Macintosh Laryngoscope Research Articles

Laryngoscopy in Neonates and Infants presenting with stridor in tertiary care hospital

INTRODUCTIONNeonatal life involves the readaptation of gas exchange from the intrauterine to extrauterine environment. Stridor in this period reflects a critical airway obstruction which may have been anticipated or wholly unexpected. Many congenital and acquired diseases may cause airway obstruction and respiratory distress in infants.AIMS AND OBJECTIVESTo study the causes of stridor in neonates and infants.Early diagnosis and treatment of the stridor to prevent morbidity and mortality.METHODSThe study was observational study. In this study both qualitative and quantitative approaches were used to collect, analyse and interpret the data. Patients with stridor under age of 1 year who were referred to our department were taken in this study BY DIRECT LARYNGOSCOPYDirect laryngoscopy with macintosh laryngoscope or miller’s blade was done.Results: In our study the most common symptom at presentation was stridor which was present in all 25 cases we have taken.13 cases were presented with difficulty in feeding along with the stridor. This was 2nd most common symptom of presentation.Stridor was associated with fever and cough cold in 13 cases. Change of cry along with stridor observed in 6 cases Result and CONCLUSIONFNPL is gold standard for diagnosis and very useful and safe procedure. Use of better technology and continuous monitoring in NICU/PICU in tertiary care hospital and observation by team of doctors (Pediatrician, ENT Specialist, intensivist etc.) have definitely reduced the rate of morbidity and mortality.

Two safe techniques for intubation using Macintosh laryngoscope in Covid 19 suspected patients

Two safe techniques for intubation using Macintosh laryngoscope in Covid 19 suspected patients

A comparative study of haemodynamic effects of single-blinded orotracheal intubations with intubating laryngeal mask airway, Macintosh and McGrath video laryngoscopes.

The efficacy of an intubation technique is crucial to the success of ventilation therapies. Intubating laryngeal mask airway (ILMA), Macintosh and McGrath techniques are yet to be evaluated thoroughly. Orotracheal intubations with ILMA, McGrath, and Macintosh laryngoscopes are compared based on haemodynamic changes, time taken for intubations, and success rate. This is aprospective, single-blinded, randomised controlled trial. Primary outcome: identification of the most efficient intubation technique. Secondary outcomes: haemodynamic parameters, time taken for intubation and the rate of success of intubation. Patients enrolled: 90. Groups: 3. Each participant is randomly assigned to agroup. Inclusion criteria: both sexes, age: 18-55 years, ASA: Ior II, Mallampati < III, Mouth opening > 2 fingers, BMI < 40 kg m-2, any elective surgery, general anaesthesia requiring endotracheal intubation. The haemodynamic changes, time taken for intubations, and success rate during ILMA, Macintosh and McGrath intubations were recorded and statistically analysed. Macintosh and ILMA raised the heart rate (min-1) more than McGrath at the second minute (95% CI: 76.50 ± 1.34 [McGrath] < 81.73 ± 1.46 [Macintosh] < 90.42 ± 1.24 [ILMA]). ILMA required the longest intubation time (s) (95% CI: 71.64 ± 2.14 [ILMA] > 40.26 ± 1.36 [McGrath] > 30.63 ± 1.53 [Macintosh]). Macintosh and McGrath intubations were all successful, whereas ILMA recorded two failures. However, the observed failures were statistically insignificant (95% CI: 93.33 ± 4.35%). McGrath intubation is the most efficient technique based on its haemodynamics. ILMA required the longest intubation time and statistically, rates of success of the techniques are alike.

Macintosh, Glidescope ve Airtraq Laringoskoplar ile Gerçekleştirilen Endotrakeal Entübasyon Başarılarının Karşılaştırılması

Macintosh, Glidescope ve Airtraq Laringoskoplar ile Gerçekleştirilen Endotrakeal Entübasyon Başarılarının Karşılaştırılması

C-MAC D-Blade vs Airtraq for Intubation with Manual Inline Axial Stabilisation- A Randomised Clinical Trial

