Percentage Of Glottic Opening Research Articles

Machine Learning Predictions and Identifying Key Predictors for Safer Intubation: A Study on Video Laryngoscopy Views.

This study develops a predictive model for video laryngoscopic views using advanced machine learning techniques, aiming to enhance airway management's efficiency and safety. A total of 212 participants were involved, with 169 in the training set and 43 in the test set. We assessed outcomes using the percentage of glottic opening (POGO) score and considered factors like the modified Mallampati classification, thyromental height and distance, sternomental distance, mouth opening distance, and neck circumference. A range of machine learning algorithms was employed for data analysis, including Random Forest, Light Gradient Boosting Machine, K-Nearest Neighbors, Support Vector Regression, Ridge Regression, and Lasso Regression. The models' performance was evaluated on the test set, with Root Mean Squared Error values ranging from 20.4 to 21.9. SHapley Additive exPlanations value analysis revealed that age is a consistent and significant predictor of POGO score across all models, highlighting its critical role in the predictive accuracy of these techniques.

A Comparison of the Effectiveness of the McCoy Laryngoscope and the C-MAC D-Blade Video Laryngoscope in Obese Patients.

Background and Objective: Obesity is associated with difficult or failed intubation attempts, making general anesthesia challenging for anesthesiologists to perform. The purpose of this study was to evaluate and compare the efficacy of a McCoy laryngoscope and a C-MAC D-blade video laryngoscope for intubation in obese patients with a body mass index (BMI) ≥ 35 kg/m2. Methods: In total, 104 patients were randomly assigned to be intubated with a McCoy (McCoy group) or C-MAC D-blade video laryngoscope (C-MAC group). The primary outcome was intubation time. The secondary outcomes were vocal cord exposure time, vocal cord passage time, proportion of successful intubation, mask ventilation scale, intubation difficulty scale (IDS), percentage of glottis opening (POGO) score, and hemodynamic variables. Results: Although the intubation time did not significantly differ, the C-MAC group showed shorter vocal cord exposure times and a higher rate of successful vocal cord exposure within 5 s. The IDS value was significantly lower in the C-MAC group than in the McCoy group. The proportion of patients who required an increase in lifting force during laryngoscopy was higher in the McCoy group than in the C-MAC group, which may explain the difference in MAP between the groups. Conclusions: Both the McCoy laryngoscope and the C-MAC D-blade video laryngoscope were useful during the intubation of obese patients. The C-MAC D-blade video laryngoscope might be more useful for obese patients in terms of hemodynamic stability.

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 < 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.

Non-inferiority randomized controlled trial comparing CricOid pressure and para-laryngeal pressure in parturients undergoing cesarean delivery: NiCOP trial

BackgroundCricoid pressure has been surrounded with controversies regarding its effectiveness. Application of ultrasound-guided para-laryngeal (PL) force has been shown to occlude the esophagus effectively compared with cricoid pressure (CP) in awake patients. We hypothesized that there would be no meaningful difference in the change in antero-posterior esophageal diameter from with application of cricoid or para-laryngeal pressure in parturients undergoing cesarean delivery under general anesthesia. MethodsIn this prospective, randomized, non-inferiority trial, 40 parturients scheduled for elective cesarean delivery under general anesthesia were randomized to receive rapid sequence induction with either cricoid pressure (n = 20) or para-laryngeal pressure (n = 20). The antero-posterior diameter of the esophagus, measured by sonography, was the primary outcome. Visualization of the esophagus, its position in relation to the glottic aperture, esophageal occlusion, percentage of glottic opening (POGO), time to intubation, first pass success rate, overall success rate and adverse events like desaturation or bronchospasm were secondary outcomes. ResultsThe mean change in anterior-posterior diameter in the CP group was 0.17 ±0.1 cm vs. 0.28 ±0.1 cm in the PL group. The mean difference (CP-para-laryngeal pressure) between the groups was -0.11 (95% CI −0.17 to −0.1) cm. As the upper limit of the 95% CI was lower than the prespecified non-inferiority margin (δ = −0.2), non-inferiority was established (P <0.001]. There was no significant difference in the POGO score (P = 0.818), time to intubation (P =0.55), or intubation attempts (P = 0.99). ConclusionsPara-laryngeal pressure was non-inferior to CP in occluding the esophagus in parturients undergoing cesarean delivery under general anesthesia and furthermore, no significant deterioration in intubation parameters was seen.

