thirty-eight nurse anesthesiologists intubated the trachea of a manikin (Laerdal Airway Management Trainer) with a Trachway intubating stylet or a Macintosh laryngoscope in easy and difficult laryngoscopy scenarios. The duration of the intubation attempts, success rates, dental trauma, and ease of use (0=very easy; 10=very difficult) were recorded. The primary endpoint was the duration of the successful tracheal intubation attempt in the difficult laryngoscopy scenario. Data are presented as means (SD). Both devices resulted in similar tracheal intubation performance in the easy laryngoscopy scenario. However, the Trachway intubating stylet provided shorter intubation times (20.8±5.6 vs. 25.5±7.3s; p=0.003) and easier intubations (2.4±1.6 vs. 5.7±1.8; p<0.001) compared with the Macintosh laryngoscope in the difficult laryngoscopy scenario. All tracheal intubations were successful and no dental trauma was observed when using the Trachway intubating stylet. We concluded that the Trachway intubating stylet, when used by novices, is effective in both easy and difficult laryngoscopy scenarios. In difficult laryngoscopy scenarios, this device provided faster, easier, and less traumatic intubation than the Macintosh laryngoscope.

Tracheal intubation during chest compressions using Pentax-AWS®, GlideScope®, and Macintosh laryngoscope: a randomized crossover trial using a mannequin

A randomized crossover trial was conducted to compare the performance of two videolaryngoscopes (Pentax-AWS(®), GlideScope(®)) with the Macintosh laryngoscope for tracheal intubation during continuous chest compressions on a mannequin. Thirty-two inexperienced junior interns performed tracheal intubations on an advanced life support simulator with either a normal or difficult airway scenario. The sequence of intubating devices and airway difficulty were randomized. The following data were measured and recorded: time to complete tracheal intubation (primary end point), overall success rate, time to visualize the vocal cords, percentage of glottic opening, dental compression, and ease of intubation. With a normal airway, the times (median [interquartile range]) to complete tracheal intubation were shorter with the Pentax-AWS (12.1 [10.1-14.4] sec) and the GlideScope (14.3 [12.4-17.6] sec) than with the Macintosh laryngoscope (16.5 [13.1-22.1] sec) (P<0.03 for both). The time difference between the two videolaryngoscopes was not statistically significant. With a difficult airway scenario, the times to complete tracheal intubation were 13.9 [10.9-20.4] sec, 19.2 [16.4-32.3] sec, and 30.1 [21.0-56.5] sec, respectively (P<0.05 for all differences). The videolaryngoscopes were also more effective than the Macintosh laryngoscope with respect to secondary outcomes. The two videolaryngoscopes were superior to the Macintosh laryngoscope in terms of performing tracheal intubation during continuous chest compressions on a mannequin. In a difficult airway scenario simulating cardiac arrest, the Pentax-AWS performed better than the GlideScope.

Airway Scope and Macintosh Laryngoscope for Tracheal Intubation in Patients Lying on the Ground

Direct laryngoscopy of a patient lying on the ground is difficult because the intubator's head is far above the head of the patient, making alignment of the intubator's visual axis with the patient's tracheal axis difficult. The Airway Scope is a laryngoscope designed to facilitate tracheal intubation without requiring alignment of the oral, pharyngeal, and tracheal axes. We thus tested the hypothesis that intubation with the Airway Scope is faster than with the Macintosh laryngoscope in subjects lying on the ground. Adult surgical patients were enrolled. After anesthesia induction, direct laryngoscopy was performed and airway characteristics noted. Patients were randomly assigned to tracheal intubation by either the Airway Scope (n = 50) or the Macintosh laryngoscope (n = 50). The intubator performed tracheal intubation from a table positioned at the same height as that of the operating table, thus simulating intubating on the ground. An unblinded observer recorded overall intubation success rate, time required for intubation, the number of attempts required for successful intubation, and airway complications related to intubation. Of these, the primary end point was time required for intubation. Overall intubation success rates were 98% with the Airway Scope and 100% with the Macintosh laryngoscope. Intubation was 17 s faster with the Airway Scope (mean, 18 (SD, 4) seconds) versus the Macintosh laryngoscope (35 (16) seconds). The number of intubation attempts was similar with each device. The incidences of airway complications were similar, with no hypoxia (Spo(2) <95%) occurring in either group. Both the Airway Scope and the Macintosh laryngoscope offer high success rates in adequately prepared paralyzed patients lying supine at ground level in the hands of a skilled practitioner. However, the Airway Scope facilitated faster tracheal intubation.

Is the Airtraq optical laryngoscope effective in tracheal intubation by novice personnel?

BackgroundMacintosh laryngoscopic intubation is a lifesaving procedure, but a difficult skill to learn. The Airtraq optical laryngoscope (AOL) is a novel intubation device with advantages over the direct laryngoscope for untrained personnel in a manikin study. We compared the effectiveness of AOL with Macintosh laryngoscope for tracheal intubation by novice personnel.MethodsWe selected 37 medical students with no prior tracheal intubation experience and educated them on using both laryngoscopes. Seventy-four patients were randomly divided into two groups (group A: AOL, group M: Macintosh laryngoscope). We recorded the tracheal intubation success rate, intubation time, number of attempts, intubation difficulty scale, and adverse effects.ResultsThe total success rate was similar in the two groups, but the success rate at first attempt was higher in group A (P < 0.01). Group A also showed reduced duration and attempts at intubation, as well as adverse effects such as oral cavity injury. Additionally, participant reports indicated that using the AOL was easier than the Macintosh laryngoscope (P < 0.01).ConclusionsThe AOL is a more effective instrument for tracheal intubation than Macintosh laryngoscope when used by novice personnel.

Comparison of the Pentax Airway Scope® and McGrath® Videolaryngoscope with the Macintosh Laryngoscope in Tracheal Intubation by Anaesthetists Unfamiliar with Videolaryngoscopes: A Manikin Study

Videolaryngoscopes are becoming widely available and have been suggested as a replacement for the Macintosh in cases of cervical instability or even for use in the first instance. There is limited existing data on the use of videoscopes by experienced anaesthetists who are inexperienced in the use of videoscopes. We used a manikin model to compare time to intubation between the Macintosh blade, Pentax Airway Scope and the McGrath videolaryngoscope in a simulated urgent intubation by 23 experienced anaesthetists with no prior experience in the use of these videoscopes. We also measured the number of attempts and success of intubation within three minutes. Ease of device use and laryngoscopic view obtained were also recorded. We found that all participants could intubate the manikin within three minutes, with a median of one attempt using the Pentax Airway Scope. Only 48% of participants (n=11) could intubate within three minutes using the McGrath videolaryngoscope and required a median of three attempts. This difference occurred despite the majority of anaesthetists obtaining a Grade 1 Cormack and Lehane view with both videoscopes. We demonstrated that anaesthetists who were naive to these videoscopes can successfully intubate the trachea using the Pentax Airway Scope but not the McGrath videolaryngoscope.