Macintosh Laryngoscope In Patients Research Articles

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 the McGRATHTM Video Laryngoscope and Macintosh Laryngoscope for Orotracheal Intubation in a Simulated Difficult Airway Scenario: An Open-Label, Randomized Clinical Trial

Background and Objectives: Difficult intubation, which may be encountered unexpectedly during anesthesia, can increase patients' morbidity and mortality. The McGRATH video laryngoscope is known to provide improved laryngeal visibility in patients with difficult or normal airways. The purpose of this study was to evaluate the efficacy of the McGRATH video laryngoscope for orotracheal intubation compared with that of conventional Macintosh laryngoscopes in simulated difficult airway scenarios. Materials and Methods: In this randomized controlled trial, patients who were scheduled for surgery under general anesthesia requiring orotracheal intubation were assigned to the Macintosh laryngoscope (n = 50) or McGRATH video laryngoscope (n = 45) groups. In this study, to create a simulated difficult airway condition, the subjects performed manual in-line stabilization and applied a soft cervical collar. The primary outcome was the rate of successful intubation within 30 s. The time required for an intubation, glottis grade, intubation difficulty scale (IDS score), the subjective ease of intubation, and optimal external laryngeal manipulation (OLEM) were evaluated. In addition, complications caused by each blade were investigated. Results: The intubation success rate within 30 s was not significantly different between the two groups (44 (88.0%) vs. 36 (80.0%), p = 0.286). The glottic grade was better in the McGRATH group than in the Macintosh group (p = 0.029), but neither the intubation time (26.3 ± 8.2 s vs. 24.2 ± 5.0 s, p = 0.134) nor the rates of oral bleeding (2 (4.0%) vs. 0 (0.0%)) and tooth injury (0 (0.0%) vs. 1 (2.2%)) were significantly different between the two groups. Conclusions: The use of the McGRATH video laryngoscope did not improve the intubation success rate or shorten the intubation time. However, the McGRATH video laryngoscope provided a better glottis view than the conventional Macintosh laryngoscope in patients with a simulated difficult airway.

Comparative Evaluation of King Vision Video Laryngoscope, McCoy and Macintosh Laryngoscopes in Patients Scheduled for Mucormycosis Surgery: A Randomised Clinical Trial

Introduction: Mucormycosis, an aggressive fungal infection may result in a difficult airway owing to its inflammation. King Vision Video Laryngoscope (KVVL) is a useful addition to a difficult airway armamentarium. McCoy laryngoscope with hinged tip is well-known equipment of difficult airway cart. Conventional Macintosh laryngoscope dominates in anaesthesia practice. Standard, existing and contemporary devices were compared in difficult airways resulting from mucormycosis. Aim: To compare the relative performance of KVVL, McCoy, and Macintosh laryngoscopes based on the ease of intubation and haemodynamic response in patients with mucormycosis. Materials and Methods: The present study was a randomised clinical trial done during June-August 2021 on 90 consenting patients of 18-65 years age, belonging to either sex with microbiologically confirmed mucormycosis undergoing debridement surgery. Group A was intubated with a non channeled KVVL, while group B had McCoy and group C had Macintosh laryngoscope. Primary outcome parameters were Cormack Lehane (CL) grade, time from laryngoscopy to successful intubation, number of attempts, any adjuncts or optimisation maneuvers, and any mucosal injury. Secondary outcome parameters were Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Blood Pressure (MBP) measured on arrival, before induction, after induction, and at 1, 2, 3, 5, and 7 minutes after intubation. Comparison of quantitative variables not normally distributed were analysed using Kruskal Wallis test. Post-hoc analysis by Dunn's multiple pairwise comparison test. Friedman test followed by pairwise comparison was done to compare haemodynamic parameters within each group. Chi-square test was used for qualitative variables. The p-value ≤0.05 was considered to be statistically significant. Results: CL grade was lowest in group B (1.83±0.38) against group A (1.93±0.25), group C (2.13±0.35) with p-value of 0.029. Time from laryngoscopy to successful intubation was the least in group B (19.5±3.98) against group A (26.07±9.8), group C (21.33±3.74) with p-value of 0.002. No significant difference was there in the number of attempts, airway adjuncts/optimisation maneuvers, mucosal injury. Haemodynamic variables were comparable. Conclusion: McCoy laryngoscope was found to perform best in difficult airways resulting from mucormycosis. It was most effective for glottic visualisation, with the shortest time to successful intubation and, haemodynamic parameters were comparable to KVVL and Macintosh laryngoscopes.

