Macintosh Laryngoscope Research Articles

Comparison of ease of intubation and glottic visualisation using Miller (paraglossal approach) and Macintosh laryngoscope in adults: A randomised crossover study

Comparison of ease of intubation and glottic visualisation using Miller (paraglossal approach) and Macintosh laryngoscope in adults: A randomised crossover study

Comparison of Macintosh laryngoscope and King Vision video laryngoscope for endotracheal intubation in adult patients

Background: Development of video laryngoscope has made management of airway easier. 0ur study was aimed to compare the efficacy of Macintosh laryngoscope and King Vision video laryngoscope for endotracheal intubation in adult patients under general anesthesia. Objectives: The primary objective of the study was to compare the glottic view obtained , the need for external manipulation, endotracheal tube insertion time and attempts taken for successful intubation with Macintosh laryngoscope and King Vision video laryngoscope. The secondary objective was to estimate the changes in hemodynamic parameters and to evaluate the occurrence of complications during intubation. Materials and Methods: The study included 136 patients posted for surgery under general anesthesia. Patients were randomly allocated in group C (N=68) and group V (N=68 ).Endotracheal intubation was done in group C by Macintosh and in group V by King Vision video laryngoscope. Laryngoscopy was assessed by Cormack Lehane grading and the need for any manipulation. The intubation time was calculated with each blade. Hemodynamic parameters were recorded and any complication during laryngoscopy and intubation were noted. The observations were analysed statistically by SPSS Program for windows version 28. Results: In group C, 61.8% of patients had Cormack and Lehane score I while in group V 76.5 % of patients had score I . Mean time of successful intubation was 34.90±8.35 sec in group C while in group V it was 32.82± 5.20 second . There was no statistical difference in distribution of patients according to number of attempts of intubation. In group C, 64.7% of patients needed external laryngeal pressure while in group V 97.1 % patients were intubated without external laryngeal pressure. Both the groups were comparable in relation to changes in hemodynamic parameters and any complications associated with laryngoscopy and intubation. Conclusion: We conclude that glottic view is better obtained with King Vision Video laryngoscope whereas optimisation of position and external laryngeal manipulation is often required with Macintosh laryngoscope to get similar glottic view. Introduction of King Vision video laryngoscope into the oral cavity takes time but intubation is easier with it. Hemodynamic variables and complications during the procedure are equally distributed between the two devices.

Impacto del uso universal del videolaringoscopio McGrath como primera opción para todas las intubaciones en el quirófano: protocolo del estudio prospectivo, multicéntrico VIDEOLAR-SURGERY con metodología pre-post

IntroductionUsual tracheal intubation performed in the operating room is based on direct laryngoscopy, using a standard Macintosh laryngoscope. Several authors recommend the universal use of a videolaryngoscope as the first option for all intubations, regardless of whether the patient has predictors of a difficult airway or not. We hypothesize that using the McGrath videolaryngoscope as the first intubation option increases the frequency of patients with easy intubation, and decreases complications associated to the intubation. Methods and analysisThe VIDEOLAR-SURGERY trial is a prospective, multicenter, open-label, interventional, before-after study. In the pre-implementation period (non-interventional phase, 6-9months [2600 intubations]), 35 anesthesiologists from 8hospitals perform all tracheal intubations for an elective or urgent surgical procedure using the standard Macintosh direct laryngoscope as the first intubation option. During the implementation period (2months), a McGrath Mac videolaryngoscope is provided to each anesthesiologist to train in its use. During the post-implementation period (interventional-phase, 6-9months [2600 intubations]), the 35 anesthesiologists perform all tracheal intubations using a McGrath Mac videolaryngoscope as the first intubation option. The main objective of present study is to evaluate whether the use of a McGrath Mac videolaryngoscope as the first intubation option, improves the percentage of patients with easy intubation compared with the standard Macintosh laryngoscope. Ethics and disseminationThe study protocol was approved May 2, 2023, by the Ethics Committee of Galicia, Spain (CEI-SL, code No. 2023-177), and was registered into the Clinicaltrials.gov clinical trials registry with No. NCT NCT05850260. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If videolaryngoscope improves easy intubation compared with Macintosh direct laryngoscope when it is used for all intubations in operating room, its use may will become standard practice, thereby decreasing complications associated with the intubation procedure.

