Video Laryngoscopy For Intubation Research Articles

Channelled versus nonchannelled Macintosh videolaryngoscope blades in patients with a cervical collar: a randomized controlled noninferiority trial.

Channelled blades have the advantage of avoiding stylet use and potential airway injury during videolaryngoscopic intubation. Nevertheless, the effectiveness of channelled Macintosh-type blades has not yet been fully established. We sought to assess the utility of channelled Macintosh-type blades for videolaryngoscopic intubation under cervical spine immobilization. We conducted a randomized controlled noninferiority trial in neurosurgical patients with a difficult airway simulated by a cervical collar. Videolaryngoscopic intubation with a reinforced tracheal tube was performed using a channelled Macintosh-type blade without a stylet (channelled group, n = 130) or a nonchannelled Macintosh-type blade with a stylet (nonchannelled group, n = 131). The primary outcome was intubation success rate. Secondary outcomes included time to intubation and incidence or severity of intubation-related complications (subglottic, lingual, and dental injuries; bleeding; sore throat; and hoarseness). The initial intubation success rate was 98% and 99% in the channelled and nonchannelled groups, respectively, showing the noninferiority of the channelled group (difference in proportions -0.8%; 95% confidence interval [CI], -4.8% to 2.9%; predefined noninferiority margin, -5%; P = 0.62). Fewer participants in the channelled group had subglottic injuries than in the nonchannelled group (32% [32/100] vs 57% [54/95]; difference in proportions, -25%; 95% CI, -39% to -11%; P < 0.001). There were no significant differences between the two groups in the overall intubation success rate, time to intubation, and incidence or severity of other intubation-related complications. For videolaryngoscopic intubation in patients with a cervical collar, channelled Macintosh-type blades are an alternative to nonchannelled Macintosh-type blades, with a noninferior initial intubation success rate and a lower incidence of subglottic injury. CRIS.nih.go.kr ( KCT0005186 ); first submitted 29 June 2020.

Managing a difficult airway due to supraglottic masses: successful videolaryngoscopic intubation after induction of general anesthesia.

While awake, flexible bronchoscopic intubation has long been considered the gold standard for managing anticipated difficult airways, the videolaryngoscope has emerged as a viable alternative. In addition, the decision to perform awake intubation or to proceed with airway management after induction of general anesthesia should be grounded in a comprehensive assessment of risks and benefits. A 41-year old female patient was scheduled for excision of bilateral, mobile, and pedunculated masses on both aryepiglottic folds, which covered almost the entire upper part of the glottis. We conducted a comprehensive evaluation of the patient's signs and symptoms, which included neither stridor nor dyspnea in any position, along with the otolaryngologist's opinion and the findings from the laryngeal fiberscopic examination. Given the potential challenges and risks associated with awake flexible bronchoscopic intubation for this patient, we decided to proceed with gentle tracheal intubation using a videolaryngoscope under general anesthesia. In case of failed mask ventilation and tracheal intubation, we had preplanned strategies, including awakening the patient or performing an emergent tracheostomy, along with preparations to support these strategies. Ensuring that mask ventilation was maintained with ease, the patient was sequentially administered intravenous propofol, remifentanil, and rocuronium. Under sufficient depth of anesthesia, intubation using a videolaryngoscope was successfully performed without any complications. Videolaryngoscopic intubation after induction of general anesthesia can be a feasible alternative for managing difficult airways in patients with supraglottic masses. This approachshould be based on a comprehensive preoperative evaluation, adequate preparation, and preplanned strategies to address potential challenges, such as inadequate oxygenation and unsuccessful tracheal intubation.

Use of Risk Assessment and Management Program System and Videolaryngoscopy for Intubation in Obese Patients: A Case Report

Background: Controlling the airway is the anesthesiologist’s primary concern, as all sedatives and the general anesthesia technique require a patent airway for the transfer of gases between the lungs and the surrounding airway. The evaluation of the patient’s airway during the preanesthetic examination assists the anesthesiologist in planning the intubation technique to safeguard the airway. One reliable sign of airway blockage is body mass index (BMI). Case: A 62-year-old male with BMI 43 kg/m2 was posted for open umbilical hernia repair. Vital parameters were estimated. The chosen anesthesia technique was general anesthesia combined with epidural analgesia. The patient was put in the Risk Assessment and Management Program (RAMP) position using pillows to create a 25° angle that lined up the external auditory meatus and sternal notch on a level plane. Auscultation and the EtCO2 graph were used to confirm that the endotracheal tube was positioned correctly. Conclusion: A severely obese patient with limited neck extension was successfully intubated using a videolaryngoscope in the RAMP position, and the intubation went smoothly after extubation.