First-pass Success Rate and Number of Attempts Required for Intubation in Anticipated Difficult Airway: Comparison between Macintosh and Channeled King Vision Video Laryngoscopes.

Video laryngoscopy has been shown to improvise Cormack-Lehane grading and rate of successful tracheal intubation and is now incorporated in most of the difficult airway guidelines. Since there is scarce literature regarding the use of channeled blade of King Vision video laryngoscope (KVVL) in anticipated difficult intubation, we planned to undertake this randomized control trial to assess the performance of channeled blade of KVVL and Macintosh laryngoscope in patients with anticipated difficult intubation. This prospective randomized study was conducted in a tertiary care hospital. Patients fulfilling the inclusion criteria were randomly assigned equally to the KVVL group or Macintosh group. The primary outcome of the study was intubation success in the first attempt and number of attempts required for intubation, and the secondary outcomes were Cormack-Lehane grading and time required to intubate in both the groups. The first-pass success of intubation was 88.6% in the KVVL group and 76.5% in the Macintosh group (P = 0.035). The second attempt of intubation was required in 11.4% and 20.6% of patients in the KVVL and Macintosh groups, respectively. Cormack Lehane Grade I was achieved in 100% of patients of the KVVL group as compared to 29.4% of patients in the Macintosh group. Moreover, the difference was statistically significant (P = 0.035). The mean duration of intubation was prolonged in the KVVL group as compared to the Macintosh group, and the difference was statistically significant (P = 0.04). The channeled blade of KVVL had a higher first-pass success rate and required fewer attempts to intubate when used in patients with anticipated difficult intubation. Further, the KVVL was found to be significantly better than the Macintosh laryngoscope in terms of Cormack-Lehane grading, but the time taken to intubate the trachea was more in the KVVL group.

Evaluation of the use of the channeled King Vision video laryngoscope in improving glottic visualisation in patients with limited glottic view with the Macintosh laryngoscope: A prospective observational study.

Background and Aims:The role of King Vision videolaryngoscope (KVL) is well known in the anticipated difficult airway. However, its performance in patients with unanticipated restricted view of the glottis has never been investigated. The aim of this study was to evaluate the performance of KVL in patients with limited glottic view (POGO score <50%).Methods:Eighty-five patients fulfilling the inclusion criteria were included in this study. Laryngoscopy was performed in each patient with Macintosh blade followed by the channeled KVL. The laryngeal view obtained with each device was recorded using POGO score and Cormack--Lehane (CL) grade. After that, endotracheal intubation was attempted with the KVL. The haemodynamic parameters, the time taken for endotracheal tube placement and intubation, failure to intubate, modified intubation difficulty score and airway complications were also recorded.Results:There was a statistically significant improvement in the POGO scores with the use of KVL: 20 (0,40) vs 90 (40,100) (P < 0.001). The frequency of CL grade I and II increased from 63% with conventional laryngoscopy to 100% with the KVL. Although the time taken to obtain the best glottic view was significantly longer with the KVL as compared to the Macintosh blade (P < 0.001), the first attempt success rate was 97.65%.Conclusion:Channeled KVL when used by experienced operators provides superior laryngeal view as compared to Macintosh laryngoscope in patients with restricted glottic view (POGO score <50%) without any major airway complications.