Comparative Evaluation of Linscope and King Vision Video Laryngoscopes in Tracheal Intubation: A Randomized Controlled Trial.

Introduction Indirect laryngoscopy has become a widely accepted method for learning the techniques of airway management. The incorporation of small, less expensive, and yet more reliable video cameras in laryngoscopes has given the process of laryngoscopy and intubation a big leap. The King Visionvideo laryngoscope (Medline Industries, USA) has demonstrated promise in several settings while the Linscope video laryngoscope(Centrum, Turkey) is a newly launched device and no literature is available to the best of our knowledge. Therefore, we aimed to compare the performance of the Linscope video laryngoscope (VL) and King Vision video laryngoscope. Method This is a randomized controlled trial study. Seventy patients, after approval from the institute's ethical clearance, were divided into two groups. In Group A, patients were intubated with Linscope VL and in Group B patients were intubated with King Vision VL as per the protocol. The primary outcome measure was the duration of tracheal intubation. Secondary outcomes were measured by the number of attempts, ease of intubation, and glottic view. Results Both Linscope VL and King Vision VL groups were comparable in terms of mean intubation time (20.34 s vs. 19.45 s). The endotracheal intubation with both devices was 100% successful at the first attempt. Both the devices provided a percentage of glottic opening (POGO) score of > 70% and a clear vision of the glottis. The POGO score obtained with King Vision VL was 83.57 ± 11.41% and with Linscope VL was 87.85 ± 10.31%. POGO score was greater with Linscope VL compared to King Vision VL, but the difference was not statistically significant (p-value>0.05). Conclusion King Vision demonstrated shorter intubation time and fewer optimization maneuvers. Both devices achieved a 100% success rate on the first attempt. While both devices are viable first-line options, King Vision's well-established efficacy in the literature suggests its preference over Linscope till extensive evidence is available in the future.

Usefulness of video laryngoscopy in tracheal intubation at thyroid surgical position for intraoperative neuromonitoring

This observational study aimed to compare the glottic view between video and direct laryngoscopy for tracheal intubation in the surgical position for thyroid surgery with intraoperative neuromonitoring. Patients scheduled for elective thyroid surgery with intraoperative neuromonitoring were enrolled. After the induction of anesthesia, patients were positioned in the thyroid surgical posture with a standard inclined pillow under their head and back. An investigator assessed the glottic view using the percentage of glottic opening (POGO) scale and the modified Cormack–Lehane grade in direct laryngoscopy and then video laryngoscopy sequentially while using the same McGRATH™ MAC video laryngoscope at once, with or without external laryngeal manipulation, at the surgical position. A total of thirty-nine patients were participated in this study. Without external laryngeal manipulation, the POGO scale significantly improved during video laryngoscopy compared to direct laryngoscopy in the thyroid surgical position (60.0 ± 38.2% vs. 22.4 ± 23.8%; mean difference (MD) 37.6%, 95% confidence interval (CI) = [29.1, 46.0], P < 0.001). Additionally, with external laryngeal manipulation, the POGO scale showed a significant improvement during video laryngoscopy compared to direct laryngoscopy (84.6 ± 22.9% vs. 58.0 ± 36.3%; MD 26.7%, 95% CI = [18.4, 35.0] (P < 0.001). The superiority of video laryngoscopy was also observed for the modified Cormack–Lehane grade. In conclusion, video laryngoscopy with the McGRATH™ MAC video laryngoscope, when compared to direct laryngoscopy with it, improved the glottic view during tracheal intubation in the thyroid surgical position. This enhancement may potentially facilitate the proper placement of the electromyography tracheal tube and prevent tube displacement due to positional change for thyroid surgery.

Pilot multicenter study to determine the utility of point-of-care ultrasound to predict difficulty of tracheal intubation using videolaryngoscopy with the McGrath™ Mac videolaryngoscope.

