Macintosh Laryngoscope Research Articles

Is older still good, or even better? Evaluation of possibility of using Miller laryngoscope for intubation in adults and comparison with the most widely used Macintosh laryngoscope. Protocol of a crossover randomized control trial

BackgroundMacintosh laryngoscope is the most widely used laryngoscope for intubation. In some patients, e.g. with flaccid, drooping, aplastic epiglottis, usage of this laryngoscope, or even videolaryngoscopes, may not provide visualization of a glottis. Elevation of the laryngopharynx, like in intubation with Miller laryngoscope, may significantly improve intubating conditions. MethodsAn anaesthesiologist with over 20 years of experience will perform direct laryngoscopy with randomly chosen Miller or Macintosh blade, evaluating the visibility of rima glottidis with Cormack-Lehane classification and POGO score with and without external laryngeal pressure. Then the second evaluation of glottis with other blade type will be obtained and the patient will be intubated. Comparison of the rima glottidis visibility when using both blades will be the primary endpoint of the study. The secondary endpoints consist of: demonstrating whether there is a group of adult patients in whom the use of the Miller blade associated with better vocal cord visibility may be predicted based on an anesthesiological examination, and whether external laryngeal pressure improves vocal cord visualization more when using the Miller blade compared with the Macintosh blade. Sample sizeWe performed minimal sample size calculations based on the data derived from the first 60 patients. We assessed the minimal sample size to obtain the alpha of 5 % and power of 90 %. We decide to enroll at least 286 patients. Discussionthis will be the first trial assessing Miller and Macintosh blades in the same population of adult patients. It will determine group of patients in whom Miller laryngoscope will provide better visualization of rima glottidis than Macintosh blade and associated technique, diminishing rate of prolonging intubations and reducing possible aftermaths of hypoxia.

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.

A randomized comparison of the performance of Airtraq videolaryngoscope versus Macintosh laryngoscope in simulated rapid sequence induction of anaesthesia

Application of cricoid pressure during rapid sequence induction (RSI) of anaesthesia leads to difficult airway. No channeled videolaryngoscope (VL) has been compared with the Macintosh laryngoscope for facilitating intubation in RSI. Thus, we compared Airtraq® VL with Macintosh laryngoscope for simulated RSI in patients scheduled for elective surgeries.Following approval from Institutional Ethics Committee-Human Research, this randomized study was conducted. Patients of either sex, aged 18-65yr, ASA grade I/II, scheduled for elective surgeries under GA were included. 'Group DL' underwent direct laryngoscopy (DL) using Macintosh laryngoscope and Group VL with Airtraq® videolaryngoscope. Time taken for intubation, Cormack-Lehane (CL) grade of laryngeal view, number of intubation attempts, and haemodynamic parameters were noted. Student t-test and chi square test were used for statistical analysis.A total of 140 patients with 70 in each group were included. The mean time taken for intubation was significantly higher in VL group (84.70 ± 28.05s) than DL group (23.90 ± 6.67s). The optimal laryngeal view (i.e. CL grade I or II) was significantly improved in VL group than DL group i.e. 97% vs 94%. In group DL, 99% (n=69) were intubated in first attempt; whereas 60% (n=42) in Group VL (p<0.001). Hemodynamics was better in group VL.Airtraq® VL is better than conventional Macintosh laryngoscope for endotracheal intubation during RSI in terms of optimal glottic view, ease of intubation and haemodynamics. On the contrary, the “time taken to intubation” and the first attempt intubation rate were higher with Airtraq® VL.

Anaesthesia Management of Congenital Alveolar Synechiae Release in a Neonate

Abstract A neonate, with complete fibrous congenital alveolar synechiae and amniotic band syndrome affecting the upper and lower limbs, was posted for surgical release of synechiae under anaesthesia. A neonate with no mouth opening poses many anaesthesia challenges. The surgical and anaesthesia plan was discussed with ear, nose and throat surgeons. Topicalisation of airway, small aliquots of intravenous (IV) ketamine and propofol and sevoflurane inhalation helped achieve adequate depth of anaesthesia to carry out flexible intubating video endoscope-guided nasotracheal intubation successfully. Post-surgery, a check laryngoscopy with D-Blade of C-MACR (Karl Storz Video Macintosh Laryngoscope) video laryngoscope revealed a Cormack Lehane view of grade IV. The trachea was not extubated on table and the baby was shifted back to the neonatal intensive care unit with pressure support ventilation and followed by tracheal extubation next morning. Rest of the course for the baby was uneventful. Anticipation, planning, preparedness, vigilance and team work during anaesthesia management led to a successful outcome in this case.