Comparison of King Vision Video Laryngoscope with Macintosh Laryngoscope in Patients Requiring Nasal Intubation for Oromaxillofacial Surgery-A Randomised Controlled Study

Introduction: Anaesthesiologists are at constant risk of contracting Corona Virus Disease 2019 (COVID-19) disease. They are constantly conducting surgical procedures despite being surrounded by pandemic. Patients requiring Nasotracheal Intubation (NTI) for oromaxillofacial surgery expose anaesthesiologists to aerosol-risk. Video laryngoscope simplifies NTI with diminished aerosol exposure, decreased time and difficulty for intubation in patients undergoing oromaxillofacial surgery. Aim: This study was intended to compare the effectiveness of King Vision Video Laryngoscope (KVVL) and Macintosh laryngoscope in patients requiring NTI for oromaxillofacial procedures. Materials and Methods: This prospective randomised controlled study was conducted on total of 40 patients undergoing oromaxillofacial surgery under general anaesthesia with NTI in Parul Sevashram Hospital, Vadodara, India, from September 2020 to February 2021. Patients were randomly allocated into group KL and group ML of 20 patients each. Laryngoscopy in group KL was performed with KVVL (non-channelled blade), while in group ML patients were intubated using Macintosh laryngoscope. Intubation time, Modified Nasointubation Difficulty Scale (MNIDS), haemodynamic parameters, and complications were noted. Student t-test and chi-square test were used respectively for continuous and categorical variables. Results: There was no significant difference in the mean age, weight and gender between the groups KL and ML (p-value>0.05). The mean age of the group KL patients were 32.65 years and group ML was 33.95 years which was not statistically significant. Time required for passing tube from glottic opening to trachea (T3) was significantly less (13.5 seconds) in group KL than (17.4 seconds) in group ML (p-value <0.001). A total of 16 patients (80%) and 12 (60%) patients respectively, in group KL and group ML had MNIDS of 0. Increase in Heart Rate (HR) and Mean Arterial Pressure (MAP) was significantly higher in group ML than group KL. Also, a video laryngoscope increases the distance between the operator and airway and hence reduces aerosol exposure. Conclusion: Intubation time, assist manoeuvre, and change of head position were less in group KL than group ML. KVVL reduces distance between patient and anaesthesiologist. Video laryngoscopes reduce aerosol transmission better than macintosh laryngoscopes. Thus, the video laryngoscopes were found better than macintosh laryngoscopes.

Evaluation of the True View PCD Video Laryngoscope for Oral Endotracheal Intubation

Background: Truview PCD video laryngoscope is particularly planned to assist in locating the endotracheal tube in addition to observe the admission of the tube into the glottis. The present study was performed to assess the outlook of glottic opening and relief of intubation between the Truview PCD laryngoscope and Macintosh laryngoscope in patients undergoes general anaesthesia. Subjects and Methods: Ninety patients of ASA grade 1 and 2 aged 18-60 years, posted for elective surgery under general anaesthesia needing endotracheal intubation were arbitrarily allocated into group 1 (Truview PCD laryngoscope n=45) and group 2 (Macintosh laryngoscope n=45). The two groups were compared for demographic data, intubation difficulty score, Cormack-Lehane grade, time to intubate, number of intubation attempts and hemodynamic parameters. Conclusion: Truview PCD can be measured as an alternate intubation device, especially in difficult intubation conditions.

Tracheal intubation using the Airtraq video laryngoscope vs. Macintosh laryngoscope in patients with anticipated difficult intubation

BackgroundVarious types of laryngoscopes have been invented to ameliorate the laryngoscopic view of the glottis, in normal and difficult airway, which helps anaesthesiologists to secure the airway during anaesthesia. In this prospective study, we aimed to compare the efficacy of the Airtraq video laryngoscope (AVL) and the Macintosh curved-blade laryngoscope (MBL), by using a common clinical assessment tool in patients with modified Mallampati class III and IV. MethodsA total of 60 patients [group A (AVL) and group M (MBL)] with modified Mallampati class III and IV listed for general anaesthesia were included. Each patient was intubated with either of the laryngoscope based on the group allotted. Time taken for tracheal intubation, grade of visualisation of glottis and need for manoeuvres to optimise the glottic view were compared. ResultsThe degree of the glottic view during successful intubation attempt was easily appreciated in group A (p < 0.0001). Difference in the requirement of manoeuvres for optimising the laryngeal view/assisting in intubation as assessed by manoeuvre score was easily appreciated in group A (p < 0.010). Rise in heart rate and mean arterial pressure 1 and 2 min after intubation was more in group M than in group A (p < 0.0001). No event of any airway trauma, as evidenced by visible trauma to lips or oral mucosa or blood on laryngoscope, was observed with either of the laryngoscope. ConclusionThe novel AVL provides better intubation conditions with greater ease of intubation, better glottic view and lesser haemodynamic alterations during laryngoscopy than MBL.