Impact of universal use of the McGrath videolaryngoscope as the first option for all intubations in the operating room: The multicentre prospective before-after VIDEOLAR-SURGERY study protocol

IntroductionStandard tracheal intubation performed in the operating room is based on direct laryngoscopy using a standard Macintosh laryngoscope. Several authors recommend the universal use of a video laryngoscope as the first option for all intubations, regardless of whether the patient has predictors of a difficult airway or not. We hypothesize that using the McGrath video laryngoscope as the first intubation option increases the frequency of patients with easy intubation, and decreases intubation-related complications. Methods and analysisThe VIDEOLAR-SURGERY trial is a prospective, multicentre, open-label, interventional, before-after study. In the pre-implementation period (non-interventional phase, 6-9 months [2600 intubations]), 35 anaesthesiologists from 8 hospitals perform all tracheal intubations for an elective or urgent surgical procedure using the standard Macintosh direct laryngoscope as the first intubation option. During the implementation period (2 months), each anaesthesiologist is given a McGrath Mac video laryngoscope and trained in its use. During the post-implementation period (interventional-phase, 6-9 months [2600 intubations]), the 35 anaesthesiologists perform all tracheal intubations using a McGrath Mac video laryngoscope as the first intubation option. The main objective of this study is to evaluate whether the use of a McGrath Mac video laryngoscope as the first intubation option increases the percentage of patients with easy intubation compared with the standard Macintosh laryngoscope. Ethics and disseminationThe study protocol was approved on 2 May 2023 by the Ethics Committee of Galicia, Spain (CEI-SL, code No. 2023-177), and was registered on the Clinicaltrials.gov clinical trials registry under No. NCT NCT05850260. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If video laryngoscopy improves easy intubation compared with Macintosh direct laryngoscopy in all operating room intubations, its use may well become standard practice, thereby decreasing the risks of intubation-related complications.

Impact of Operating Table Height on the Difficulty of Mask Ventilation and Laryngoscopic View.

Background/Objectives: Airway management techniques, including mask ventilation and tracheal intubation, are vital across medical settings. However, these procedures can be challenging, especially when environmental conditions are less than ideal. This study explores how the height of the operating table affects the difficulty of anesthesia techniques involving mask ventilation and tracheal intubation. Methods: Twenty anesthesiologists participated in this study. We assessed the difficulty of procedures such as mask ventilation, Macintosh laryngoscopy, and video laryngoscopy using McGRATH and AWS, on a four-level scale. The operating table's height was adjusted at four points: the operator's umbilicus, the inferior margin of the 12th rib, the xiphoid process, and the nipple. Results: Mask ventilation was easiest at the operating table's height aligned with the inferior margin of the 12th rib. Conversely, direct laryngoscopic exposure was perceived as easier at higher table heights, with nipple height being optimal. The McGRATH laryngoscopy showed consistent difficulty across table heights, whereas the AWS tended to be somewhat more difficult at greater heights. Conclusions: The optimal bed height for video laryngoscopy coincided with that for mask ventilation. Video laryngoscopy offers enhanced flexibility in optimal patient positioning compared to Macintosh laryngoscopy, contributing to its advantages in tracheal intubation procedures.

Comparison of AirAngel® vs. Storz® videolaryngoscope and Macintosh® laryngoscope for endotracheal intubation training: prospective randomized crossover study

BackgroundFor both normal and difficult airway management, VL is thought to be more effective. However, VL seems far from being offered as a standard option in both healthcare delivery and educational activities in low-income countries, considering its high costs. Therefore, three-dimensional(3D)printed VLs may be considered an alternative to conventional VLs in low-income countries and other places with limited resources. Our objective was to compare the efficacy of AirAngel 3D-printed VL (3D-PVL) with those of commercially available Storz® VL (SVL) and conventional Macintosh® laryngoscope (MCL) in normal and difficult airway scenarios in the hands of inexperienced users.MethodsThis is a prospective randomized crossover manikin study that included 126 senior medical students with no experience in intubation. The effectiveness of all three laryngoscopy devices in the hands of inexperienced users was evaluated in terms of intubation time, glottic visualization, ease of use, endotracheal tube placement, and intubation success rate. Between 2020 and 2022, 126 last year medical students participated in the study.ResultsMCL resulted in significantly longer intubation times than 3D-PVL and SVL in the difficult airway scenario, with no significant difference between 3DPVL and SVL (Wilcoxon test, p < 0.016; Bonferroni correction MCL: 28.54 s; SVL: 26.68 s; 3DPVL: 26.64 s). Both SVL and 3D-PVL resulted in significantly better Cormack − Lehane grades in both normal and difficult airway scenarios, and thus provided better glottic viewing than MCL, with no significant difference between 3D-PVL and SVL (Wilcoxon test, p < 0.016; Bonferroni correction, MCL: 1.73; SVL: 1.29; 3DPVL: 1.25). The SVL was the easiest device to use for normal airway scenarios (1: very easy, 5: very difficult), while the MCL was the most difficult (MCL: 2.64; 3DPVL: 1.98; SVL: 1.49). Conversely, no significant difference was found between 3DPVL and other devices in terms of ease of use in difficult airway scenarios and in terms of accurate placement of the endotracheal tube and successful intubation attempts.Conclusion3D-PVL is a good educational and possible clinical alternative to conventional VL, particularly in places with limited resources, due to its low cost.