Introduction: One of the most important skills in anaesthesia is securing the airway with an endotracheal tube. Difficult tracheal intubation however is considered one of the major contributors of anaesthesia related morbidity and mortality. Video laryngoscopy offers several advantages during endotracheal intubation. The view of the glottis provided by Videolaryngoscopes is better compared to the Macintosh laryngoscope in difficult airways which makes it more attractive for routine difficult airway intubations. Aim: To compare the time taken for intubation between two Videolaryngoscopes, namely C-MAC D-blade and Airtraq and to assess the quality of laryngoscopy view between the two groups. Materials and Methods: This was a randomised clinical trial conducted in 116 American Society of Anesthesiologists 1 (ASA1) and ASA2 patients undergoing elective surgeries in Pondicherry Institute of Medical Sciences. Patients are randomised into two groups, Group C-MAC D-blade and Group Airtraq by computer randomisation. Statistical analysis was performed using t-test, Repeated measures of ANOVA was used to find the significance from preinduction to 10 mins period for each group and Bonferoni’s correction for intergroup comparison. Results: The time taken for intubation was comparable in two study groups (Group C-MAC D-blade 41.88 secs) and (Group Airtraq -40.78 sec) with p-value of 0.734. Laryngoscopic view was not statistically significant with p-value of 0.083. Optimisation maneuvers were required in 63.8% in Group Airtraq on comparison with 44.8% in Group C-MAC D-blade. In both Group C-MAC D-blade and Group Airtraq, there was a significant rise in the heart rate and BP at 0 minute compared to preinduction. But after 5 minutes, the heart rate and BP were back to preinduction values. Conclusion: Both the Videolaryngoscopes, C-MAC D-blade and Airtraq performed equally, with respect to time taken for intubation and laryngoscopic view. However, External Laryngeal Manipulation (ELM) was required more in Group Airtraq and was statistically significant.

A Comparative Study in Airway Novices Using King Vision Videolaryngoscope and Conventional Macintosh Direct Laryngoscope for Endotracheal Intubation.

Background and Objectives:Tracheal intubation using laryngoscopy is a fundamental skill, for an anesthesiologist. However, teaching this skill is difficult since Macintosh direct laryngoscope (DL) allows only one individual to view the larynx during the procedure. Hence, this study aimed to determine whether King Vision® videolaryngoscope (KVL) provides any advantage over direct laryngoscopy in teaching this skill to airway novices.Materials and Methods:In this prospective randomized crossover study, Ethical Committee clearance was obtained from the institutional review board (MSRMC/EC/2017) and the study was registered with Clinical Trial Registry. After informed consent, 53 medical students were allotted to perform laryngoscopy and endotracheal intubation on a manikin by using either KVL or Macintosh DL. The participants first performed laryngoscopy with either KVL or Macintosh DL following a brief instruction and then crossed over to the second arm of the study to perform laryngoscopy using the other scope. The primary outcome measure was the time for successful endotracheal intubation. The secondary outcome measures were incidence of esophageal intubation (EI), excess application of pressure on maxillary teeth excess maxillary pressure, and success rate.Results:Mean time for endotracheal intubation was significantly faster using KVL than in DL (44.64 vs. 87.72 s; P < 0.001). No significant difference was found in the incidence of esophageal intubation 15.1% in KVL group versus 24.5% in DL group (P = 0.223). In the KVL group, 81.1% did not apply pressure on maxillary teeth versus 26.4% in the DL group (P < 0.001). The success rate of intubation was 100% in the KVL group versus 86.8% in the DL group (P = 0.006).Conclusion:The KVL is a more effective tool to teach endotracheal intubation in comparison to Macintosh laryngoscope in airway novice medical students. Clinical trial registry India registration number: CTRI/2017/11/010491.

The Effect of Fiberoptic Bronchoscopy-guided Technique for Placement of a Left-sided Double-lumen Tube on the Intubation Performance Compared with the Conventional Method Using a Macintosh Laryngoscope

Background: The accurate placement of the double-lumen endotracheal tube is imperative for effective one-lung ventilation in thoracic surgery. Malpositioning and repositioning of a misplaced tube may cause excessive trauma. Objective: We hypothesized that the fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement would reduce the incidence of malpositioning as compared to the conventional method using the Macintosh laryngoscope. Methods: Fifty patients scheduled to undergo elective thoracic surgery were recruited and randomly assigned to the fiberoptic bronchoscope-guided [n=25; Group F] and conventional [n=25; Group C] method groups, according to the method of double-lumen endotracheal tube placement. The primary outcome was the incidence of double-lumen endotracheal tube malpositioning observed under the fiberoptic bronchoscope after initial placement. Secondary outcomes included the times for placement, confirmation, and total procedure of double-lumen endotracheal tube intubation. Results: The incidence of malpositioning after initial double-lumen endotracheal tube placement was significantly lower in Group F than in Group C (20.0% vs 68.0%). In addition, the time for placement was significantly higher in Group F than in Group C, and that for confirmation was significantly lower in Group F than in Group C. Conclusion: The fiberoptic bronchoscope-guided method for double-lumen endotracheal tube placement can reduce the incidence of malpositioning after initial placement and expedite the intubation process with a double-lumen endotracheal tube in thoracic surgery.