Nasotracheal intubation with Glidescope Videolaryngosocope and Macintosh laryngoscope in patients with head and neck cancer

Nasotracheal intubation with Glidescope Videolaryngosocope and Macintosh laryngoscope in patients with head and neck cancer

Assessing the effectiveness of the AirtraQ laryngoscope versus the standard macintosh laryngoscope in patients with cervical spine immobilization

Assessing the effectiveness of the AirtraQ laryngoscope versus the standard macintosh laryngoscope in patients with cervical spine immobilization

Comparison of hemodynamic responses to endotracheal intubation with the GlideScope video laryngoscope and Macintosh laryngoscope in patients undergoing cardiovascular surgery.

This study aimed to compare hemodynamic response to endotracheal intubation using GlideScope and Macintosh laryngoscopes in patients who underwent cardiovascular surgery. A total of 74 patients were enrolled in the study. Patients were randomly assigned into two groups either a GlideScope (n=37) or a Macintosh laryngoscope (n=37). Laryngoscopy time, heart rate, invasive arterial pressure and rate pressure product were compared during induction and until five minutes after laryngoscopy at 11 time points. Seventy patients completed the study. The intubation time was similar in both groups (14.1±4.0 sec vs. 13.2±4.2 sec; p=0.22). Hemodynamic values including heart rate, systolic, diastolic and mean arterial pressure and rate pressure product were similar at all-time points. The laryngoscopy time was also similar between groups. The GlideScope video laryngoscope did not show any advantage on hemodynamic response in patients undergoing cardiovascular surgery when compared to Macintosh laryngoscope.

Comparison of haemodynamic responses to tracheal intubation using Macintosh and Airtraq® laryngoscope in patients with simulated cervical spine injury

Background: Mechanical stimulation of airway structures occurs during laryngoscopy. The magnitude of cardiovascular response is related to the force and duration of laryngoscopy. Video laryngoscopes like Airtraq® will help us to intubate patients with restricted neck movements without much manipulation but are bulkier than conventional Macintosh laryngoscope. We compared Airtraq® and Macintosh laryngoscopes in patients with simulated cervical spine injury with respect to haemodynamic fluctuations. Methodology: A prospective, randomized study involving patients who are undergoing elective surgical procedures under GA. After routine preoperative preparation and monitoring, patients were administered conventional general anaesthesia. Preloaded Airtraq® or Macintosh laryngoscope was used for intubation. The outcome variables of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at regular intervals. Duration for intubation, manoeuvers required to optimize laryngeal view, glottic view, number of attempts taken and complications if any, were noted down as secondary objectives. Results: We observed that there is no significant difference in the average of variation in HR (p=0.078), SBP (p=0.515) and MAP (p=0.057) from the baseline between the two groups. We performed independent sample t test to know whether there is any significant difference for average duration of intubation, glottic view, ease of intubation and complications and we observed that there is significant difference in average duration of intubation (p=0.002) between two groups. Conclusion: Haemodynamic response caused by intubation with Airtraq® and Macintosh laryngoscopes in simulated cervical spine injury were comparable.

Evaluation of ease of intubation using C-MAC Vs Macintosh laryngoscope in patients with the application of manual inline axial stabilization - A randomized comparative study