Comparative study of two different intubating doses of cisatracurium for hemodynamic changes during coronary artery bypass grafting under general anaesthesia

: The aim of the study was to compare hemodynamic response, assessment of intubating condition, time to achieve TOF 0 and any adverse effects associated with two different doses of cisatracurium i.e., 0.15mg/kg (3x ED95) and 0.3mg/kg (6x ED95) for endotracheal intubation during Coronary artery bypass grafting (CABG). : It was a prospective single blinded randomized controlled clinical trial, conducted by two investigators in 296 patients aged between 50-70 years of both sexes of ASA III grades. Patients having ejection fraction &amp;#62;45% and undergoing CABG were included in the study. Patients with neuromuscular diseases, anticipated difficult airway, morbid obesity and any associated valvular heart diseases were excluded from the study. Patients were randomly allocated into 2 groups depending on the doses of cisatracurium. Group R (n=148) → received 0.15 mg/kg, Group D (n=148) → received of 0.3 mg/kg. After 60 seconds of injecting cisatracurium, TOF was recorded every 30 seconds until it reaches 0, then laryngoscopy and endotracheal intubation was carried out using Macintosh laryngoscope blade no. 4 by one of the senior investigators who was blinded. The vital parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Mean arterial pressure (MAP) were monitored for 10 minutes after the administration of cisatracurium. Patients were monitored clinically for any adverse effects of histamine release. : The mean time required to achieve TOF 0 in Group D (0.3mg/kg) was shorter compared to Group R (0.15mg/kg) which was statistically significant. During intubation Group D showed statistically significant stable heart rate variation than Group R. Mean SBP, DBP and MAP did not differ between groups. No incidence of histamine release was observed in any of the group. : Patients who received 0.3mg/kg of cisatracurium showed stable heart rate fluctuation during laryngoscopy and intubation and lesser time to achieve TOF 0 compared to patients who received 0.15mg/kg of cisatracurium.

Comparison of C-MAC ® conventional blade, D-Blade ™ , and Macintosh laryngoscopes for endotracheal intubation in patients with simulated immobilization using manual in-line stabilization: A randomized trial.

A difficult airway is anticipated with cervical spine injuries (CSIs) as immobilization techniques such as manual in-line stabilization (MILS) are used, which distort the oro-pharyngeal-laryngeal axis. Video laryngoscopes (VLs) make difficult airway management easy, as they do not require axis alignment. The present study aimed to compare the total time taken by Macintosh laryngoscope (ML), conventional blade, and D-blade ™ of C-MAC ® VL in simulated CSI scenarios using MILS. Ninety patients were randomly allocated into three groups: Group M (ML), Group C (conventional blade of C-MAC ® ), and Group D (D-blade ™ of C-MAC ® ) with MILS applied before intubation. Primary outcome was the total time taken for successful intubation, while secondary outcomes were to assess Cormack-Lehane (CL) grade, number of attempts, hemodynamic response, and associated complications. Total time for intubation in Group C was 23.40 ± 7.06 sec compared to 35.27 ± 6.53 and 47.27 ± 2.53 sec in groups D and M, respectively ( P < 0.001). CL-grade I was observed in 15/30 (50%) in Group M, 25/30 (83.3%) in Group C, and 29/30 (96.7%) in Group D. Group M reported 7/30 (23.3%) failed intubations, while none were observed in other groups. Hemodynamic parameters were significantly higher at 3 and 5 min in Group M. Postoperative sore throat was recorded in 12/30 (40%) in Group M compared to 3/30 (10%) in groups C and D each ( P value 0.037). C-MAC ® VL requires less time for intubation, provides better glottic view, and has higher success, with better attenuation of hemodynamic response and fewer complications compared to ML.

