Type Of Laryngoscope Research Articles

Comparison of Three Tracheal Intubation Procedures Using Personal Protective Equipment, Direct and Video Laryngoscopes: An Open, Randomized, Parallel Clinical Trial

Background: During the COVID-19 pandemic, severe respiratory failure is a life-threatening condition, and life-saving tracheal intubation is a high-risk aerosol- and droplet-generating procedure. It is crucial to protect healthcare workers without compromising patient safety during intubation. The use of personal protective equipment (PPE) and different types of laryngoscopes are measures to reduce the risk of infectious transmission that might impact the intubation process. Objectives: This study aimed to evaluate the effects of different levels of PPE and types of laryngoscopes on the duration of the intubation process and its success rate. Methods: We conducted an open, randomized, parallel clinical trial on non-COVID-19 adult patients scheduled for elective and emergency surgeries under general anesthesia from November 2021 to May 2022. Patients were divided into three groups: Group 1 was intubated using a video-guided laryngoscope with operators wearing level three PPE; group 2 was intubated using a direct laryngoscope with operators wearing level three PPE; and group 3 was intubated using a direct laryngoscope with operators wearing level two PPE. Intubation was performed by 2nd- and 3rd-year anesthesia residents. Results: The duration of intubation varied significantly among the groups, with Group 1 taking the longest time (P = 0.046). Group 3 had a higher success rate for first-attempt intubation (P = 0.056). Conclusions: The use of PPE and video-guided laryngoscopy had varying effects on the intubation procedure, with the most notable impact being on the overall length of intubation. Further research with a larger sample size is needed to validate these findings.

Video laryngoscopy and direct laryngoscopy for cardiac arrest: A meta-analysis of clinical studies and trials

BackgroundIntubation is an essential procedure in cardiopulmonary resuscitation (CPR). We conducted a systematic review and meta-analysis of trials and studies comparing the performance of video laryngoscope (VL) and direct laryngoscope (DL) in endotracheal intubation (ETI) during CPR in cardiac arrest (OHCA) patients. MethodsWe searched the PUBMED, EMBASE, and Cochrane library databases. We analyzed the first-pass success rate, total intubation time, Cormack–Lehane grade (CL grade), esophageal intubation rate, and dental injury rate among the in-hospital cardiac arrest (IHCA) patients or out-of-hospital cardiac arrest (OHCA) patients. We demonstrated the pooled results of continuous outcomes by mean difference (MD) and dichotomous outcomes by odds ratio (OR), with a 95% confidence interval (CI) using a random-effects model. ResultsWe obtained six observational studies and one randomized control trial. The pooled results showed a significant increase in first-pass success rate (OR: 1.86, 95% CI: 1.41, 2.47), Cormack–Lehane (CL) grade (OR: 2.01, 95% CI: 1.59,2.53), and a decrease of esophageal intubation rate (OR: 0.25, 95% CI: 0.08, 0.85) in the VL group compared with DL group. Also, a non-significant decrease in dental injury rate [OR: 0.23, 95% CI: 0.05, 1.08) was observed in the VL group compared with the DL group. There was no statistical difference between the VL and DL groups, although the VL group seemed to have a shorter total intubation time (MD: -15.43, 95% CI: −34.67, 3.81). Types of laryngoscopes were not associated with the rate of ROSC [OR 1.01 (0.95,1.07); P = 0.83]. No differences in survival outcomes were observed between the two approaches. ConclusionsCompared to DL, VL was found to be associated with first-pass success and CL grade. We recommend prioritizing VL over DL when performing ETIs for patients with cardiac arrest.

DirEct versus VIdeo LaryngosCopE (DEVICE): protocol and statistical analysis plan for a randomised clinical trial in critically ill adults undergoing emergency tracheal intubation

IntroductionAmong critically ill patients undergoing orotracheal intubation in the emergency department (ED) or intensive care unit (ICU), failure to visualise the vocal cords and intubate the trachea on the first...