Medcaptain® video laryngoscope improves nasotracheal intubation in maxillofacial surgery: A randomized clinical trial

BackgroundNasotracheal intubation may be required to secure the airway in oral and maxillofacial surgery. AimTo evaluate the effectiveness of the video laryngoscope compared with the Macintosh laryngoscope for nasotracheal intubation in maxillofacial surgery. MethodsThis prospective, randomized, single-blind trial compared the video laryngoscope with the Macintosh laryngoscope for nasotracheal intubation in the adult population.The patients were randomized into two groups: Group M, which underwent intubation with a Macintosh laryngoscope; and Group V, which underwent intubation with a video laryngoscope (Medcaptain®), using an adapted blade (no. 3 for women and no. 4 for men). The modified nasotracheal intubation difficulty scale (NIDS), the three-step evaluation of nasotracheal intubation, the Cormack–Lehane score, the percentage of glottic opening (POGO) scale, and complications were compared. ResultsIn total, 62 patients (31 in each group) were included in the study. The total intubation duration, oropharynx–glottis time, and glottis–trachea time were significantly lower in Group V compared with Group M (p = 0.001, p = 0.007, and p = 0.008, respectively). Group V also had a significantly lower NIDS score (p = 0.001), a higher POGO score (p = 0.002), and a lower Cormack–Lehane score (p = 0.034) compared with Group M. The use of Magill forceps was less frequent in Group V (p = 0.002). The two groups showed comparable results for nose–oropharynx time, epistaxis, and hoarseness (p = 0.068, p = 0.43, and p = 0.74, respectively). ConclusionVideo laryngoscopy appears to provide easier and faster nasotracheal intubation in maxillofacial surgery. Clinical trial registrationThis study was registered in the Pan African Clinical Trials Registry (PACTR) under the reference PACTR202303563303199.

The efficacy of apneic oxygenation during intubation using a prototype of an oxygenation laryngoscope - a technical simulation

BackgroundRecently, a non-commercial oxygenation laryngoscope was able to maintain apneic oxygenation during simulated intubation efforts. Since that prototype was 3 mm wider than a standard Macintosh laryngoscope blade, the intubation performance of this device may differ from standard blades. A new prototype of an oxygenation laryngoscope was developed, consisting of a standard-size Macintosh blade and a fixed oxygen supply line to the side. Actually, it is unclear at which point of this blade the oxygen supply line should end to facilitate the best possible oxygen supply for apneic oxygenation.MethodsIn this simulation study using a standardized human airway manikin, the efficacy of apneic oxygenation by oxygen insufflation using standard and modified Macintosh blades was compared: a standard Macintosh blade without oxygen supply line as control, one with an additional oxygen supply line ending proximal near the handle, one with the line ending at the middle of the blade, and one with the line ending near the tip. A preoxygenated test lung was connected to an oximeter with a flow rate of 200ml/min, simulating oxygen consumption of a male adult, and to the trachea of an anatomically correctly shaped airway manikin. Apneic oxygenation was performed and oxygen content was measured over a 20-minutes observation period. Experiments were repeated five times for each laryngoscope blade.ResultsOxygen percentage in the test lung dropped from 100 ± 0% at the start of the experiment to 53 ± 1.5% in the room air control group (p < 0.001 compared to all other groups), and to 74 ± 2.5% in the proximal oxygen line group, whereas oxygen percentage remained at 100% in both the medium and distal oxygen line groups (p = 1 between these groups; p < 0.001 between all other groups).ConclusionsIn this simulation study with a preoxygenated airway manikin, the use of a modified Macintosh laryngoscope blade with oxygen line attached at the tip or at the middle were able to maintain apneic oxygenation without measurable drop of oxygen content over 20 min. Proximal placement of the oxygen supply line still showed an advantage against room air, however it did not completely prevent room air from entering the airway.Trial registrationNot applicable.