The i-view® Video Laryngoscope Compared With the Macintosh Laryngoscope Does Not Enhance the Endotracheal Intubation Skills of Dental Students.

Background A disposable i-view® video laryngoscope (Intersurgical Limited, Berkshire, United Kingdom) is yet to be used to educate medical and dental students, who must learn endotracheal intubation skills. Additionally, the advantage of the i-view® use for the purpose, compared with the Macintosh laryngoscope, is unknown. We aimed to first determine whether the i-view® video laryngoscope enhances endotracheal intubation skills among dental students compared with the Macintosh laryngoscope. Methodology A prospective, observational, simulation study was conducted among 67 dental students in their sixth clinical year of education. Intubation skills were evaluated on a computer-assisted simulator with a standardized manikin. Each student was asked to intubate using the conventional Macintosh laryngoscope and the i-view® video laryngoscope in the trachea of the simulator's manikin. We collected objective data, including the retroflection angle of the manikin, the maxillary incisor contact pressure, time from picking up the laryngoscope to ventilation, intubation success, and intubation delay. Each student was further asked to grade their subjective evaluation concerning the visual field, Cormack and Lehane classification, operability, stability, needed force for intubation, and easiness during intubation. Results Enrolled dental students quoted that the i-view® video laryngoscope demonstrated better visual field, Cormackand Lehane classification, operability, and stability than the Macintosh laryngoscope. However, they felt intubation easiness could have been better using Macintosh than i-view®. Intubation time, failure rate, and delay rate did not differ between the two laryngoscopes. Nevertheless, the maxillary incisor contact pressure (medianinterquartile range (IQR)) during the intubation increased in the i-view® intubation compared with Macintosh (32 (24 to 41) vs. 25 (18 to 35) N, p = 0.010). Conclusions We first demonstrated that the i-view® video laryngoscope compared with the Macintosh laryngoscope does not enhance the endotracheal intubation skills of dental students. However, the possible repeated use as an educational simulator training tool may add some advantages to the experience of video laryngoscope in both medical and dental students.

Evaluating the impact of intubation pillow on laryngoscopy grade in children: A Randomized controlled trial

Abstract Background: Laryngoscopy and intubation remain critical in pediatric patients as compared to adult patients due to different anatomy. This study was conducted to compare the Cormack and Lehane grade (CL) of laryngoscopy, percentage of glottic opening (POGO) score, and the efficacy of backward upward rightward pressure (BURP) maneuver to improve laryngoscopy grade with or without the use of intubation pillow. Subjects and Methods: A randomized controlled trial was done from January 2020 to July 2020 on 68 children with 34 children in Group 1 (with intubation pillow) and 34 patients in Group 2 (without intubation pillow). Children between 5 and 12 years of age (the American Society of Anesthesiologists class I and II) planned for surgery under general anesthesia with endotracheal tube were included in this study. Pillow of 4 cm size was used in 5–9 years and 6 cm pillow in 9–12 years of age group. Macintosh laryngoscope was used for intubation. CL grading and POGO score were assessed. BURP maneuver was given in cases of difficult laryngoscopy of CL grade above 2 and its effect on improvement in CL grading was measured. Results: Group 1 children had significantly more CL grade I (83.3% vs. 16.7%); significantly lesser CL Grade IIb (23.1% vs. 76.9%, P = 0.001); and significantly more POGO score (97% vs. 86%, P &lt; 0.05) than Group 2. The use of BURP maneuver significantly improved the laryngoscopy view in both the groups. Conclusions: The use of intubation pillow in children between 5 and 12 years of age facilitated better laryngoscopy view and POGO score.

Comparison of king vision video laryngoscope with macintosh laryngoscope for nasotracheal intubation: Randomized control study