The Effect of Laryngoscope Types on Hemodynamic Response and Intracranial Pressure by ONSD Measurement in Neurosurgery at Sanglah General Hospital: A Case Series

Object: Endotracheal intubation is the gold standard for ensuring a safe airway when applying general anesthesia. Endotracheal intubation can cause an increase in intracranial pressure (ICP). Ultrasound measurement of optic nerve sheath diameter (ONSD) is known as an accurate monitor of increased intracranial pressure. However, it is not known how the ICP fluctuations are caused by endotracheal intubation using various types of laryngoscopy. Therefore, the authors investigated the hemodynamic changes and intracranial pressure caused by the two types of laryngoscope used for endotracheal intubation in neurosurgical patients undergoing general anesthesia. Cases: The authors report 4 patients as a case series from the Central Operating Theatre (COT) of Sanglah General Hospital, Denpasar, Bali. We were performed optical nerve sheath diameter (ONSD) measurements on both eyeballs of those patients. All of the patients were performed general anaesthesia with endotracheal intubation. Correlation between ONSD and ICP measurements was determined, and changes were seen based on baseline data obtained from before intubation to 10 minutes after intubation. Sheath diameter more than 5.5 mm had a higher ICP value predicate than 15 mmHg with 100% sensitivity (95% CI, 100-100) and 100% specificity (95% CI, 100-100). Discussion: Our case series demonstrated a change in ICP in each patient endotracheal intubation with a McGrath video laryngoscope and a Macintosh laryngoscope, then the authors examined the optic nerve sheath by performing ultrasonography after induction before intubation (T0), 1 minute (T1), 3 minutes (T3), 5 minutes (T5) and 10 minutes after intubation (T10), which is known to increase ICP. In all patients ICP increased above normal values in baseline. There was a difference in diameter between the right and left eyes according to the location of each tumor. During tracheal manipulation, at first minute there was an increase in diameter in both eyes with ONSD increasing > 0,5 mm from the baseline value, and starting to decrease at 3, 5 minutes, and approaching or equal to the baseline value at 10 minutes. Conclusion: In neurosurgical patients undergoing general anesthesia with endotracheal intubation, laryngoscopy is unavoidable, the use of the type of laryngoscope should be carefully considered in order to select and use a better type of laryngoscope to prevent hemodynamic shock. Hemodynamic monitoring with patient monitors and ONSD ultrasonography is an accurate, simple, and rapid measure to detect ICP elevations and ICP changes in real time. Therefore, ONSD could be a useful tool for monitoring ICP, especially in conditions where invasive ICP monitoring is not available. Keywords: laryngoscope, hemodinamik, intracranial, ONSD, neurosurgery

Comparison Between McCoy Laryngoscope and C-MAC Video Laryngoscope in Anticipated Difficult Airway: A Prospective Randomised Study.

Objective: Prolonged laryngoscopy and failure to intubate are associated with increased morbidity and mortality. Need to improve glottic visualisation and ease of intubation has led to the introduction of various types of laryngoscopes. This study compares the effectiveness of C-MAC video laryngoscope (VL) with McCoy laryngoscope in patients with an anticipated difficult airway.Methods: This prospective randomised single-blinded single-centre study included patients with modified Mallampati grades 3 and 4, divided into two groups I and II of 65 patients each. Group I was intubated using C-MAC and group II with McCoy Laryngoscope. Modified Cormack Lehane grade of visualisation, time to intubate, intubation difficulty scale score and complications were recorded.Results: C-MAC VL provides a higher proportion of modified Cormack Lehane grade I visualisation (63% vs 35.3, p=0.0017), the lesser median time of intubation in seconds (15 vs 18, p=0.0007) and significantly lesser median intubation difficulty score (0 vs 3) when compared to McCoy.Conclusions: C-MAC VL provided better visualisation of glottis and easier tracheal intubation that too in a significantly lesser time. We conclude and recommend the use of C-MAC VL over McCoy for endotracheal intubation in patients with predicted difficult airways, especially in modified Mallampati grades 3 and 4.

A Comparison of McGrath Videolaryngoscope versus Macintosh Laryngoscope for Nasotracheal Intubation: A Systematic Review and Meta-Analysis.