Protective potential of different mouthguard thicknesses against perianaesthetic dental trauma: a patient specific-finite element study

Perianaesthetic dental trauma is a common anaesthesia-related complication. Theprevious studies have shown a lack of knowledge regarding mouthguard usage and controversial results related to perianaesthetic dental trauma prevention. This study aimed to conduct a finite element analysis of the compressive and tensile stresses on the tooth-periodontal ligament-bone complex using custom-made mouthguards of different thicknesses and glass fibre splints to prevent perianaesthetic dental trauma. Custom-fitted ethylene-vinyl acetate mouthguards of two different thicknesses (2 and 3 mm) and glass fibre splint were modelled. A linear static finite element analysis was performed by applying a rigid Macintosh laryngoscope to the palatal surface of the maxillary central incisors at 150 N. The model without a mouthguard and glass fibre splint showed the highest stress values at the palatinal root surfaces during the impact. Increasing the mouthguard thickness significantly decreased the stress-strain values regardless of the presence of the glass fibre splint. Maximum stresses in the group using the 3 mm mouthguard were the lowest compared with the other groups.

Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study

BackgroundSternomental displacement (SMDD) is a surrogate indicator for cervical spine (C-spine) mobility. SMDD revealed good potential to predict difficult airway, but its validity in obese patients is not evident. Therefore, this study assessed the performance of SMDD with neck circumference (NC) in predicting difficult airway in obese surgical patients. The study involved 135 adult patients with body mass index (BMI) ≥ 35 kg/m2 scheduled for elective surgeries under general anesthesia with endotracheal tubes (ETT) inserted using Macintosh laryngoscopes. The airway was assessed using SMDD, NC, and modified Mallampati test (MMT). Difficult laryngoscopy view (DLV) was defined as Cormack–Lehane (C-L) grade ≥ 3. The accuracy of the SMDD in predicting DLV was set as the primary endpoint, while the accuracy of the SMDD compared to that of NC, MMT, and NC/SMDD ratio in predicting difficult airway was set as the secondary endpoint.ResultsThe DLV cases were 28 of 135 (20.7%), with a mean BMI of 41.1 ± 3.3 kg/m2. SMDD < 5cm and NC > 43 cm could predict DLV with an area under the receiver operating characteristic curve (AUROC) of 0.97 and 0.83 respectively. SMDD and NC had a good negative correlation (r = − 0.6; 95% CI = 0.7 to 0.4; p = 0.0001). The NC/SMDD ratio had the best prediction for DLV (AUROC of 0.98 at a cut-off value > 7.8).ConclusionsIn obese surgical patients, SMDD and NC/SMDD ratios are excellent predictors for DLV when the cut-off values are < 5cm and > 7.8, respectively.Trial registrationClinicalTrials.gov, NCT04524546. Registered in August 2020.

ETView SL versus Macintosh Direct Laryngoscope for Endotracheal Intubation Amid Simulated COVID-19 Cardiac Arrest: A Randomized Crossover Study.

Airway management procedures, such as endotracheal intubation (ETI), pose a significant risk of aerosol generation, requiring robust personal protective equipment (PPE) against aerosol-generating procedures (AGP). This study aimed to assess the impact of PPE-AGP on intubation success rates, time to intubation, and glottic visualization using ETView and a standard Macintosh laryngoscope (MAC). A total of 52 physicians participated in this prospective, observational, randomized crossover study conducted in a medical simulation setting. Participants included COVID-19 patients with cardiac arrest scenarios with and without PPE-AGP who were intubated with ETView and MAC. During intubation without PPE-AGP, ETView showed a similar first-pass success rate (FPS) but had a shorter intubation time and better glottal hydration compared to MAC. In scenario B (with PPE-AGP), ETView outperformed MAC in FPS, initiation time, and glottic visualization. The use of PPE-AGP had little impact on ETView's performance. However, it negatively affected the Macintosh laryngoscope, reducing FPS and glottic visibility. Participants found intubation with ETView easier in both scenarios. In conclusion, as compared to the Macintosh laryngoscope, ETView demonstrated higher performance under the circumstances of the simulation, especially when PPE-AGP was used.