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.

Comparing Macintosh, Miller and Truview Laryngoscopes for Evaluation of Intubation Difficulty in Patients with Immobilized Cervical Spine

Context: To evaluate intubation difficulty comparing Macintosh, Miller and Truview blades in patients with immobilized cervical spine. Aims: 1. To compare the difficulty during orotracheal intubation between Macintosh, Miller or Truview laryngoscopes utilizing the Intubation Difficulty Scale (IDS). 2. To compare the time taken for intubation. 3. Success rate of intubation in the three groups. Settings and Designs: Prospective randomized cross sectional study. Methods and Materials: This study was conducted in healthy Patients to evaluate the difficulty during intubation using the mentioned laryngoscopes, with the neck immobilized using Manual In-line Axial Stabilization (MIAS). Evaluation was done using intubation difficulty score (having seven parameters), success rate and duration of intubation. Intubation failure was defined as duration exceeding 120 seconds for which MIAS was relaxed and intubation was done conventionally. Statistics: One Way Analysis of Variance with Duncan’s mean test. Results: All patients in the Macintosh group , 18 (90%) in Miller group and 16 (80%) in Truview group were intubated successfully. The duration of intubation was significantly longer and IDS score, least in Truviewgroup. Truview provided better glottic view and required less optimizing maneuvers. Conclusions: The Intubation Difficulty Scale (IDS) score in parients with cervical spine immobilization (MIAS) is significantly least with TruView laryngoscope compared to conventional laryngoscopy using Macintosh or Miller laryngoscope. The time taken for intubation was shortest with Macintosh laryngoscope. Success rate of intubation is highest with Macintosh laryngoscope while it is least with TruView laryngoscope under the stipulated time limit (120 seconds) for laryngoscopy.

A comparative study of laryngeal view and pressor response by using three different blades- Macintosh, miller and Mccoy laryngoscopes

Maintenance of airway during anaesthesia is very important to anaesthesiologist. A prospective, randomized study was conducted in 90 patients (ASA-I & II) posted for various surgeries under general anaesthesia with endotracheal intubation to evaluate differences in glottic view, attempts and duration of laryngoscopy and intubation attempts along with hemodynamic variability associated with the three blades- Macintosh, McCoy and Miller laryngoscope blade. Patients were randomly allocated in three groups. In first group laryngoscopy was done with Macintosh blade, in second group with Miller blade, in third group with McCoy blade. In this study it was found that McCoy laryngoscope is distinctly superior to the Macintosh and Miller with less hemodynamic changes and better glottic visualization. Degree of difficulty in intubation was more with Miller blade in comparison to Macintosh and McCoy blade which is statistically significant (p value < 0> Keywords: Cormack lehane grade, Macintosh blade, McCoy blade, Miller blade, Degree of difficulty in intubation.

Use of the GlideScope does not lower the hemodynamic response to tracheal intubation more than the Macintosh laryngoscope: a systematic review and meta-analysis.

Background:It is presently unclear whether the hemodynamic response to intubation is less marked with indirect laryngoscopy using the GlideScope (GlideScope) than with direct laryngoscopy using the Macintosh laryngoscope. Thus, the aim of this study was to determine whether using the GlideScope lowers the hemodynamic response to tracheal intubation more than using the Macintosh laryngoscope.Methods:We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim was to determine whether the heart rate (HR) and mean blood pressure (MBP) 60 s after tracheal intubation with the GlideScope were lower than after intubation with the Macintosh laryngoscope. We expressed pooled differences in HR and MBP between the devices as the weighted mean difference with 95% confidence interval and also performed trial sequential analysis (TSA). Second, we examined whether use of the GlideScope resulted in lower post-intubation hemodynamic responses at 120, 180, and 300 s compared with use of the Macintosh laryngoscope. For sensitivity analysis, we used a multivariate random effects model that accounted for within-study correlation of the longitudinal data.Results:The literature search identified 13 articles. HR and MBP at 60 seconds post-intubation was not significantly lower with the GlideScope than with the Macintosh (HR vs MBP: weighted mean difference = 0.22 vs 2.56; 95% confidence interval −3.43 to 3.88 vs −0.82 to 5.93; P = .90 vs 0.14; I2 = 77% vs 63%: Cochran Q, 52.7 vs 27.2). Use of the GlideScope was not associated with a significantly lower HR or MBP at 120, 180, or 300 s post-intubation. TSA indicated that the total sample size was over the futility boundary for HR and MBP. Sensitivity analysis indicated no significant association between use of the GlideScope and a lower HR or MBP at any measurement point.Conclusions:Compared with the Macintosh laryngoscope, the GlideScope did not lower the hemodynamic response after tracheal intubation. Sensitivity analysis results supported this finding, and the results of TSA suggest that the total sample size exceeded the TSA monitoring boundary for HR and MBP.