Background: In this study, it was shown that the routine use of McGrath videolaryngoscopy may improve intubation success rates. The benefits to using a videolaryngoscope in nasotracheal intubation were also demonstrated. However, no solid evidence concerning the effectiveness of the use of McGrath videolaryngoscopes in nasotracheal intubation has previously been reported. As a result, we questioned whether, in adult patients who underwent oral and maxillofacial surgeries with nasotracheal intubation (P), the use of a McGrath videolaryngoscope (I) compared with a Macintosh laryngoscope (C) could reduce the intubation time, improve glottis visualization to a score of classification 1 in the Cormack–Lehane classification system, and improve the first-attempt success rate (O). The secondary outcomes measured were the rate of the use of Magill forceps and the external laryngeal pressure (BURP) maneuver used. Methods: An extensive literature search was conducted using databases. Only randomized controlled trials that compared the McGrath videolaryngoscopy and Macintosh laryngoscopy techniques in nasotracheal intubation in adult patients were included. Results: Five articles met the inclusion criteria and were included in the final analysis (n = 331 patients). The results showed a significant decrease in intubation time and a higher rate of classification 1 scores in the Cormack–Lehane classification system, but no difference in the first-attempt success rates were found between the McGrath group and the Macintosh group. Decreases in the rate of the use of Magill forceps and the use of the external laryngeal pressure maneuver were also found in the pooled analysis. With regard to the overall risk of bias, the selected trials were classified to have at least a moderate risk of bias, because none of the trials could blind the operator to the type of laryngoscope used. Conclusions: Our analysis suggests that the use of a McGrath videolaryngoscope in nasotracheal intubation resulted in shorter intubation times, improved views of the glottis and similar first-success rates in adult patients who received general anesthesia for dental, oral, maxillofacial, or head and neck cancer surgery, and also reduced the use of Magill forceps and the BURP maneuver.

Elective Tracheal Intubation With the VieScope-A Prospective Randomized Non-inferiority Pilot Study (VieScOP-Trial).

BackgroundTracheal intubation is commonly performed after direct laryngoscopy using Macintosh laryngoscopes (MacL), but visualization of the larynx may be inadequate. The VieScope (VSC) as a new type of laryngoscope consisting of a straight, shielded, illuminated tube used to perform intubation via a bougie was investigated in this prospective randomized trial in patients without expected difficult airways.MethodsWith ethics approval, 2 × 29 patients for elective surgery were randomized 1:1 to intubation with VSC or MacL. Endpoints were first attempt success rates (FAS), Percentage of Glottis Opening Scale (POGO), time to intubation (TTI), and difficulty ratings on visual analog scales (0–100, lower values better). Data are given as mean ± standard deviation.ResultsThe FAS was 83 ± 38% for VSC and 86 ± 34% for MacL (P = 0.723). For VSC, POGO was 86 ± 17% and for MacL 68 ± 30% (P = 0.007). TTI for VSC was 93 ± 67s vs. 38 ± 17 for MacL (P < 0.001). Difficulty of intubation was rated 23 ± 22 for VSC vs. 18 ± 22 for MacL (P = 0.422), viewing conditions 12 ± 15 vs. 24 ± 25 (P = 0.031), and difficulty of tube placement was rated 27 ± 30 vs. 7 ± 8 (P = 0.001).ConclusionNo difference in FAS was detected between VSC and MacL. Visualization of the larynx was superior using the VSC, while TTI was prolonged and tube placement via bougie was more challenging. The VSC could be an alternative to MacL in patients with difficult laryngoscopy, but this should be investigated further in patients with expected difficult airways.

Intubation using VieScope vs. Video laryngoscopy in full personal protective equipment \u2013 a randomized, controlled simulation trial