A comparative study to evaluate the cervical spine movements during laryngoscopy using Macintosh and Airtraq laryngoscopes.

Intubation with Macintosh requires flexing the lower cervical spine and extending the atlanto-occipital joint to create a "line of sight." Primary aim of study was to compare the extent of cervical spine movement during laryngoscopy using conventional Macintosh laryngoscope and Airtraq. A total of 25 patients of either sex between the age group of 18 and 60 years, having American Society of Anesthesiologists (ASA) physical status of Grade-I and Grade-II, scheduled for elective surgery under image control requiring general anesthesia and intubation were enrolled. A baseline image of the lateral cervical spine including the first four cervical vertebrae was taken by an image intensifier. After administration of general anesthesia, laryngoscopy was first performed using a Macintosh laryngoscope and a second X-ray image of the lateral cervical spine was taken. The second laryngoscopy using a Airtraq laryngoscope was done and the third image of the lateral cervical spine was taken. Angles between occiput and C1; C1 and C2; C2 and C3; C3 and C4; and occiput and C4 were calculated. Atlanto-occipital distance (AOD) was calculated as the distance between occiput and C1. Macintosh showed greater cervical movement as compared with Airtraq but a significant difference in the movement was observed at C2-C3 and C0-C4. Baseline mean AOD was 2.21 ± 1.25 mm, after Macintosh and Airtraq laryngoscopy was found to be 1.13 ± 0.60 and 1.6 ± 0.78 mm, respectively, and was found to be significant (P < 0.05). We conclude that Airtraq allows intubation with less movement of the upper cervical spine makes Airtraq preferred equipment for intubation in patients with a potential cervical spine injury.

Cardiovascular responses to laryngoscopy and tracheal intubation with GlideScope or Macintosh laryngoscope in elderly patients undergoing gynecologic surgery: A randomize clinical trial

Introduction: The purpose of this study was to compare the GlideScope and Macintosh laryngoscopes for cardiovascular response to laryngoscopy and endotracheal intubation in elderly patients undergoing gynecological procedures. Methods: In this clinical trial, endotracheal intubation was performed using a GlideScope (study group; n=35) and Macintosh laryngoscope (control group; n=35). Hemodynamic parameters were recorded, before induction of anesthesia (baseline), 30 and 15 seconds after starting the laryngoscopy, and every minute up to 5 minutes after intubation. Intubation time and complications of laryngoscopy and intubation were compared between two study groups. Results: Systolic blood pressure (SBP) in 1 (P=0.002), 2 (P=0.003) and 3 (P=0.003) minutes were significantly lower in the study group than that of the control group. The duration of laryngoscopy and intubation was not statistically different between two study groups. The frequency of hypertension after endotracheal intubation in the study group (20%) was significantly lower than that of patients in the control group (45.7%) (P=0.02). There was no significant difference in terms of postoperative complications related to laryngoscopy and intubation (hoarseness and sore throat) between two study groups (P&gt;0.05). Conclusion: This study showed that the use of GlideScope better attenuated cardiovascular responses to laryngoscopy and intubation compared to Macintosh laryngoscope in elderly patients undergoing gynecologic surgery. Also, the frequency of hypertension following laryngoscopy and endotracheal intubation was lower with GlideScope compared to Macintosh laryngoscope. Durations of laryngoscopy, intubation and postoperative complications related to airway management (hoarseness and sore throat) were similar.

Sanyar Video Laryngoscope Improved Time and First Pass Success of Tracheal Intubation in Intensive Care Unit in Compared to Direct Laryngoscopy