Clinical airway screening tests used to predict difficulties during airway management have low sensitivity and specificity. Point-of-care airway ultrasound has described measurements related to problems with difficult direct laryngoscopy. Nevertheless, the correlation between ultrasound parameters and videolaryngoscopy has not been published yet. The aim of this multicenter, prospective observational pilot study was to evaluate the applicability of clinical parameters and ultrasound measurements to find potential tracheal intubation difficulties when videolaryngoscopy is used. Preoperatively, six clinical airway assessments were performed: (1) modified Mallampati score, (2) thyromental distance, (3) sternomental distance, (4) interincisal distance, (5) upper lip bite test, and (6) neck circumference. Six ultrasound parameters were measured in awake patients: (1) distance from skin to hyoid bone, (2) distance from skin to epiglottis, (3) hyomental distance in neutral head position, (4) hyomental distance in head-extended position, (5) distance from skin to the deepest part of the palate, and (6) sagittal tongue area. And finally, there was one ultrasound measure obtained in anesthetized patients, the compressed sagittal tongue area during videolaryngoscopy. The difficulty for tracheal intubation using a McGrath™ Mac videolaryngoscope, the percentage of glottic opening, and Cormack-Lehane grade were also assessed. In this cohort of 119 subjects, tongue dimensions, particularly the sagittal tongue area, showed a robust association with increased intubation difficulty using videolaryngoscopy. A multiparametric model combining the following three ultrasound variables in awake patients: (a) the distance from skin to epiglottis, (b) the distance from skin to the deepest part of the palate, and (c) the sagittal tongue area, yielded a sensitivity of 92.3%, specificity of 94.5%, positive predictive value of 82.8%, and negative predictive value of 97.8% (p < 0.001). Point-of-care airway ultrasound emerges as a more useful tool compared to traditional clinical scales to anticipate possible challenges during videolaryngoscopic intubation.

Comparison of the Effectiveness of the Miller Laryngoscope and the McGrath-MAC Video Laryngoscope in Direct Visualization of the Glottic Opening.

Background and Objective: Placing the laryngoscope blade directly under the epiglottis (known as the direct view (DV) method) during videolaryngoscopy offers a superior view of the glottis when compared to the indirect method of lifting the epiglottis by positioning the Macintosh blade tip over the vallecula. While there are few studies comparing glottic views using Miller and Macintosh blades in pediatric patients, we have not come across such a study in adults. In this study, we aimed to compare the effectiveness and hemodynamic responses of the Miller laryngoscope and the McGrath-MAC videolaryngoscope (VL) in visualizing the glottic opening using the DV method. Material and Methods: A prospective study was conducted between August and December 2022 at XXX Hospital on 85 patients scheduled for surgical procedures involving endotracheal intubation. Patients were divided into two groups: Miller laryngoscope (Group M) and McGrath-MAC videolaryngoscope (Group VL) and intubated using the direct lifting method of the epiglottis. Hemodynamic responses before and after induction, as well as during laryngoscopy, intubation time, number of attempts, Cormack and Lehane (C&L) score, percentage of glottic opening (POGO), duration of the view of the opening, and need for external laryngeal pressure during intubation were recorded. Results: Both laryngoscopes showed similar effectiveness in terms of POGO and C&L score when used with the direct lifting method of the epiglottis. The median POGO values according to the DV method were 80% in Group M and 70% in Group VL (p = 0.099). Hemodynamic responses, intubation time, number of attempts, duration of view of the glottis opening, and the need for external laryngeal pressure were similar between the groups. Conclusions: Due to its ability to provide effective intubation conditions, we believe that the McGrath-MAC VL, when used with the indirect view method, can also be utilized in anesthesia practices alongside the DV method.

Hyperangulated blades or direct epiglottis lifting to optimize glottis visualization in difficult Macintosh videolaryngoscopy: a non-inferiority analysis of a prospective observational study