Biochemical markers and haemodynamic changes of stress response after intubation with direct laryngoscopy versus video laryngoscopy versus fiberoptic intubation: A comparative study

Laryngoscopy and intubation leads to stimulation of pharyngeal and tracheolaryngeal nociceptors resulting in haemodynamic stress response (HDSR). Stress response is regulated by two primary neuroendocrine systems- the hypothalamus pituitary adrenocortical (HPA) and sympathetic adrenomedullary (SAM) system. Salivary alpha-amylase (SAA) level can be used as an index of the SAM activity, and serum cortisol as an index of HPA activity. This study was aimed to compare three different intubation techniques namely Macintosh laryngoscope, Video laryngoscope and Fiberoptic bronchoscope to observe stress response. This prospective, comparative and observational study was carried out at 120 patients undergoing various elective surgeries under general anaesthesia. Patients were allocated after randomization into three study groups- Group D (Direct laryngoscope), Group V (Video laryngoscope) and Group F (Fiberoptic bronchoscope) with 40 patients in each. Saliva and venous blood samples were collected before inducing the patients and 5-minutes after intubation. Blood pressure, heart rate and saturation were monitored at fixed intervals.A significant difference was observed in the post-intubation values (p=0.0001) of salivary alpha amylase levels by direct laryngoscopy and fiberoptic laryngoscopy, while it was insignificant in video laryngoscopy (p=0.919). Post intubation cortisol level was significantly high in all three groups. However, on group comparison of mean differences of serum cortisol levels, a significant mean difference was seen between D vs V group (p=0.0001), and V vs F group (p=0.0001), while it was not significant in D vs F group (0.157). In addition, changes in mean arterial pressure and heart rate, at 1- and 5-min post- intubation were least in group V. Video laryngoscopy is a safe, and reliable technique. Moreover, it causes lesser stress response to patients in comparison to direct laryngoscopy and fiberoptic groups.

마네킹을 이용한 어려운 기도에서 부지 기관 내 삽관의 효과

Purpose: This study aimed to find out the effectiveness of gum elastic bougies for intubation in comparison to stylet according to airway type using a manikin. Methods: The study subjects were 52 paramedic students who intubated using a Macintosh laryngoscope and compared stylet and gum elastic bougie use in a 7.5 mmID endotracheal tube, on a manikin with either normal or difficult airway. Difficult airway was made Philadelphia neck collar. Collected data included intubation time, accuracy and ease of intubation, later analyzed by frequency analysis, descriptive analysis, independent t-test, chi square test, paired t-test, and McNemar test using SPSS Statistics 18.0. Results: There was a significant difference in intubation time according to intubation device and airway type (p=.000). There was no significant difference in accuracy of intubation according to intubation device or airway type (normal airway p=1.000, difficult airway p=.052). There was a significant difference in ease of intubation scale according to intubation device and airway type (p=.000, p=.000). Conclusion: Based on the speed and ease of intubation, gum elastic bougie is recommended for intubation in patients with difficult airways such as those with cervical injury.