Background: Airway management and tracheal intubation in the ICU is a difficult procedure that may be concomitant with major complications. The purpose of this study was to evaluate the effect of the SANYAR ® video laryngoscope(S-VL) on laryngeal view and first Pass Success of tracheal Intubation compared with direct laryngoscopy.&#x0D; Methods: This comparative, prospective clinical study was conducted on 120 adult patients in a single-center, in a surgical ICU under the supervision of an anesthesiologist in a university hospital. Difficult airway predictors, glottic view, first Pass Success of tracheal Intubation and time of intubation were evaluated with Macintosh laryngoscopy (ML) or the SANYAR® Video Laryngoscope(S-VL).&#x0D; Results: Tracheal intubation was performed in 58 critically ill patients using ML and 62 patients using S-VL. According to Cormack and Lehane (C&amp;L) grading glottic visualization was more difficult using ML (41%, C&amp;L grade 3 and 4) compared with S-VL (13%, C&amp;L grade 3 and 4) p&lt;0.001. Intubation of trachea was more successful in the first attempt, in patients with at least one difficult airway predictor with a S-VL compared to ML (87% vs. 38%; P = 0.001), time of intubation was also shorter by using S-VL.&#x0D; Conclusion: Among critically ill patients in the intensive care unit, who require intubation, the SANYAR video laryngoscopy improved glottis view compared to the Macintosh direct laryngoscopy and first-pass orotracheal intubation rate especially in patients with potentially difficult airways.

Comparative evaluation of C-MAC and McGrath MAC videolaryngoscopes with Macintosh direct laryngoscope for endotracheal intubation in adult patients undergoing elective surgeries.

Videolaryngoscopes have an undisputed role in difficult airway management, but their role in routine intubation scenarios remains underappreciated. McGrath MAC is a lightweight laryngoscope with a disposable blade. It remains to be proven if it performs as efficiently as the reusable videolaryngoscopes like C-MAC and whether it has an advantage over standard Macintosh laryngoscope in predicted normal airways. We recruited 180 adult patients and randomly divided them into three groups for intubation with either Macintosh laryngoscope (Group-A), C-MAC (Group-B), and McGrath (Group-C). The primary objective was to compare the first attempt success rate. Secondary objectives included Cormack-Lehane (CL) grades, laryngoscopy time, intubation time, ease of intubation, need for optimization manoeuver, and the number of passes to place the endotracheal tube. The two videolaryngoscopes provided a superior first attempt success rate as compared to Macintosh laryngoscope (P = 0.027). The CL grade-I was 100% in group B, 41.7% in group-A and 90% in group-C (B vs C; P = 0.037). Laryngoscopy time was 9.9 ± 2.5 s, 12.6 ± 0.8 s, and 13.1 ± 0.8 s for groups A, B, and C, respectively (B vs C; P = 0.001). Intubation time was 24.4 ± 12 s, 28.3 ± 1.9 s, and 37.3 ± 5.8 s for groups A, B, and C, respectively (P < 0.0001). The number of tube passes was highest in group C. Videolaryngoscopes provided a superior glottic view and resulted in a superior first attempt success rate as compared to Macintosh laryngoscope. When comparing the two videolaryngoscopes, C-MAC resulted in better intubation characteristics (shorter intubation time, better glottic views, and higher first-attempt success rates) and should be preferred over McGrath for intubation in adult patients with normal airways.

Evaluation of the Hemodynamic Response during Laryngoscopy and Intubation using McCOY and Macintosh Laryngoscope Blades