Nasotracheal intubation is essential in oro-maxillofacial surgeries to provide a good operational field along with a secured airway. In this study, we aim to compare king vision video laryngoscope with conventional Macintosh laryngoscope for nasotracheal intubation in ear, nose throat and oro-maxillofacial surgeries under general anaesthesia. A total of 102 patients were posted for elective oro-maxillofacial surgeries under general anaesthesia with nasal intubation. Patients were randomized to two different groups. In group K nasotracheal intubation was done with king vision video laryngoscope (KVVL) and in group M with Macintosh laryngoscope. Primary objective was to compare total intubation time and each time intervals (time A: placement of the nasal tube from selected nostril to oropharynx; time B: use of devices to view the glottis, and time C: for nasal tube to be advanced from oropharynx into trachea and removal of the laryngoscope from oral cavity). Secondary objectives were to compare scores of Modified Naso Intubation Difficulty Scale (MNIDS) and haemodynamic responses.The mean total intubation time, and time C interval were noted in King Vision Video Laryngoscope group (37.29±7.83 s and 15.99±8.9 s) and Macintosh laryngoscope group (46.11±10.05 s and 19.86±9.96 s) respectively. There was significant difference between these two groups in terms of mean total intubation time, and time C interval (total time, p=0.001 and time C, p=0.041). The level of difficulty in intubation noted using MNIDS score which is zero in 52.9% patients in King Vision group and 23.5% in Macintosh group (p=0.011).As compared to Macintosh laryngoscope, the king vision laryngoscope requires lesser time for nasotracheal intubation. In addition, Intubation is easier with the king vision laryngoscope than with the Macintosh laryngoscope.

The Clinical Usability Evaluation of an Attachable Video Laryngoscope in the Simulated Tracheal Intubation Scenario: A Manikin Study.

The aim of this study was to assess the usefulness of an attachable video laryngoscope (AVL) by attaching a camera and a monitor to a conventional Macintosh laryngoscope (CML). Normal and tongue edema airway scenarios were simulated using a manikin. Twenty physicians performed tracheal intubations using CML, AVL, Pentax Airwayscope® (AWS), and McGrath MAC® (MAC) in each scenario. Ten physicians who had clinical experience in using tracheal intubation were designated as the skilled group, and another ten physicians who were affiliated with other departments and had little clinical experience using tracheal intubation were designated as the unskilled group. The time required for intubation and the success rate were recorded. The degree of difficulty of use and glottic view assessment were scored by participants. All 20 participants successfully completed the study. There was no difference in tracheal intubation success rate and intubation time in the normal airway scenario in both skilled and unskilled groups. In the experienced group, AWS had the highest success rate (100%) in the tongue edema airway scenario, followed by AVL (60%), MAC (60%), and CML (10%) (p = 0.001). The time required to intubate using AWS was significantly shorter than that with AVL (10.2 s vs. 19.2 s) or MAC (10.2 s vs. 20.4 s, p = 0.007). The difficulty of using AVL was significantly lower than that of CML (7.8 vs. 2.8; p < 0.001). For the experienced group, AVL was interpreted as being inferior to AWS but better than MAC. Similarly, in the unskilled group, AVL had a similar success rate and tracheal intubation time as MAC in the tongue edema scenario, but this was not statistically significant. The difficulty of using AVL was significantly lower than that of CML (8.8 vs. 3.3; p < 0.001). AVL may be an alternative for VL.

Comparison of the HugeMed video laryngoscope with the Macintosh direct laryngoscope for nasotracheal tracheal intubation in children undergoing dental treatment: a randomized controlled clinical study

ABSTRACT Objectives The aim of this study was to compare the performance of the HugeMed® videolaryngoscope with a direct Macintosh laryngoscope for nasotracheal intubation. Methods Eighty-eight children aged 4–10 years were randomly assigned to either the HugeMed® videolaryngoscope (HVL) or the Macintosh direct laryngoscope (MDL) group. Intubation difficulty, glottic view grade, time-to-intubation, number of tracheal intubation attempts, use of external laryngeal manipulation and Magill forceps, recovery time, pediatric-anesthesia-delirium-scale (PAEDS) scores, pain due to tracheal intubation, and laryngeal bleeding were evaluated. Results Easy tracheal intubation incidence was higher in the HVL group than that in the MDL group (p = 0.001). Glottic view was better in the HVL group as compared to the MDL group (p = 0.027). There was no difference between the groups in terms of time-to-tracheal intubation, number of tracheal intubation attempts, Magill forceps usage, pain, and bleeding due to tracheal intubation. The need for external laryngeal manipulation (p = 0.004) and PAEDS scores (p = 0.006) were higher in the MDL group than those in the HVL group. Conclusion HugeMed® videolaryngoscope may provide easier tracheal intubation, create a better glottic view, and significantly reduce the need for additional manipulation compared to the Macintosh direct laryngoscope, for nasotracheal intubation. Clinical trial registration www.clinicaltrial.gov identifier is NCT05121597