BackgroundVieScope is a new type of laryngoscope, with a straight, transparent and illuminated blade, allowing for direct line of sight towards the larynx. In addition, VieScope is disposed of after single patient use, which can avoid cross-contaminations of contagious material. This has gained importance especially when treating patients with highly contagious infectious diseases, such as during the SARS-CoV2 pandemic. In this context, VieScope has not been evaluated yet in a clinical study.Material and methodsThis study compared intubation with VieScope to video-laryngoscopy (GlideScope) in normal and difficult airway in a standardized airway manikin in a randomized controlled simulation trial. Thirty-five medical specialists were asked to perform endotracheal intubation in full personal protective equipment (PPE). Primary endpoint was correct tube position. First-pass rate (i.e., success rate at the first attempt), time until intubation and time until first correct ventilation were registered as secondary endpoints.ResultsFor correct tracheal tube placement, there was no significant difference between VieScope and GlideScope in normal and difficult airway conditions. VieScope had over 91% fist-pass success rate in normal airway setting. VieScope had a comparable success rate to GlideScope in difficult airway, but had a significantly longer time until intubation and time until ventilation.ConclusionVieScope and GlideScope had high success rates in normal as well as in difficult airway. There was no unrecognized esophageal intubation in either group. Overall time for intubation was longer in the VieScope group, though in an acceptable range given in literature.Results from this simulation study suggest that VieScope may be an acceptable alternative for tracheal intubation in full PPE.Trial RegistrationThe study was registered at the German Clinical Trials Register www.drks.de (Registration date: 09/11/2020; TrialID: DRKS00023406).

English

BACKGROUND First-pass success is the successful intubation on the first attempt. It is the desired goal of emergency intubation and failure to achieve it may increase the risk of adverse effects. With failure of first pass intubation, life-threatening complications occur, commonly in critically ill patients. The aim of this study is to determine the association between the success of first-pass intubation and frequency of adverse events during endotracheal intubation. METHODS A cross sectional analytical study was done in a tertiary care hospital between October 2016 and October 2017. 100 failed first-pass intubation cases and 100 successful first-pass intubation cases were evaluated for factors associated with failed first-pass intubation and frequency of adverse events following intubation. RESULTS The groups were matched with respect to gender, induction agent use, fentanyl use and type of laryngoscope used. Mean age in failed first-pass intubation group was 5.61 years higher than subjects in successful first-pass intubation group (P = 0.016). Proportion of subjects with difficult airway was 19 % in failed first-pass intubation group and 3 % in successful first-pass intubation (P &lt; 0.001). Failed first-pass intubation cases had higher frequency of adverse events like oesophageal intubation (9 % vs. 0 %), aspiration (7 % vs. 1 %), cuff leakage (2 % vs. 0 %) and hypotension (7 % vs. 1 %) compared to successful first-pass intubation cases. CONCLUSIONS The frequency of adverse events was high in failed first-pass intubation. Older age and presence of difficult airway were factors significantly associated with failed first-pass intubation. KEYWORDS First Pass Intubation, First-Pass Success, Adverse Events, Emergency Department, Failed First Attempt, Endotracheal Intubation

The Impact of Videolaryngoscopy on Endotracheal Intubation Success by a Pediatric/Neonatal Critical Care Transport Team

Introduction Endotracheal intubation may be required for the transport of critically ill neonates and children. Data suggest that first pass success (FPS) is associated with lower rates of complications. Thus, understanding factors associated with FPS can have important implications for clinical outcomes. We aimed to determine the impact of videolaryngoscopy (VL) on FPS by a pediatric critical care transport team (CCTT). Methods: We performed a retrospective cross-sectional study on pediatric patients (≤ 18 years of age) requiring endotracheal intubation by a tertiary care-based pediatric CCTT between 2011 and 2019. Patients were categorized as neonatal (≤ 28 days of age, either preterm or term) or pediatric (> 28 days of age). All intubation attempts using VL were performed with the C-MAC videolaryngoscope. Our primary outcome was rate of FPS. Descriptive statistics of patient, provider, and procedure characteristics were calculated. Multivariate regression was used to test the association between FPS and type of laryngoscope (video versus direct) adjusting for significant clinical predictors. Results: Over the study period, 135 patients were intubated by the CCTT. Sixty percent of these patients were neonates, and 40% were pediatric. The overall FPS rate was 61%, with lower rates in neonates (54%) and higher rates in pediatric patients (70%). Use of videolaryngoscopy increased over the study period. First pass success rate using the C-MAC videolaryngoscope was 72% compared to 42% for direct laryngoscopy across the whole study population. In adjusted analyses, FPS using VL was significantly higher in the pediatric patient population (aOR 12.42 [95%CI 3.33, 46.29]), but not in neonates (aOR 1.08 [0.44, 2.63]). Use of VL increased significantly over the study period. Conclusion: We found use of a C-MAC videolaryngoscope by a critical care transport team was associated with improved FPS during endotracheal intubation of pediatric patients but not neonates, after controlling for other patient and provider characteristics. In addition to the impact on FPS, use of VL may offer additional educational and quality benefits.