Background and Aims : Endotracheal intubation in patients with cervical spine injury can be challenging particularly in the presence of manual in line stabilization. Video laryngoscopes can be used in these situations as their popularity is growing in the management of difficult airway and recently Difficult Airway Society (DAS) has included these devices in their algorithm. Methods : Sixty ASA 1 and 2 patients with normal airway requiring general anesthesia with endotracheal intubation were recruited for this randomized comparative simulative study. Neck was stabilized using manual inline axial stabilization maneuver and endotracheal intubation was carried out using either C-MAC or Macintosh laryngoscope. The following parameters were compared: intubation difficulty score (IDS), Cormack Lehane (CL) glottis view, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). Hemodynamic parameters were noted at following intervals: pre-induction, pre intubation, immediate post intubation and 3 minutes after intubation. The data was analyzed using statistical tests Fischer exact test, Chi-square and independent two tailed student t test Results: Superior glottis view was observed in C-MAC group (CL-1: 56.7 % vs 30%, CL-2: 36.7% vs 56.7%, CL-3: 6.7% vs 10%, CL-4: none vs 3.3% in C-MAC and Macintosh group respectively). There was no difference in intubation difficulty score (p=0.822) and hemodynamic parameters also showed no clinical and statistical differences. Conclusion: The present study shows good glottis view with C-MAC; although, IDS score is similar to conventional Macintosh laryngoscopy. The haemodynamic parameters are comparable in both groups. Overall, the C-MAC laryngoscope gives better glottis view indicating clinical significance.

A randomised cross‐over trial comparing the McGrath® Series 5 videolaryngoscope with the Macintosh laryngoscope in patients with cervical spine immobilisation

We compared the performance of the McGrath® Series 5 videolaryngoscope with the Macintosh laryngoscope in 49 patients without suspected cervical spine pathology, whose cervical spine was immobilised using a semi-rigid collar. The primary outcome was the view obtained at laryngoscopy. Secondary outcomes included time to tracheal intubation, rates of successful intubation and incidence of complications. In all patients, the view was better (92%) or the same (8%) in the McGrath group versus the Macintosh group (p < 0.01). There were no failed intubations in the McGrath group and seven (28%) in the Macintosh group (p < 0.02). There was no statistical difference in time taken to intubate or incidence of complications. We conclude that the McGrath® Series 5 is a superior laryngoscope when cervical spine immobilisation is maintained during tracheal intubation.

Truview EVO2 Laryngoscope Reduces Intubation Difficulty in Maxillofacial Surgeries

Recently, there has been a dramatic increase in the use of the Truview EVO2 for the management of patients with potentially difficult airways. However, the comparison of Truview EVO2 with the classic Macintosh laryngoscope in patients with maxillofacial trauma remains unevaluated. Thus, the purpose of this study was to evaluate and compare the intubation conditions with the Truview EVO2 video laryngoscope and the Macintosh laryngoscope in patients with maxillofacial injury. Forty-two patients with American Society of Anesthesiologists status I and II requiring nasotracheal intubation for maxillofacial surgery were included in this prospective randomized trial. Anesthesia was induced with fentanyl 2μg/kg, propofol 2 to 3mg/kg, and rocuronium bromide 0.6mg/kg. Intubation was performed with the Macintosh laryngoscope or the Truview EVO2 video laryngoscope. Comparative data based on the Intubation Difficulty Scale score were assessed as the primary outcome. Laryngoscopic view, time taken for glottis visualization, time taken to pass the endotracheal tube, total time to intubate, and the number of optimizing and hemodynamic variables were recorded as secondary outcomes. The 2 groups were comparable in patient characteristics and preoperative airway assessment parameters. The Intubation Difficulty Scale score was significantly less in the Truview EVO2 group compared with the Macintosh group (mean ± standard deviation, 0.30 ± 0.7 vs 1.70 ± 1.8; P= .002). The Truview EVO2 video laryngoscope required significantly less time for glottic visualization (9.40 ± 10.9; P= .002). The Truview EVO2 provided a significantly better laryngoscopic view as graded by the percentage of glottic opening and the modified Cormack-Lehane grading system compared with the Macintosh laryngoscope (P < .002). The hemodynamic variables, number of optimizing maneuvers, and the incidence of side-effects were comparable in the 2 groups. The Truview EVO2 performs better than the Macintosh laryngoscope because it considerably decreases the intubation difficulty in patients undergoing maxillofacial surgeries. Therefore, the Truview EVO2 could be a good alternative for managing a difficult airway in patients with maxillofacial injury.

Evaluation of the Hemodynamic Response to Endotracheal Intubation Comparing the Airtraq(®) with Macintosh Laryngoscopes in Cardiac Surgical Patients.