A comparison of Vie Scope and standard Macintosh laryngoscopes in a simulated condition of an entrapped trauma patient with simultaneous cervical spine immobilisation - A randomised, controlled manikin trial

BackgroundTracheal intubation remains the gold standard in the management of the injured. Airway management of trauma patients, especially in pre-hospital settings is often challenging and may be associated with serious complications. In the current practice, standard laryngoscopes are being superseded by new generation devices such as video laryngoscopes. One of the recently-introduced airway devices is the Vie Scope. It is an illuminated intubating device with a design similar to Miller's straight intubating blade. The intubation technique using the Vie Scope requires the use of a bougie, which is inserted first and then after removing the scope the endotracheal tube is railroaded over the introducer. AimThe aim of this study was to evaluate the Vie Scope for intubation in a simulated condition of an entrapped trauma patient with simultaneous cervical spine immobilisation. MethodsAn intubation manikin with the cervical collar on was placed on and secured to the driver's seat of a passenger car. The car was then positioned on its left side. The time required to insert the device and achieve a successful glottic visualisation as well as the intubation and successful ventilation time were recorded. The glottic view was assessed using the Cormack-Lehane classification. The first attempt success rate of intubation and the ease of use by the operator were also assessed. ResultsFifty fully qualified and experienced paramedics participated in the study. The standard Macintosh laryngoscope required shorter mean time to obtain the glottic view 12.7 s (±4.64) vs. 18.8 s (±5.86), p < 0.0001, however, better view of the glottis was obtained with the Vie Scope. The time to intubation and successful ventilation was significantly shorter when the Macintosh laryngoscope was used 35.03 s (±5.27) vs. 51.1 s (±6.28), p = 0.02. There were no failed intubation attempts when the Macintosh laryngoscope was used. ConclusionAlthough the Vie Scope provided better glottic visualisation, because of the specific technique, the Macintosh laryngoscope was superior in terms of the time required to visualise the glottis, the time to intubation and successful ventilation. Moreover, the Macintosh laryngoscope was found to be easier and more convenient to use.

Comparison of Macintosh Laryngoscope, King Vision®, VividTrac®, AirAngel Blade®, and a Custom-Made 3D-Printed Video Laryngoscope for Difficult and Normal Airways in Mannequins by Novices-A Non-Inferiority Trial.

Background: Endotracheal intubation (ETI) is a cornerstone of airway management. The gold standard device for ETI is still the direct laryngoscope (DL). However, video laryngoscopes (VLs) are now also widely available and have several proven advantages. The VL technique has been included in the major airway management guidelines. During the COVID-19 pandemic, supply chain disruption has raised demand for 3D-printed medical equipment, including 3D-printed VLs. However, studies on performance are only sparsely available; thus, we aimed to compare 3D-printed VLs to the DL and other VLs made with conventional manufacturing technology. Methods: Forty-eight medical students were recruited to serve as novice users. Following brief, standardized training, students executed ETI with the DL, the King Vision® (KV), the VividTrac® (VT), the AirAngel Blade® (AAB), and a custom-made 3D-printed VL (3DVL) on the Laerdal® airway management trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma, and user satisfaction. Results: The KV and VT are proved to be superior (p < 0.05) to the DL in both scenarios. The 3DVL's performance was similar (p > 0.05) or significantly better than that of the DL and mainly non-inferior (p > 0.05) compared to the KV and VT in both scenarios. Regardless of the scenario, the AAB proved to be inferior (p < 0.05) even to the DL in the majority of the variables. The differences between the devices were more pronounced in the difficult airway scenario. The user satisfaction scores were in concordance with the aforementioned performance of the scopes. Conclusions: Based upon our results, we cannot recommend the AAB over the DL, KV, or VT. However, as the 3DVL showed, 3D printing indeed can provide useful or even superior VLs, but prior to clinical use, meticulous evaluation might be recommended.

The Production, Assessment, and Utility of 3D-Printed Video Laryngoscopes in Eastern India: A Low-Cost Alternative to Conventional Video Laryngoscopes.