Effects of the anesthesiologist\u2019s experience on postoperative hoarseness after double-lumen endotracheal tube intubation: a single-center propensity score-matched analysis

BackgroundPostoperative hoarseness after general anesthesia is associated with patient discomfort and dissatisfaction. A recent large retrospective study showed that single-lumen endotracheal tube intubation by a trainee did not alter the incidence of postoperative pharyngeal symptoms compared with intubation by a senior anesthesiologist. However, there is limited information about the relationship between the anesthesiologist’s experience and hoarseness after double-lumen endotracheal tube intubation. We tested the hypothesis that double-lumen endotracheal tube intubation performed by a trainee increases the incidence of postoperative hoarseness compared to intubation by a senior anesthesiologist.MethodsThis retrospective observational study included patients who underwent lung resection between April 2015 and March 2018 at a university hospital. Double-lumen endotracheal tube intubation was carried out with a Macintosh laryngoscope. We divided the patients into 2 groups - one group comprised of patients who were intubated by a trainee anesthesiologist with < 2 years of experience, and the other group comprised of those who underwent intubation by a senior anesthesiologist with ≥2 years of experience. The primary outcome was the incidence of postoperative hoarseness 24 h after surgery and we collected data on postoperative hoarseness using a checklist of postanesthetic adverse events. One-to-one propensity score matching was conducted and P values < 0.05 were considered statistically significant.ResultsThere was a total of 256 eligible patients, of which 153 underwent intubation by trainee anesthesiologists, and the remaining 103 patients were intubated by a senior anesthesiologist. The one-to-one propensity score matching resulted in 96 pairs of patients for the groups. The incidence of postoperative hoarseness 24 h after surgery was significantly higher in patients who were intubated by a trainee anesthesiologist than in patients who were intubated by a senior anesthesiologist (9.4% vs. 2.1%, respectively; P = 0.03).ConclusionsDouble-lumen endotracheal tube intubation by trainee anesthesiologists with < 2 years of experience increased the incidence of postoperative hoarseness 24 h after surgery compared to intubation by senior anesthesiologists with ≥2 years of experience.

The effect of cricoid pressure on tracheal intubation in adult patients: a systematic review and meta-analysis.

This meta-analysis aimed to assess the impact of cricoid pressure (CP) application on intubation outcomes. Electronic databases (i.e., MEDLINE, PubMed, Embase, and Cochrane review) were searched from inception to 2 June 2020 for randomized-controlled trials that assessed the intubation outcomes in adult patients using laryngoscopic approaches with and without the application of CP (i.e., CP vs non-CP group). The primary outcome was the successful first-attempt intubation rate (SFAIR), and the secondary outcomes were intubation time, incidences of poor laryngoscopic views (i.e., Cormack and Lehane grade 3-4), airway complications, and pulmonary aspiration. A total of five trials (published from 2005 to 2018) were included, and all tracheal intubations were performed by anesthesiologists or nurse anesthetists with a video (n = 3) or Macintosh laryngoscope (n = 2) in the operating room. We found no significant difference in SFAIR (risk ratio [RR], 0.98; P = 0.37), incidence of poor laryngoscopic views (RR, 1.49; P = 0.21), and risk of sore throat (RR, 1.17; P = 0.73) between the two groups. Nevertheless, the intubation time on the first successful attempt was slightly longer (weighted mean difference = 4.40 sec, P = 0.002) and risk of hoarseness was higher (RR, 1.70; P = 0.03) in the CP group compared with in the non-CP group. The secondary outcome "pulmonary aspiration" was not analyzed because only one trial was available. The application of CP did not have a negative impact on the SFAIR or laryngoscopic view. Nevertheless, this maneuver may slightly prolong intubation time and increase the risk of postoperative hoarseness.

Video Laryngoscope Intubation With an Aerosol Barrier Device: A Randomized Sequential Crossover Pilot Study.

Objectives:To assess the impact of the use of aerosol barrier device, Splashguard-CG, on the endotracheal intubation with different types of laryngoscope.Design:A pilot randomized sequential crossover simulation study.Setting:A single academic center in Japan.Subjects:Physicians in a single academic university hospital in Japan.Interventions:Use of Splashguard-CG.Measurements and Main Results:All participants were asked to perform endotracheal intubation to a manikin simulator using three different devices (Macintosh laryngoscope; Airway Scope [Nihon Kohden, Tokyo, Japan]; and McGRATH MAC [Aircraft Medical, Edinburgh, United Kingdom]) with and without Splashguard-CG in place, which required a total of six attempts and measured the intubation time as the primary outcome. Thirty physicians (15 experienced physicians and 15 less-experienced physicians) were included. Intubation time using Macintosh laryngoscope was significantly longer in the group with Macintosh laryngoscope and Splashguard-CG compared with the group without Splashguard-CG by the median difference of 4.3 seconds (interquartile range, 2.6–7.4 s; p < 0.001). There was no significant increase in the intubation time with or without Splashguard-CG for the Airway Scope (0.6 s; interquartile range, –3.7 to 3.2 s; p = 0.97) and the McGRATH MAC (0.5 s; interquartile range, –1.4 to 4.6 s; p = 0.09). This trend was found in both the experienced and less-experienced groups. We observed significant increases of subjective difficulty of the endotracheal intubation evaluated by using a Visual Analog Scale in the Splashguard-CG groups for all three types of devices.Conclusions:The use of a video laryngoscope with an aerosol barrier device does not impact the time required endotracheal intubation in a simulation environment. This method can be considered as airway management for coronavirus disease 2019.