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

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

Oncological and Surgical Outcomes of Patients Treated by Transoral CO2 Laser Cordectomy for Early-Stage Glottic Squamous Cell Carcinoma: A Retrospective Chart Review

To investigate the feasibility and the outcomes of transoral laser CO2 microsurgery (TLM) for resection of early-stage squamous cell carcinoma (SCC) of the vocal folds through several additional surgical procedures and tips improving the glottic exposure. Retrospective chart review of patients treated by TLM cordectomy in a single European University Hospital for early-stage vocal fold SCCs (Tis, T1a, T1b, and T2). The following TLM outcomes were studied regarding the tumor size (Tis and T1a vs T1b and T2) and the margin status (negative vs positive/suspicious): patient position; type of laryngoscope; requirement to external counter pressure; resection of supraglottic structures (eg, ventricular band, epiglottic petiole, and suprahyoid epiglottis); pre- and postoperative complications; overall survival; disease-specific survival (DSS); and disease-free survival (DFS). A total of 148 patients were included. The TLM was realized in 95.3% of cases. External counter pressure, partial, or total vestibulectomy were necessary in 65.9%, 57.4%, and 4.2% of cases, respectively. A resection of the epiglottic petiole was required in 24.8% of cases. The realization of both epiglottis petiole resection and vestibulectomies were significantly higher in patients with T2 and T1b SCCs compared to those with T1a and Tis SCCs (P = .01). Different procedure tips were described for improving the laryngeal exposition. The 5-year laryngeal preservation rate, DSS, and DFS were significantly better in patients without SCC involvement of the anterior commissure, and did not vary according to the margin status. The laryngeal exposure difficulties did not impact the margin status. The exposure of glottis is possible in 95% of cases of early-stage vocal cord SCC but requires the use of several additional surgical procedures, especially for anterior commissure SCCs. The SCC involvement of the vocal fold anterior commissure is associated with lower DSS, DFS, and laryngeal preservation rate.

Airway management in the critically ill patient - How can we improve?

Introduction The NAP4 demonstrated adverse airway outcomes are associated with poor airway assessment and poor planning. 25% of major airway events occur in the Intensive Care Unit (ICU) or emergency department (ED), and the outcome of these events are more likely to lead to permanent harm or death compared with the operating theatre. This study set out to review documentation of intubations in ICU patients, including the pre-procedure planning taking place to identify areas for improvement. Methods Single institution retrospective review of documentation of endotracheal intubations performed by ICU staff (on either ICU or a ward/ED) over a six week period in an English district general teaching hospital. Criteria assessed were: use of a pre-intubation checklist, documentation of name and grade of intubator, airway assessment, time of intubation, drugs and doses given, number of attempts at intubation, use of cricoid pressure, laryngoscopy grade, ETT size + length at teeth, type of laryngoscope used, monitoring used (including etCO2), ventilator settings and any complications. Results In the 6 week study period, there were 15 intubation episodes identified and reviewed (12 on ICU, 3 in ED). See attached table for full results. Discussion The lowest performing domain was airway assessment (0%). The explanation for this is likely in part due to the acutely unwell nature of ICU patients making airway assessment more challenging than in an elective setting. Another particularly low scoring domain was the use of a pre-procedure checklist (33%). Considering the NAP findings associating adverse airway events with poor airway assessment and planning, these are concerning findings, and unlikely to be isolated to this hospital. We suggested education to promote the routine use of a pre-intubation checklist that incorporates an airway assessment and procedural plan.

Video Laryngoscopy vs. Direct Laryngoscopy.

Video Laryngoscopy vs. Direct Laryngoscopy.

Predicting laryngeal exposure in microlaryngoscopy: External validation of the laryngoscore.