Basic elements of general anesthesia includeunconsciousness, amnesia, analgesia, muscle relaxation,diminished motor response to noxious stimuli, and reversibility.Muscle relaxation necessitates securing ventilation withendotracheal intubation. Laryngoscopy forms an importantpart of general anaesthesia and endotracheal intubation.Laryngoscopes are used to view the larynx and adjacentstructures for inserting an endotracheal tube into the trachea.Laryngoscopy aims to obtain good visualization of the vocalcords to facilitate smooth endotracheal intubation. The directlaryngoscopic view is best seen in sniffing in the morning airposition, improving the glottis view. Laryngoscopy triggers majorstress responses, one due to sympathetic stimulation releasingcatecholamines that leads to tachycardia and hypertension,which increases the myocardial oxygen demand, and the otherdue to vagal stimulation leading to parasympathetic activationthat manifests as bradycardia and hypotension. Both may becatastrophic in patients with a known history of ischemic heartdisease.Materials and Methods: This hospital-based prospective,observational study was carried out in the Department ofAnaesthesiology, Shri Ram Murti Smarak Institute of MedicalSciences, Bareilly over 112 patients of ASA physical status Iand II, undergoing elective surgery under general anaesthesiaduring a period of 18 months (February 2021 to June 2022).Results: In our study, a total of 112 patients were included,50.0% of cases were managed by Macintosh blade thoseconsisting of group I, and 50.0% of cases were managed byMcCoy blade, those consisting of group II. Pre-op Heart rate(HR) was 80.56 ± 11.48 and 76.79 ± 10.90 in group I and II,respectively and it was reduced pre-intubation in both groupsand it increased significantly during laryngoscopy (p &lt;0.05).Pre-op systolic blood pressure (SBP) was 116.56 ± 11.55 and119.48 ± 11.41 in group I and II, respectively and it was reducedat pre-intubation in both groups and it increased significantlyduring laryngoscopy (p &lt;0.05). Pre-op diastolic blood pressure(DBP) was 73.17 ± 8.54 and 73.61 ± 10.29 in group I and II,respectively and it decreased at pre-intubation and again, it wasincreased during laryngoscopy (p &lt;0.05). Pre-op mean arterialpressure (MAP) was 87.79 ± 8.64 and 89.28 ± 9.0 in group Iand II, respectively and it was decreased at pre-intubationand again, it was increased during laryngoscopy (p&lt;0.05).ECG was found normal in both groups at all time duration withtachycardia, but no change in the ST segment was noticed inany group.Conclusion: Our study concludes that the McCoy bladeproduces significantly lesser marked hemodynamic changes.The vitals like heart rate, systolic blood pressure, diastolicblood pressure and mean arterial pressure all rise in bothgroups following the laryngoscopy and intubation but increaseswith McCoy were less and insignificant than Macintoshlaryngoscopes.

A pilot, prospective trial of IntuBrite® versus Macintosh direct laryngoscopy for paramedic endotracheal intubation in out of hospital cardiac arrest

BackgroundIntubation in the case of out-of-hospital cardiac arrest (OHCA) is one of the most difficult procedures for Emergency Medical Services (EMS). The use of a laryngoscope with a dual light source is an interesting alternative to classic laryngoscopes. However, there are as yet no prospective data concerning the use of double light direct laryngoscopy (DL) by paramedics in traditional ground ambulance agencies in OHCA.MethodsWe performed a non-blinded trial in a single EMS in Poland within ambulances crews, comparing time and first pass success (FPS) for endotracheal intubation (ETI) in DL using the IntuBrite® (INT) and Macintosh laryngoscope (MCL) during cardiopulmonary resuscitation (CPR). We collected both patient and provider demographic information along with intubation details. The time and success rates were compared using an intention-to-treat analysis.ResultsOver a period of 40 months, a total of 86 intubations were performed using 42 INT and 44 MCL based on an intention-to-treat analysis. The FPS time of the ETI attempt (13.49 vs. 15.55 s) using an INT which was shorter than MCL was used (p < 0.05). First attempt success (34/42, 80.9% vs. 29/44, 64.4%) was comparable for INT and MCL with no statistical significance.ConclusionsWe found a statistically significant difference in intubation attempt time when the INT laryngoscope was used. Intubation first attempt success rates with INT and MCL were comparable with no statistical significance during CPR performed by paramedics.Trial RegistrationTrial was registered in Clinical Trials: NCT05607836 (10/28/2022)

Intraocular Pressure Changes Following Laryngoscopy and Tracheal Inubation with Macintosh Laryngoscope and Videolaryngoscope (King Vision) In Non-Ophthalmic Surgeries: A Randomized Study

Intraocular Pressure Changes Following Laryngoscopy and Tracheal Inubation with Macintosh Laryngoscope and Videolaryngoscope (King Vision) In Non-Ophthalmic Surgeries: A Randomized Study

Comparing the usefulness of VividTrac and classic Macintosh laryngoscope in intubation in pediatric patients with cleft palate