Introduction:Cardiac patients are more prone to develop hemodynamic instability on induction of anesthesia and endotracheal intubation. The Airtraq® optical laryngoscope is a single-use rigid video laryngoscope that has been developed to facilitate tracheal intubation. There are limited studies comparing differences in the circulatory responses to Airtraq® and direct Macintosh larynngoscopy in cardiac patients.Aim:The purpose of our study was to evaluate whether there was clinically significant difference between the hemodynamic response to orotracheal intubation guided by either of the two devices (Airtraq® and Macintosh laryngoscopes) in patients who underwent coronary artery bypass grafting surgery.Material and methods:In this clinical study we analyzed the hemodynamic response to endotracheal intubation performed with Airtraq® or Macintosh laryngoscopes in patients who underwent elective coronary artery bypass graft surgery under general anesthesia.Results:We analyzed: blood pressure (systolic, diastolic, mean), heart rate and peripheral oxygen saturation (all notified before induction in anesthesia, immediately after induction, at the time of intubation and thereafter one and five minutes after intubation). We also recorded the maximal values of blood pressure and heart rate, as well as calculated the product of heart rate and systolic blood pressure. There were statistically significant differences in the hemodynamic response between the groups. At the time of intubation, there was significant inter-group difference in heart rate, systolic, diastolic and mean blood pressure. Endotracheal intubation with Macintosh laryngoscope was accompanied by significant increase in blood pressure and heart rate compared to Airtraq® group.Conclusion:The Airtraq® laryngoscope performed better than the Macintosh laryngoscope in terms of hemodynamic to the patient undergoing routine coronary artery bypass graft surgery.

A comparative study between Truview PCD laryngoscope and Macintosh laryngoscope in viewing glottic opening and ease of intubation: A crossover study

Background:TruviewPCD laryngoscope is specially designed to aid positioning of the endotracheal tube as well as to record entry of the tube into glottis. Aim of the study is to compare the view of glottic opening and ease of intubation between TruviewPCD laryngoscope and Macintosh laryngoscope in patients undergoing general anesthesia (GA).Methodology:Two hundred patients undergoing elective surgery, under GA were randomized into two groups, Group TV and Group ML. In Group TV, TrueviewPCD laryngoscope was used initially to visualize the vocal cords for Cormack and Lehane grading (CLG) and to spray the vocal cords with 10% lignocaine. Then the patient was ventilated for 1 min and Macintosh laryngoscope was used to visualize the vocal cords for CLG and proceed with intubation. In Group ML, Macintosh laryngoscope was used initially and later TruviewPCD laryngoscope. Time to intubation, CLG, number of attempts and hemodynamic parameters were recorded.Results:Ninety-six and 89 patients had CLG1 visualization when TruviewPCD laryngoscope was used as 1st and 2nd device respectively compared to 41 and 68 with Macintosh laryngoscope (P = 0.00). Four patients had CLG 4 visualization with Macintosh laryngoscope that turned out to be grade II visualization with TruviewPCD laryngoscope (P = 0.00). Mean time taken for intubation with TruviewPCD and Macintosh laryngoscope was 21.10 ± 5.64 s and 15.79 ± 2.76 s respectively (P = 0.00).Conclusion:Better visualization with lesser CLG was found with TruviewPCD laryngoscope but it took longer time for intubation than Macintosh laryngoscope. The hemodynamic response to intubation was significantly less with the use of TruviewPCD laryngoscope when compared to that of Macintosh laryngoscope.

A comparison between the McGrath videolaryngoscope and the Macintosh laryngoscope for laryngeal viewing in patients receiving cervical vertebral surgery