Direct versus indirect epiglottis elevation in cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization: a randomized controlled trial

BackgroundDuring videolaryngoscopic intubation, direct epiglottis elevation provides a higher percentage of glottic opening score than indirect epiglottis elevation. In this randomized controlled trial, we compared cervical spine movement during videolaryngoscopic intubation under manual in-line stabilization between the two glottis exposure methods.MethodsVideolaryngoscopic intubation under manual in-line stabilization was performed using C-MAC® D-blade: direct (n = 51) and indirect (n = 51) epiglottis elevation groups. The percentage of glottic opening score was set equally at 50% during videolaryngoscopic intubation in both groups. The primary outcome measure was cervical spine movement during videolaryngoscopic intubation at the occiput–C1, C1–C2, and C2–C5. The secondary outcome measures included intubation performance (intubation success rate and intubation time).ResultsCervical spine movement during videolaryngoscopic intubation was significantly smaller at the occiput–C1 in the direct epiglottis elevation group than in the indirect epiglottis elevation group (mean [standard deviation] 3.9 [4.0] vs. 5.8 [3.4] °, P = 0.011), whereas it was not significantly different at the C1–C2 and C2–C5 between the two groups. All intubations were successful on the first attempt, achieving a percentage of glottic opening score of 50% in both groups. Intubation time was longer in the direct epiglottis elevation group (median [interquartile range] 29.0 [24.0–35.0] vs. 22.0 [18.0–27.0] s, P < 0.001).ConclusionsWhen performing videolaryngoscopic intubation under manual in-line stabilization, direct epiglottis elevation can be more beneficial than indirect epiglottis elevation in reducing cervical spine movement during videolaryngoscopic intubation at the occiput–C1.Trial registrationClinical Research Information Service (number: KCT0006239, date: 10/06/2021).

Comparison of Intubating Condition of the McGrath® Video Laryngoscope With and Without Muscle Relaxant

Objective: The objectives of this study were to evaluate the intubating conditions using the McGrath® Series 5 Portable Video Laryngoscope (VL) with and without a muscle relaxant.Material and Methods: This randomized, prospective study was performed in 34 patients with ASA (American Society of Anesthesiologist) I-II who required oroendotracheal tube intubation. The patients were divided into two groups asthe rocuronium group and the placebo (saline) group. McGrath® VL intubation was initiated after 90 seconds when thepatient was fully relaxed. The primary outcome was the conditions of tracheal intubation between the two groups. Thesecondary outcome were the success rate of the first intubation attempt, time to intubation, required propofol dosagefor intubation, and the anesthetic events during the intraoperative and recovery room periods were evaluated.Results: Compared to the placebo group, the intubating conditions in the rocuronium group were more acceptable(excellent or good conditions) (88.2 vs. 41.2%; p-value=0.007). There were no significant differences in the successrates of first attempt intubations (16(94.1), 13(76.5); p-value=0.4). In comparison to the rocuronium group, the placebogroup required more propofol (218 mg vs. 186 mg; p-value=0.023). The rates of intraoperative and recovery roomevents were similar.Conclusion: Overall the intubating conditions when using the McGrath® VL Series 5 Portable Video Laryngoscope usingmuscle relaxants were more acceptable than when not using muscle relaxants, but there were no significant differencesin the number of attempts, time to intubation, and anesthetic events between the study groups.

Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest – a randomised manikin study

BackgroundAlthough airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes.MethodsIn this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants‘ subjective assessment of aerosol release using a Likert-scale (0 = no release–10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3.ResultsA total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8).ConclusionsCOVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers.

Nasendoscopy to Predict Difficult Videolaryngoscopy: A Multivariable Model Development Study.

Transnasal videoendoscopy (TVE) is the standard of care when staging pharyngolaryngeal lesions. This prospective study determined if preoperative TVE improves the prediction of difficult videolaryngoscopic intubation in adults with expected difficult airway management in addition to the Simplified Airway Risk Index (SARI). 374 anesthetics were included (252 with preoperative TVE). The primary outcome was a difficult airway alert issued by the anesthetist after Macintosh videolaryngoscopy. SARI, clinical factors (dysphagia, dysphonia, cough, stridor, sex, age and height) and TVE findings were used to fit three multivariable mixed logistic regression models; least absolute shrinkage and selection operator (LASSO) regression was used to select co-variables. SARI predicted the primary outcome (odds ratio [OR] 1.33; 95% confidence interval [CI] 1.13-1.58). The Akaike information criterion for SARI (327.1) improved when TVE parameters were added (311.0). The Likelihood ratio test for SARI plus TVE parameters was better than for SARI plus clinical factors (p < 0.001). Vestibular fold lesions (OR 1.82; 95% CI 0.40-8.29), epiglottic lesions (OR 3.37; 0.73-15.54), pharyngeal secretion retention (OR 3.01; 1.05-8.63), restricted view on rima glottidis <50% (OR 2.13; 0.51-8.89) and ≥50% (OR 2.52; 0.44-14.56) were concerning. TVE improved prediction of difficult videolaryngoscopy in addition to traditional bedside airway examinations.