PurposeIt is unknown if direct epiglottis lifting or conversion to hyperangulated videolaryngoscopes, or even direct epiglottis lifting with hyperangulated videolaryngoscopes, may optimize glottis visualization in situations where Macintosh videolaryngoscopy turns out to be more difficult than expected. This study aims to determine if the percentage of glottic opening (POGO) improvement achieved by direct epiglottis lifting is non-inferior to the one accomplished by a conversion to hyperangulated videolaryngoscopy in these situations.MethodsOne or more optimization techniques were applied in 129 difficult Macintosh videolaryngoscopy cases in this secondary analysis of a prospective observational study. Stored videos were reviewed by at least three independent observers who assessed the POGO and six glottis view grades. A linear mixed regression and a linear regression model were fitted. Estimated marginal means were used to analyze differences between optimization maneuvers.ResultsIn this study, 163 optimization maneuvers (77 direct epiglottis lifting, 57 hyperangulated videolaryngoscopy and 29 direct epiglottis lifting with a hyperangulated videolaryngoscope) were applied exclusively or sequentially. Vocal cords were not visible in 91.5% of the cases with Macintosh videolaryngoscopy, 24.7% with direct epiglottis lifting, 36.8% with hyperangulated videolaryngoscopy and 0% with direct lifting with a hyperangulated videolaryngoscope. Conversion to direct epiglottis lifting improved POGO (mean + 49.7%; 95% confidence interval [CI] 41.4 to 58.0; p &amp;lt; 0.001) and glottis view (mean + 2.2 grades; 95% CI 1.9 to 2.5; p &amp;lt; 0.001). Conversion to hyperangulated videolaryngoscopy improved POGO (mean + 43.7%; 95% CI 34.1 to 53.3; p &amp;lt; 0.001) and glottis view (mean + 1.9 grades; 95% CI 1.6 to 2.2; p &amp;lt; 0.001). The difference in POGO improvement between conversion to direct epiglottis lifting and conversion to hyperangulated videolaryngoscopy is: mean 6.0%; 95% CI −6.5–18.5%; hence non-inferiority was confirmed.ConclusionWhen Macintosh videolaryngoscopy turned out to be difficult, glottis exposure with direct epiglottis lifting was non-inferior to the one gathered by conversion to hyperangulated videolaryngoscopy. A combination of both maneuvers yields the best result.Clinical trial registrationClinicalTrials.gov, NCT03950934.

I-gel Plus acts as a superior conduit for fiberoptic intubation than standard i-gel

The supraglottic airway (SGA) is widely used. I-gel Plus is a next-generation i-gel with some improvements, including facilitation of fiberoptic tracheal intubation (FOI). To compare the performance of i-gel Plus and standard i-gel as conduits for FOI, a Thiel-embalmed cadaveric study was conducted. Twenty-two anesthesiologists were enrolled as operators in Experiment 1. The i-gel Plus and standard i-gel were inserted into one cadaver, and the FOI was performed through each SGA. The primary outcome was time required for FOI. The secondary outcomes were the number of attempts and visual analog scale (VAS) score for difficulty in FOI. Moreover, fiberoptic views of the vocal cords in each SGA were assessed by an attending anesthesiologist using nine cadavers in Experiment 2. The percentage of glottic opening (POGO) score without fiberscope tip upward flexion and upward angle of the fiberscope tip to obtain a 100% POGO score were evaluated as secondary outcomes. The time for FOI through i-gel Plus was significantly shorter than that through standard i-gel (median (IQR), i-gel Plus: 30.3 (25.4–39.0) s, vs standard i-gel: 54.7 (29.6–135.0) s; median of differences, 24.4 s; adjusted 95% confidence interval, 3.0–105.7; adjusted P = 0.040). Although the number of attempts for successful FOI was not significantly different, the VAS score for difficulty in the i-gel Plus group was significantly lower (easier) than that in the standard i-gel group. Moreover, i-gel Plus required a significantly smaller upward angle of the fiberscope tip to obtain a 100% POGO score. FOI can be performed more easily using i-gel Plus than using standard i-gel because of the improved fiberoptic visibility of vocal cords.

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 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.

OBESITY AND ANTICIPATED DIFFICULT AIRWAY- A COMPREHENSIVE APPROACH WITH VIDEOLARYNGOSCOPY, RAMP POSITION, SEVOFLURANE AND OPIOID FREE ANAESTHESIA