BackgroundSurgical repair for pediatric patients with cleft palate is performed under general anesthesia requiring endotracheal intubation. However, intubating these cases is usually difficult because of the cleft itself and associated airway abnormalities. VividTrac, a video laryngoscopy that could provide a real-time picture of the glottic area, could be helpful in these cases.MethodsWe conducted the current prospective investigation to compare VividTrac and conventional Macintosh laryngoscope in intubating pediatric patients with cleft palate.ResultsAll patient demographics did not express significant differences between the two groups. The number of trials and the first trial success rate were in favor of group L. The former had mean values of 1.28 and 1.05, while the latter occurred in 81.4% and 97.7% of patients in groups L and V, respectively. Group V showed a significant increase in the time interval passing between mouth opening and connecting the tube with the ventilator.Nonetheless, the difficulty of intubation was increased in group L. The need for cricoid pressure and tube introducer was increased in group L.ConclusionsVividTrac laryngoscope could be a valid and more suitable option for intubation in pediatric patients with cleft palate. Compared to the conventional laryngoscope, it has a higher success rate, lower attempt number, and lower need for assisting maneuvers.

The Importance of Median Glossoepiglottic Fold Engagement on Laryngeal View and Tracheal Intubation Success in Children.

Our study objective was to determine if the location of laryngoscope blade tip placement is associated with clinically important tracheal intubation outcomes in a pediatric emergency department. We conducted a video-based observational study of pediatric emergency department patients undergoing tracheal intubation with standard geometry Macintosh and Miller video laryngoscope blades (Storz C-MAC, Karl Storz). Our main exposures were direct lifting of the epiglottis versus blade tip placement within the vallecula and median glossoepiglottic fold engagement versus not when the blade tip was placed in the vallecula. Our main outcomes were glottic visualization and procedural success. We compared measures of glottic visualization between successful and unsuccessful attempts using generalized linear mixed models. Proceduralists placed the blade tip in the vallecula (indirectly lifting the epiglottis) during 123 (71.9%) of 171 attempts. When compared with indirectly lifting the epiglottis, directly lifting the epiglottis was associated with improved visualization-by percentage of glottic opening (POGO) (adjusted odds ratio [AOR], 11.0; 95% confidence interval [CI], 5.1 to 23.6) and modified Cormack-Lehane (AOR, 21.5; 95% CI, 6.6 to 69.9). When in the vallecula, engagement of the median glossoepiglottic fold was associated with improved POGO (AOR, 3.6; 95% CI, 1.9 to 6.8), modified Cormack-Lehane (AOR, 3.9; 95% CI, 1.1 to 14.1), and success (AOR, 9.9; 95% CI, 2.3 to 43.7). Emergency tracheal intubation can be performed in children at a high level by directly or indirectly lifting the epiglottis. If indirectly lifting the epiglottis, median glossoepiglottic fold engagement is helpful in maximizing glottic visualization and procedural success.

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 C-MACTM Videolaryngoscope with Macintosh Laryngoscope in Anticipated Difficult Airway

Background: Failure to intubate is one of the dreaded outcomes of airway management. Videolaryngoscopes have the potential to increase intubation success by overcoming the shortcomings of direct laryngoscopy. This study aimed to compare the first-attempt intubation success rate of the C-MACTM videolaryngoscope and Macintosh laryngoscope in patients with anticipated difficult airways. Methods: Eighty adult patients with multiple predictors of difficult airway scheduled for surgery under general anaesthesia were randomised either into Group C (first using the C-MACTM videolaryngoscope) or Group D (first using the Macintosh laryngoscope). Laryngoscopy was done sequentially with both laryngoscopes in a patient based on the randomisation. The primary outcome was the first-attempt intubation success rate. Intubation time, Cormack–Lehane view, use of airway adjuncts and the need for external laryngeal manipulations constituted the secondary outcomes. Results: The first-attempt intubation success rate was 100% in both groups with the P value 1.0 and the intubation time was 26 s in Group C and 24.4 s in Group D with P = 0.17. The C-MACTM videolaryngoscope provided better grades of laryngoscopic view than direct laryngoscopy (P = 0.02). Tracheal tube introducer-assisted intubation (P = 0.01) and requirement of laryngeal manipulation to aid intubation (P = 0.01) were higher with the Macintosh laryngoscope. Conclusion: The Macintosh laryngoscope was comparable to the C-MACTM videolaryngoscope in terms of intubation success, intubation time and complications. However, an increased requirement for external laryngeal manipulation, lifting force and the use of an introducer for intubation were noted in the Macintosh group.