Introduction Recognizing the limitations of traditional direct laryngoscopes, particularly in difficult airway situations, video laryngoscopy has emerged as a potentially safer and more effective alternative. This study evaluated the utility of two 3D-printed video laryngoscopes: a standard geometry video laryngoscope (SGVL), resembling the traditional Macintosh blade, and a hyper-angulated video laryngoscope (HAVL) with a more curved design. Their performance was compared to a standard Macintosh direct laryngoscope across various intubation parameters. By leveraging the cost-effectiveness of 3D printing with polylactic acid, the study aimed to assess the potential of this technology to improve airway management across diverse clinical settings and varying levels of physician expertise. Methods This prospective randomized crossover study compared the effectiveness of 3D-printed video laryngoscopes (VL) and a standard direct laryngoscope in intubation. After obtaining IRB approval, physicians from various specialties across multiple centers participated. Participants received training on SGVL, HAVL, and DL intubation using an instructional video and hands-on practice. The training was standardized for all participants. The primary outcome measures were time to successful intubation, number of attempts, and time to visualize vocal cords. Participants were randomized to use all three laryngoscopes on a manikin, with a maximum of two attempts per scope. A 30-minute break separated each laryngoscope evaluation. Successful intubation was defined as the single insertion of each laryngoscope and bougie, followed by endotracheal tube placement and confirmation of lung inflation. Results Ninety-eight doctors, mostly from the EM team (73.5%) and ICU team (23.4%). Teams consist of consultants, residents, and medical officers of the concerned departments. Forty-eight of the participants (49%) were novice operators (<25 intubations). Successful first-attempt intubation in those with <1 year of experience with intubation (n=33) was highest for SGVL (97%) compared to DL (82%) and HAVL (67%). Participants who learned intubation through self-directed learning exhibited a higher acceptance of VL and achieved 100% success on their first attempt. Among those who followed modules or workshops, 97% had successful first-attempt intubation with VL. The average time taken to visualize the vocal cords was lower in SGVL compared to DL (5.6 vs. 7.5 seconds) (p<0.001). The HAVL also had a lower average time compared to the DL (7.1 vs. 7.5 secs) (p<0.001). However, the time taken to intubate using DL (24.2 ±8.7 sec) was similar to SGVL (28.1 ±13 sec). Lastly, the intubation time using HAVL was the longest (49.6 ±35.5 sec). The time to intubate with DL and SGVL had Spearman's rho of 0.64 (p<0.001), and DL and HAVL had 0.59 (p<0.001). Conclusions The ease of use and its cost-effective nature make 3D-printed VLs beneficial in situations where traditional VLs may not be available, especially in simulation and training.

Enhancing Airway Management: A Comparative Study of Macintosh and TAS Scope in Difficult Intubations.

Intubation is essential in anesthesia for patient safety, requiring accurate techniques for difficult airways. Achieving first-attempt success is crucial. This study evaluates traditional laryngoscopes, such as the Macintosh, versus advanced tools like the TAS Scope. This observational study, conducted from April to August 2023 at Saveetha Medical College and Hospital, involved 60 patients aged 18-65. The two groups of Macintosh laryngoscope and TAS Scope 30 each are based on airway difficulty predictors and patient characteristics. The TAS Scope group had a higher first-attempt success rate and easier intubation experiences according to Likert scale ratings. The study underscores the benefits of using advanced devices like the TAS Scope for difficult airway management, showing higher success rates and ease of use. These findings support the adoption of new technologies to enhance patient safety and intubation effectiveness.

Safety assessment of using macintosh laryngoscope, airtraq, I-view, UESCOPE by non-clinically experienced individuals on a manikin model: A randomized cross-over study