Optimal laryngeal exposure during transoral laryngeal surgery is fundamental. We aimed to evaluate the reliability of a recently proposed score (Laryngoscore) in predicting difficult laryngeal exposure (DLE) in an independent cohort of patients undergoing elective microlaryngoscopy. We also verified the relation between DLE, surgeon's expertise, and difficult intubation, and investigated possible areas for score improvement. Prospective validation study. A total of 136 patients were preoperatively evaluated using the Laryngoscore. Patients were divided into three classes according to patient position, type of laryngoscope, and need for external counterpressure to expose the anterior commissure. Based on their mean scores, two groups were identified: good laryngeal exposure (GLE) and DLE. A receiver operating characteristic curve with the Youden index was used to calculate the optimal cutoff value. The χ2 and Fisher exact test were used to correlate GLE and DLE to the surgeon's expertise and difficult intubation. The intraoperative anatomical parameters underlying DLE were also recorded. The optimal cutoff value for differentiating GLE and DLE was 4, which identified 80.6% of DLE cases. No statistically significant difference in GLE and DLE distribution was found between surgeons (P = 0.43). The correlation between difficult intubation and DLE was statistically significant (P = 0.03). The intraoperative parameters determining DLE were epiglottis characteristics (floppy, tight, or short), bulky abdomen and chest, bulky tongue base, mobile teeth, and a narrow laryngeal aditus. The Laryngoscore is reliable for detecting DLE preoperatively. The inclusion of additional parameters may allow a more complete assessment and maximize its diagnostic accuracy. 2b Laryngoscope, 129:1438-1443, 2019.

A Study on the Tactical Safety of Endotracheal Intubation Under Darkness.

Strict blackout discipline is extremely important for all military units. To be able to effectively determine wound characteristics and perform the necessary interventions at nighttime, vision and light restrictions can be mitigated through the use of tactical night vision goggles (NVGs). The lamp of the classical laryngoscope (CL) can be seen with the naked eye; infrared light, on the other hand, cannot be perceived without the use of NVGs. The aim of the study is to evaluate the safety of endotracheal intubation (ETI) procedures in the dark under tactically safe conditions with modified laryngoscope (ML) model. We developed an ML model by changing the standard lamp on a CL with an infrared light-emitting diode lamp to obtain a tool which can be used to perform ETI under night conditions in combination with NVGs. We first evaluated the safety of ETI procedures in prehospital conditions under darkness by using both the CL and the ML for the study, and then researched the procedures and methods by which ETI procedure could be performed in the dark under tactically safe conditions. In addition, to better ensure light discipline in the field of combat, we also researched the benefits, from a light discipline standpoint, of using the poncho liner (PL) and of taking advantage of the oropharyngeal region during ETIs performed by opening the laryngoscope blades directly in the mouth and using a cover. During the ETI procedures performed on the field, two experienced combatant staff simulated the enemy by determining whether the light from the two different types of laryngoscope could be seen at 100-m intervals up to 1,500 m. In all scenarios, performing observations with an NVG was more advantageous for the enemy than with the naked eye. The best measure that can be taken against this threat by the paramedic is to ensure tactical safety by having an ML and by opening the ML inside the mouth with the aid of a PL. The findings of the study are likely to shed light on the tactical safety of ETI performed with NVGs under darkness. Considering this finding, we still strongly recommend that it would be relatively safer to open the ML blade inside the mouth and to perform the procedures under a PL. In chaotic environments where it might become necessary to provide civilian health services for humanitarian aid purposes (Red Crescent, Red Cross, etc.) without NVGs, we believe that it would be relatively safer to open the CL blade inside the mouth and to perform the procedures under a PL.

Efficacy of various types of laryngoscope (direct, Pentax Airway Scope and GlideScope) for endotracheal intubation in various cervical immobilisation scenarios: a randomised cross-over simulation study

ObjectiveTo compare the efficacy of direct laryngoscopy (DL), Pentax Airway Scope (PAWS) and GlideScope video laryngoscope (GVL) systems for endotracheal intubation (ETI) in various cervical immobilisation scenarios: manual in-line stabilisation...

Airtraq, LMA CTrach and Macintosh Laryngoscopes in Tracheal Intubation Training: A Randomized Comparative Manikin Study.