Background: Anaesthetic management of obese patient can be challenging because of altered anatomy and physiology. Safe apnea period is extremely short and videolaryngoscope is believed to reduce the number of failed intubation attempts. Slow emergence with fat-soluble volatile agents may be due to delayed release from adipose stores. Use of opioids in the presence of obesity increases the occurrence of obstructive sleep apnea, hypoxia and upper airway obstruction. The aim is to provide safe airway management in obesity by reducing the number of intubation attempts and the time taken for intubation with reduced post-operative respiratory depression. Methods: 25 patients with the BMI of &gt;30kg/m2 were selected. Standard technique for induction of anaesthesia using Inj. Dexmedetomidine 1mcg/kg 10 mins before intubation with patient in RAMP position was done. HugeMed videolaryngoscope with appropriate sized blade was used and maintainance of anaesthesia with Sevoflurane and Inj. Dexmedetomidine 0.5mcg/kg/hr. Assessment consisted of number of intubation attempts, time required for intubation, visualisation of glottis, hemodynamic stress response to laryngoscopy and intubation and post-operative respiratory depression. Results: Among 25 patients, 18 patients had intubation at the first attempt, the maximum attempts taken were three in 2 patients. In majority of the patients i.e, 10, time taken for intubation was 13-15 secs. The maximum time to intubate was 18-20 secs in 2 patients. The visualisation if glottic structures assessed by Percentage Of Glottic Opening (POGO) score was 80-100% in majority of 20 patients. Most of the patients had a saturation of 96-100% post-operatively. There was a significant fall in the above hemodynamic parameters from baseline to intubation and 5mins later. The mean reduction in HR was 28.42%, SBP- 28.72%, DBP- 38.85% and MAP- 34.69%. Conclusion: This study emphasises on the use of advanced airway tools, standard intubation techniques and careful drug selection in order to prevent and minimise the risk of airway complication in obesity.

Pilot Study Examining Bed Angles and Heights During Ramped Position Intubation in the Emergency Department.

Ramped positioning during emergent endotracheal intubation has been associated with fewer peri-intubation complications, including a decrease in difficult intubations, esophageal intubations, pulmonary aspiration, and hypoxemia. However, the optimal bed angle and height for ramped position intubation have not been determined. Our objective was to examine the effect bed angle and height in the ramped position may have on laryngeal views during emergent intubation in the emergency department (ED). We performed a secondary analysis of prospectively collected quality improvement data on intubations from our ED. All adult medical intubations performed with ramped positioning in the ED over a 24-month study period (September 1, 2020, through August 30, 2022) were eligible. We compared laryngeal views using the percentage of glottic opening (POGO) score between ramp angles (≥30° and <30° from horizontal) and bed heights (relative to the intubator, including xiphoid or above, umbilicus or below, and between xiphoid and umbilicus). Of the 251 patients intubated during the study period, 201 were intubated in the supine position and 50 in the ramped position. Data forms were completed for 25 patients intubated using ramped position in the ED during the study period. The median ramp angle was 30° (interquartile range (IQR) 25, 40) with 16 (64%) subjects intubated at ≥30° and 9 (36%) subjects at <30°. The median POGO scores for bed angles ≥30° and <30° were 95% (IQR 79, 100) and 90% (IQR 75, 100), respectively. Bed heights varied, with four (16%) intubated at the xiphoid or above height, one (4%) at the umbilicus or below, and 20 (80%) between the xiphoid and umbilicus. The median POGO scores at each position were 95% (IQR 76, 100), 0% (IQR 0, 0), and 95% (IQR 79, 100), respectively. ED clinicians use a variety of bed angles and heights when intubating in the ramped position. More robust investigations are necessary to determine the optimal bed angle and height for ramped position intubation in the ED.

Endobronchial Intubation With the King Vision® and McGrath® Laryngoscopes in Simulated Easy and Difficult Airways by Novices (eKingMath).

Objective. The competency of using video laryngoscopes (VL) for double-lumen tube (DLT) endobronchial intubations can be improved with constant training as assessed by measuring the learning curves. We hypothesized that the time to DLT intubation would be reduced over the intubation attempts. Design. A crossover manikin study. Settings. University-affiliated hospital. Participants. Forty-two novice medical students unfamiliar with DLT intubation. Interventions. Participants were randomly allocated to two sequences, including DLT intubation, using King Vision and McGrath VLs. Each participant completed 100 DLT intubation attempts on both simulated easy and difficult airways on two different mannikins using the study devices (25 attempts for each). Measurements and Main Results. The primary outcome was the time to DLT intubation. The secondary outcomes included the best glottic view, optimizing maneuvers, and intubation first-pass success. The use of King Vision VL was associated with a significantly shorter time to DLT intubation (P < 0.044 and P < 0.05, respectively) and a higher percentage of glottic opening (POGO) compared to the McGrath VL (P < 0.011 and P < 0.002, respectively) in the simulated "easy" and "difficult" over most of the intubation attempts. In the simulated "easy" airway, the first-pass success ratio was higher when using the King Vision VL (median [Minimum-Maximum] 100% [100%-100%] and 100% [88%-100%], P = 0.012). Conclusion. Novice medical students developed skills over intubation attempts, meaning achievement of a faster DLT intubation, better laryngeal exposure, and higher success rate on simulated "easy" and "difficult" airways. A median of 9 DLT intubations was required to achieve a 92% or greater DLT intubation success rate.