BackgroundEndotracheal intubation is the best way of restoring airway patency. Covid-19 epidemic showed that the health professionals without previous experience may be forced to use this technique in the state of necessity, exposing the patients to both local and systemic complications. In our study we wanted to specify which of the four laryngoscopes is safer for a patient when used by this group of medical staff. MethodsThe study involved 55 4th year students of Faculty of Medicine and Dentistry who had never previously practiced using videolaryngoscopes and had minimal experience with the Macintosh laryngoscope. ResultsDental injury rates: Macintosh (n = 18, 33 %), I-View (n = 13, 24 %), UESCOPE (n = 10, 18 %), and Airtraq (n = 7, 13 %), though differences were not statistically significant (p = 0.071). Notable variations were observed in maximum pressure: I-View (88.9 mmHg, IQR: 72.75–106.5), Macintosh (87.1 mmHg, IQR: 75.1–110.35), UESCOPE (72.7 mmHg, IQR: 61–86), and Airtraq (54.7 mmHg, IQR: 41.8–67.25). The difference between Macintosh and I-View was not significant. Pressure during intubation showed a similar trend: Macintosh (48.3 mmHg, IQR: 42.85–59.4), I-View (45.2 mmHg, IQR: 35.7–54.85), UESCOPE (33 mmHg, IQR: 27.95–41.5), Airtraq (21.6 mmHg, IQR: 18.4–24.9). Airtraq usage correlated with shorter intubation times (9.9 s, IQR: 8.4–12.25) compared to Macintosh (27 s, IQR: 23.8–32.05), I-View (24.5 s, IQR: 19.25–31.35), and UESCOPE (23.6 s, IQR: 17–29.5). Airtraq was the best-rated device by respondents. Airway visualization was superior with Airtraq, as assessed by Cormack-Lehane and POGO scales. On the Cormack-Lehane scale, Airtraq scored 2 (IQR: 2-2), versus Macintosh (3, IQR: 3-3), I-View (2, IQR: 2–3), and UESCOPE (2, IQR: 2–3). On the POGO scale, Airtraq scored 70 % (IQR: 60%–90 %), compared to Macintosh (30 %, IQR: 20%–30 %), I-View (60 %, IQR: 30%–60 %), and UESCOPE (50 %, IQR: 30%–70 %) ConclusionsAirtraq laryngoscope on a mannequin model turned out to be device that damages the teeth the least, exerts the lowest pressure on the tongue and giving the possibility of the fastest intubation with the greatest comfort for the operator in the studied group of users.

Evaluation of IntuBrite® laryngoscope for endotracheal intubation performed by paramedics in out-of-hospital cardiac arrest with particular insight on patients with obesity – A randomised control study

BackgroundAirway management next to the high-quality chest compressions and early defibrillation is one of the most important procedures performed by paramedics during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). The aim of the presented study was to assess the time and effectiveness of endotracheal intubation performed by a paramedics during OHCA with the use of a classic Macintosh laryngoscope (MCL) and an IntuBrite laryngoscope (IBL). MethodsA total of 60 adult patients were qualified for the study. The tested laryngoscopes were evaluated in terms of the effectiveness and time of procedure, the degree of difficulty of intubation attempts and individual patient factors, with particular emphasis on obesity, which may negatively affect the intubation performance in pre-hospital care. ResultsThe overall number of successful intubations with the IBL was 30 (100 %), and with a MCL 20 (66,67 %). Efficiency of first intubation attempt (FIA) using, the IBL was 86,67 % (n = 26/30) while for the MCL it was 66,67 % (n = 20/30). During second attempt, 100 % of patients were intubated with the IBL and none with the MCL. The median time to first intubation (IT) was 18,12 s for the IBL and 19,86 s for the MCL. Non-obese patients were more effectively intubated than those with obesity (94,4 % vs 66,67 %, p = 0.01). ConclusionsFIA success of patients with OHCA using the IBL was significantly higher than the MCL (p = 0.0008), for both in the first and in the total number of intubation attempts. There were no statistically significant differences in the time of intubation between individual laryngoscopes. Non-obese patients were significantly more effectively intubated during CPR than obese patients (p = 0.01).

Comparison of Paraglossal Technique of Miller Blade Insertion with McCoy and Macintosh Adult Laryngoscopes on the Cormack–Lehane Grade in Patients with Simulated Restricted Neck Mobility—A Randomized Control Trial

Abstract Background The paucity in round-the-clock availability of advanced tools like flexible bronchoscopes and video laryngoscopes makes it preferable to have alternative easily available gadgets for securing the airway in patients with cervical spine injuries where head and neck movements must be strictly avoided. This study compared the paraglossal technique of Miller blade insertion with the McCoy and Macintosh laryngoscope blades on the Cormack and Lehane grading (CLG) in patients with simulated restricted neck mobility. Methods We randomized 90 patients undergoing general anesthesia to be intubated either using Miller blade (Group-Mill), McCoy blade (Group-McCoy), or Macintosh blade (Group-Mac) following neck restriction using a soft cervical collar. CLG grade, the number of intubation attempts, use of bougie, intubation time, and hemodynamic parameters were noted. Nonparametric data were compared using the chi-squared test and parametric data using one-way analysis of variance. Results Group-MILL had significantly higher patients with Grade-1 CLG compared to Group-Mac (p = 0.02). The number of attempts, use of bougie, and intubation time were, however, comparable among the three groups. The hemodynamic parameters at intubation were not significantly different among the groups. Conclusion In adult patients with simulated restricted neck, the Miller laryngoscope blade, despite providing a better laryngeal view, showed no benefit in decreasing the intubation time when compared to the McCoy or Macintosh blades.