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

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

Proficiencies of military medical officers in intubating difficult airways

BackgroundThis study sheds light on the proficiency of military medical officers who had received between 2 and 3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes.MethodOne hundred thirty-three doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study.ResultsThe medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1 s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4 s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2 s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4 s.ConclusionMilitary medical officers with 2–3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

SWIFT ACUTE EMERGENCY PERSONAL NOVEL VIDEO LARYNGOSCOPE (SAPNOSCOPE): AN INNOVATIVE SOLUTION AND POTENTIAL GAME-CHANGER ON THE HORIZON FOR INTUBATION IN RESOURCE-LIMITED COUNTRIES

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Video laryngoscope (VL) has emerged as a well-established tool among various health care providers both prehospital and in-hospital settings. Video laryngoscope(VL) has the advantage of higher endotracheal intubation success among nonexpert, shorter learning curve, lesser cervical spine manipulation. Intubation can be done away from the line of sight, therefore, avoiding direct droplet infection from the airway. However widespread use of Video laryngoscope(VL) is solely restricted by the cost of Video Laryngoscope(VL). We aimed to develop safe, reliable, portable, easy to manufacture and inexpensive video laryngoscope and compare with conventional Macintosh. METHODS: Flexible video borescope is an optical device that allows visualization of difficult to access place it consists of a miniature camera at one end of a flexible tube and high definition screen at the other end. Video Flexible borescope with 4.3 inch HD screen (Screen endoscope F200, Cost-34 USD )was aligned and attached to the Macintosh blade no 3(Cost-14 USD) at 5 cm from the tip. The orientation of the camera and the field was checked following which the position was secured using EPOKE epoxy resin US FDA approved(Cost-10 USD/bottle). The device was called SAPNOSCOPE(Swift Acute emergency Personal Novel video laryngoSCOPE). The overall cost of the device was 56 USD. The safety and efficacy of the device were tested on a mannequin. Intubation performed on the mannequin by 50 physicians of different specialities using SAPNOSCOPE and Macintosh laryngoscope. Rates of successful Intubation, the grade for visualization of the glottis by Cormack-Lehane score, ease of intubation, visual clarity, number of attempts, time to intubate and complication were observed. RESULTS: Both in SAPNOSCOPE and Macintosh groups were similar in the rates of successful Intubation, grade for visualization of the glottis by Cormack-Lehane score and ease of intubation. However visual clarity was better with SAPNOSCOPE 100%( 50/50). 20%(10/50) in SAPNOSCOPE required 2 nd attempt for intubation as compared to 40% (20/50) in the Macintosh group. No difference was observed in average time to intubate in SAPNOSCOPE 50.2 secs and Macintosh group 46.6 secs,( p=0.122). The complication of esophageal intubation was observed only in the Macintosh group 20% (10/50). CONCLUSIONS: SAPNOSCOPE(Swift Acute emergency Personal Novel video laryngoSCOPE ) was found to be in par with conventional Macintosh and can be a potential alternative to Macintosh for endotracheal intubation. SAPNOSCOPE has scope to be the next game-changer in a resource-limited setting CLINICAL IMPLICATIONS: The device is reliable, inexpensive and durable making it ideal for a spectrum of fields like the emergency department, paramedics, anaesthesia and education. The versatility of device allows for portability, documentation, storing, transfer of data and research. DISCLOSURES: No relevant relationships by Sapan Kumar, source=Web Response No relevant relationships by Priyamvada Singh, source=Web Response

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

BackgroundWe aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery.MethodsA total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients’ radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden’s index corresponded to an optimal cut-off value.ResultsTen variables exhibited significant statistical differences between two groups (P < 0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%).ConclusionsFour radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values.