A novel technique of handling the blade for videolaryngoscopy intubation in patients with a semi-rigid neck collar: a prospective randomized controlled trial.

Semi-rigid neck collars to protect the cervical spine can limit the extent of neck movement and mouth opening; this may further complicate orotracheal intubation. We aimed to compare intubation environments obtained with videolaryngoscopy using the technique of gliding a blade under the epiglottis and that obtained using the conventional Macintosh blade technique of blade tip placement on the vallecula. This prospective randomized study included patients aged ≥ 20 years with American Society of Anesthesiologists physical status I-III scheduled for cervical spine surgery between October 2020 and August 2021. Patients were divided into two groups according to the placement of the blade of the McGrathTM videolaryngoscope: the gliding and conventional groups. The percentage of glottic opening (POGO) score was the primary endpoint. We also recorded the time to obtain the optimal laryngoscopic view, intubation duration, and ease and satisfaction of the researcher performing intubation. Among 176 patients, the POGO scores were significantly higher in the gliding group than in the conventional group (88.9 ± 14.7 vs. 63.8 ± 27.4, P < 0.001). The time to achieve the optimal glottic view for intubation and duration of intubation were also shorter, and ease and satisfaction in performing intubation were better in the gliding group than in the conventional group. Our findings demonstrated a superior glottic view and more favorable intubation environments when the blade tip was placed under the epiglottis than using the conventional Macintosh technique in patients with immobilized cervical spine.

Change in glottic view during intubation using a KoMAC videolaryngoscope: A retrospective analysis.

Intubation with videolaryngoscopy has become popular in various clinical settings. However, despite the use of a videolaryngoscope, difficult intubation still exists and intubation failure has been reported. This retrospective study assessed the efficacy of the 2 maneuvers in improving the glottic view during videolaryngoscopic intubation. The medical records of patients who underwent videolaryngoscopic intubation and whose glottal images were stored in electronic medical charts were reviewed. The videolaryngoscopic images were divided into 3 categories according to the applied optimization techniques as follows: conventional method, with the blade tip located in the vallecular; backward-upward-rightward pressure (BURP) maneuver; and epiglottis lifting maneuver. Four independent anesthesiologists scored the visualization of the vocal folds using the percentage of glottic opening (POGO, 0-100%) scoring system. A total of 128 patients with 3 laryngeal images were analyzed. The glottic view was the most improved in the epiglottis lifting maneuver among all the techniques. The median POGO scores were 11.3, 36.9, and 63.1 in the conventional method, BURP, and epiglottis lifting maneuver, respectively (P < .001). There were significant differences in the distribution of POGO grades according to the application of BURP and epiglottis lifting maneuvers. In the POGO grades 3 and 4 subgroups, the epiglottis lifting maneuver was more effective than the BURP maneuver in improving the POGO score Inadequate visualization of the vocal folds occurred even when intubation was performed using a videolaryngoscope. The application of optimization maneuvers, such as BURP and epiglottis lifting by the blade tip, could improve the glottic view.

Comparison of Rigid and Articulating Video Stylets During Simulated Endotracheal Intubation With Hyperangulated Video Laryngoscopy

BackgroundEndotracheal tube delivery through the vocal cords can be challenging with hyperangulated video laryngoscopy due to the acute angle around the tongue and surrounding airway structures. Articulating video stylets may mitigate this issue by equipping an endotracheal tube stylet with an operator-controlled articulating end that has an additional camera at the tip. ObjectivesWe compared operator-reported ease of intubation between the traditional rigid stylet (GlideRiteⓇ Rigid Stylet, Verathon Inc., Bothell, WA) and the articulating video stylet (ProVu™ Video Stylet, Flexicare Inc., Irvine, CA) with a hyperangulated video laryngoscope (GlideScopeⓇ, Verathon Inc., Bothell, WA). MethodsParticipants performed simulated intubation using a hyperangulated video laryngoscope with both stylets in random order. We compared operator-reported ease of intubation on a 0–100 visual analogue scale (VAS), best percentage of glottic opening (POGO), and time to intubation. We compared outcomes using a paired t-test or the asymptotic Wilcoxon-Pratt signed-rank test dependent on normality. ResultsWe enrolled a convenience sample of 16 emergency department attendings, residents, and physician assistant postgraduate trainees. The median operator-reported ease of intubation on VAS was 20 (interquartile range 9, 30) for the rigid stylet and 20 (10, 30) for the articulating video stylet (p = 0.832). However, the rigid stylet had a slightly shorter mean time to intubation compared with the articulating video stylet, 6.9 (standard deviation 2.5) vs. 10.3 (4.1) s, respectively (p = 0.017). POGO was similar between groups. ConclusionsDuring simulated endotracheal intubation, the rigid and articulating video stylets had similar operator-reported ease of intubation.