Training students on simulators before allowing their direct contact with patients is well accepted. There is no clinical or manikin-based simulation study in the literature comparing tracheal intubation with Airtraq, laryngeal mask airway (LMA) CTrach and Macintosh laryngoscopes performed by medical students having no prior intubation experience. After obtaining written informed consents, 123 participants were included in the study. The participants were asked to intubate the manikin five times with each device randomly. After all the participants had completed their fifth intubations, the measurements were performed. The primary outcome variables were the first-attempt success rate and the time for a successful intubation, while the secondary outcome variables were to determine the scores of dental trauma, the difficulty visual analogue scale and the optimization manoeuvres. The LMA CTrach group revealed a significantly higher number of intubation attempts. The mean time for a successful intubation was the longest in the LMA CTrach group (17.66±8.22 s, p<0.05). Students defined the Airtraq as the easiest to use and the Macintosh laryngoscope as the most difficult device to use and learn. Dental trauma severity was significantly lower in the Airtraq group than in the other groups (p<0.05), and it was found to be 0 in 81.1% in the Airtraq group. The head extension optimization manoeuvre rate was significantly higher with the Macintosh laryngoscope than with the Airtraq laryngoscope (p<0.05). This study, in which different types of laryngoscopes were compared, revealed that the Airtraq laryngoscope has advantages, such as shorter intubation duration, less additional optimization manoeuvres, less dental trauma intensity and is easier to learn compared with the LMA CTrach and Macintosh laryngoscopes.

A Comparison of the Effects of Different Types of Laryngoscope on the Cervical Motions: Randomized Clinical Trial

The rate of cervical injury among all trauma patients is 3.1%. The most important point during intubation of those patients is not to increase the cervical injury. In this study, we hypothesize that there will be a minimal cervical extension during a laryngoscopy with the use of optical view laryngoscopes. Prospective, randomized clinical trial. One hundred and fifty adult patients with ASA physical status I to III were enrolled in our study. After routine anesthesia induction, we randomly assigned the patients into three groups according to the type of laryngoscope. Macintosh type, Truview EVO2(®) type and Airtraq® type laryngoscopes were used in Group DL (n=50), Group TW (n=50) and Group ATQ (n=50), respectively. After applying general anesthesia induction and mask ventilation, all of the patients were positioned in the neutral position. An inclinometer was placed on the forehead of the patients. Then, the extension angle during intubation and the Cormack-Lehane Score were measured and the time to intubation was recorded. One of the 50 patients in the DL Group, 2 of the 50 patients in the TW Group, and 4 of the 50 patients in the ATQ Group were excluded from the study because of the failure of intubation at defined times. The angle of cervical extension during laryngoscopy was found to be 27.24±6.71, 18.08±7.53, and 14.54±4.09 degrees in the Groups DL, TV and ATQ, respectively; these differences also had statistical significance (p=0.000). The duration of intubation was found to be 13.59±5.49, 23.60±15.23, and 29.80±13.82 seconds in Groups DL, TV and ATQ, respectively (p=0.000). A minimal cervical motion was obtained during tracheal intubation with the use of Truview EVO2® and Airtraq® types of laryngoscope compared with the Macintosh laryngoscope. (ClinicalTrials.gov Identifier: NCT02191904).

A Randomized Comparison Simulating Face to Face Endotracheal Intubation of Pentax Airway Scope, C-MAC Video Laryngoscope, Glidescope Video Laryngoscope, and Macintosh Laryngoscope.

Objectives. Early airway management is very important for severely ill patients. This study aimed to investigate the efficacy of face to face intubation in four different types of laryngoscopes (Macintosh laryngoscope, Pentax airway scope (AWS), Glidescope video laryngoscope (GVL), and C-MAC video laryngoscope (C-MAC)). Method. Ninety-five nurses and emergency medical technicians were trained to use the AWS, C-MAC, GVL and Macintosh laryngoscope with standard airway trainer manikin and face to face intubation. We compared VCET (vocal cord exposure time), tube pass time, 1st ventilation time, VCET to tube pass time, tube pass time to 1st ventilation time, and POGO (percentage of glottis opening) score. In addition, we compared success rate according to the number of attempts and complications. Result. VCET was similar among all laryngoscopes and POGO score was higher in AWS. AWS and Macintosh blade were faster than GVL and C-MAC in total intubation time. Face to face intubation success rate was lower in GVL than other laryngoscopes. Conclusion. AWS and Macintosh were favorable laryngoscopes in face to face intubation. GVL had disadvantage performing face to face intubation.