Objective To compare the laryngeal viewing of the McGrath videolaryngoscope and the Macintosh laryngoscope in patients receiving cervical vertebral surgery.Methods Fifty patients scheduled for elective cervical vertebral surgery were randomly divided into McGrath and Macintosh groups (n=25).After induction,the patients' glottis in McGrath group was displayed by the Macintosh laryngoscope and the Cormack Lehane (C/L) grade was recorded,and then the McGrath videolaryngoscope was employed to display the laryngeal structure.The order of laryngoscopy was reversed in the Macintosh group.Parameters recorded included demographics,airway assessment features (thyromental distance,mouth opening,mallampati oropharyngeal scale and neck movement),C/L grade and complications of intubation.Results There was no significant difference in demographics and airway assessment features between the two groups (P＞0.05).The C/L grade obtained with McGrath videolaryngoscope was 34∶14∶2 (Ⅰ ∶ Ⅱ ∶Ⅲ),which was significantly better than that with Macintosh laryngoscope (13∶32∶5,P＜0.01).Conclusions The McGrath videolaryngoscope has better laryngeal viewing than the Macintosh laryngoscope,and may have potential advantages in managing the intubation for cervical vertebral surgery. Key words: McGrath videolaryngoscope; Macintosh laryngoscope; Laryngeal viewing; Intratracheal intubation

A comparison of Truview EVO2 laryngoscope with Macintosh laryngoscope in routine airway management: A randomized crossover clinical trial

Background:The Truview EVO2 blade facilitates the view of vocal cords by indirect laryngoscopy and does not require the proper alignment of the oral, pharyngeal and tracheal axes as with the Macintosh blade.Methods:In a crossover fashion, we prospectively compared the view obtained at laryngoscopy with Truview EVO2 and the Macintosh blade in 110 adult patients of either sex between the age of 18 and 60 years, who were scheduled to undergo general anesthesia with endotracheal intubation. The patients were intubated with the second laryngoscope. The preoperative airway variables, laryngoscopic view, difficulty of intubation scale (IDS) score, duration of intubation, and degree of difficulty percentage of glottic opening (POGO score) of use with each laryngoscope were compared.Results:The IDS score was low and comparable between the two laryngoscopes. The laryngeal view was easy; Modified Cormack Lehane (MCL) grade 2a or less in 98.14% of the cases with the Truview laryngoscope compared to 78.7% of the cases with the Macintosh laryngoscope. Nineteen patients of MCL grade 3, one patient of grade 2b, and seven patients of grade 2a view with the Macintosh laryngoscope had MCL grade 1 view with the Truview laryngoscope. The duration of intubation was comparable between Truview and Macintosh laryngoscopes (12.1±3.8 s vs. 10.9±2.1 s).Conclusion:Truview laryngoscope performed comparably to Macintosh laryngoscope in patients with normal airway; however, the Truview laryngoscope may be a better option in difficult airway situations when the Macintosh blade fails to show the glottic opening.

Assessment of cervical spine movement during laryngoscopy with Macintosh and Truview laryngoscopes

Background:Truview laryngoscope provides an indirect view of the glottis and will cause less cervical spine movement since a ventral lifting force will not be required to visualize the glottis compared to Macintosh laryngoscope.Materials and Methods:A randomized crossover study to assess the degree of movement of cervical spine during endotracheal intubation with Truview laryngoscope was conducted in 25 adult ASA-I patients. After a standard anesthetic technique laryngoscopy was performed twice in each patient using in turn both the Macintosh and Truview laryngoscopes. A baseline radiograph with the head and neck in a neutral position was followed by a second radiograph taken during each laryngoscopy. An experienced radiologist analyzed and measured the cervical movement.Results:Significant cervical spine movement occurred at all segments when compared to the baseline with both the Macintosh and Truview laryngoscopes (P < 0.001). However, the movement was significantly less with Truview compared to the Macintosh laryngoscope at C0–C1 (21%; P = 0.005) and C1–C2 levels (32%; P = 0.009). The atlantooccipital distance (AOD) traversed while using Truview laryngoscope was significantly less than with Macintosh blade (26%; P = 0.001). Truview blade produced a better laryngoscopic view (P = 0.005) than Macintosh blade, but had a longer time to laryngoscopy (P = 0.04).Conclusion:Truview laryngoscope produced a better laryngoscopic view of glottis as compared with Macintosh laryngoscopy. It also produced significantly less cervical spine movement at C0–C1 and C1–C2 levels than with Macintosh laryngoscope in patients without cervical spine injury and without manual in-line stabilization (MILS). Further studies are warranted with Truview laryngoscope using MILS.