A COMPARATIVE STUDY OF McGRATH MAC VIDEO LARYNGOSCOPE AND MACINTOSH LARYNGOSCOPE FOR ORO-TRACHEAL INTUBATION IN NORMAL AIRWAY.

Background- Oro-tracheal intubation is practiced for oxygenation &amp; ventilation along with inhalational anesthetic delivery and in emergency conditions for securing airway. The objective of our study was to evaluate and compare the intubations by McGrath VL and Macintosh laryngoscope. A prospective, observational s Methodology- tudy in 80 patients undergoing elective surgical procedures with normal airway. All patients were premedicated and pre-oxygenated with 100% O2 for ve minutes and induced with inducing agent inj. Propofol 2mg/kg and neuromuscular blocking agent inj. Succinyl choline 1.5 mg/kg. Patients were divided into 2 groups for Macintosh Laryngoscope and McGrath VL. We have noted TTI, number of intubation attempts, C-L grade, POGO score, modication of positioning, the requirement of external laryngeal pressure manipulation and complications during and after intubations. Haemodynamic parameters were monitored and recorded. Time to intubate in McG VL Group (38.92 ± Observation &amp; Results- 11.07) was signicantly shortened than Mac L Group (57.95 ± 10.37)(). Percentage of glottic opening was better in McGrath Video Laryngoscope group (McG VL) than Macintosh laryngoscope group (Mac L). Incidence of complications were less in McG VL Group than Mac L group. The study Conclusionconcluded that McGrath MAC Video laryngoscope is better than Macintosh laryngoscope for oro-tracheal intubation in normal airway as it provides earlier time to intubate, signicantly superior glottic view, more rst attempt success rate without any complications and stable vitals.

Anti-Toothbreaker: A Novel Low-Budget Device Enabling Contactless Dental Protection and a Forbidden Technique during Direct Laryngoscopy for Endotracheal Intubation

Iatrogenic dental injury is the most common complication of conventional laryngoscopy during orotracheal intubation. The main cause is unintended pressure and leverage forces from the hard metal blade of the laryngoscope. The aim of this pilot study was to introduce and test a novel, reusable low-budget device not only providing contactless dental protection during direct laryngoscopy for endotracheal intubation, but also enabling, in contrast to established tooth protectors, active levering with conventional laryngoscopes for easier visualization of the glottis. A constructed prototype for intrahospital usage was evaluated by seven participants on a simulation manikin for airway management. Endotracheal intubation was performed with and without the device using a conventional Macintosh laryngoscope (blade size 4) and a 7.5 mm endotracheal tube (Teleflex Medical GmbH, Fellbach, Germany). Necessary time and success of first pass were determined. Degree of visualization of the glottis with and without the device was stated by the participants according to the Cormack and Lehane (CL) classification system and the Percentage of Glottic Opening (POGO) scoring system. In addition, subjective physical effort, feeling of safety regarding successful intubation, and risk for dental injury were queried on a numeric scale between 1 and 10. All participants except one stated that the intubation procedure was easier with usage of the device than without it. On average, this was subjectively perceived as being approximately 42% (range, 15-65%) easier. In addition, time to first pass success, as well as degree of glottis visualization, subjective physical effort, and feeling of safety regarding risk for dental injury, were clearly better with usage of the device. Concerning feeling of safety regarding successful intubation, there was only a minor advantage. No difference in first pass success rate and number of total attempts could be observed. The Anti-Toothbreaker is a novel, reusable low-budget device which might not only provide contactless dental protection during direct laryngoscopy for endotracheal intubation, but also enables, in contrast to established tooth protectors, active levering with conventional laryngoscopes for easier visualization of the glottis. Future human cadaveric studies are needed to investigate whether these advantages also prove themselves there.