Challenges in Anesthetic Management of Succinylcholine-induced Masseter Muscle Rigidity in Difficult Airway Patient: A Case Report

The difficult airway is already a challenging situation for anesthesiologists, in that scenario Succinylcholine (Sch) use because of its rapid onset and short duration of action makes it a neuromuscular blockage drug of choice. Development of masseter muscular rigidity is thought to be an early indicator of the occurrence of the dreaded consequence, malignant hyperthermia. Consequently, it is essential to understand the potential side effects of this widely used drug in order to successfully treat the airway. Resulting in the use of videolaryngoscopic intubation along with propofol use and the procedure was completed successfully with no intraoperative or postoperative problems. Here we described a case report of a 33-year-old male patient with a difficult airway posted for open reduction internal fixation of bilateral Lefort’s III fracture, developed Masseter Muscle Rigidity (MMR) following administration of a standard dose of Sch.

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.

No: 1566 Prospective development and validation of a multivariable diagnostic model to grade difficult videolaryngoscopic intubation: the VIDIAC classification

No: 1566 Prospective development and validation of a multivariable diagnostic model to grade difficult videolaryngoscopic intubation: the VIDIAC classification

Triad of safety, efficacy and patient comfort: videolaryngoscopic awake nasotracheal intubation using a lignocaine and propofol based technique

Currently there is a paucity of guidelines for anticipated difficult airways but awake intubation holds a pivotal position in all of these. Although awake fiberoptic intubation has long been considered the gold standard for difficult airway, awake videolaryngoscopic intubation is a promising alternative which is safe and effective, with myriad benefits like shorter duration of intubation, lesser technical skills required, shorter learning curve and better visualization when blood, copious secretions, tenacious sputum or debris obscures the glottic view. A detailed description of a lignocaine-topicalization with adjunctive propofol-sedation based technique for awake C-Mac D-Blade videolaryngoscopic intubation for anticipated extremely difficult airways in three patients follows.

A model to predict difficult airway alerts after videolaryngoscopy in adults with anticipated difficult airways - the VIDIAC score.

A model to classify the difficulty of videolaryngoscopic tracheal intubation has yet to be established. The videolaryngoscopic intubation and difficult airway classification (VIDIAC) study aimed to develop one based on variables associated with difficult videolaryngoscopic tracheal intubation. We studied 374 videolaryngoscopic tracheal intubations in 320 adults scheduled for ear, nose and throat or oral and maxillofacial surgery, for whom airway management was expected to be difficult. The primary outcome was whether an anaesthetist issued a 'difficult airway alert' after videolaryngoscopy. An alert was issued after 183 (49%) intubations. Random forest and lasso regression analysis selected six intubation-related variables associated with issuing an alert: impaired epiglottic movement; increased lifting force; direct epiglottic lifting; vocal cords clearly visible; vocal cords not visible; and enlarged arytenoids. Internal validation was performed by a 10-fold cross-validation, repeated 20 times. The mean (SD or 95%CI) area under the receiver operating characteristic curve was 0.92 (0.05) for the cross validated coefficient model and 0.92 (0.89-0.95) for a simplified unitary score (VIDIAC score with component values of -1 or 1 only). The calibration belt for the coefficient model was consistent with observed alert probabilities, from 0% to 100%, while the unitary VIDIAC score overestimated probabilities < 20% and underestimated probabilities > 70%. Discrimination of the VIDIAC score for patients more or less likely to be issued an alert was better than discrimination by the Cormack-Lehane classification, with mean (95%CI) areas under the receiver operating characteristic curve of 0.92 (0.89-0.95) vs. 0.75 (0.70-0.80), respectively, p < 0.001. Our model and score can be used to calculate the probabilities of difficult airway alerts after videolaryngoscopy.

Anesthesia Management in An Adult Patient with Desbuquois Syndrome

Desbuquois syndrome (DS) is a rare disease that can be accompanied by a difficult airway. In the literature, there are usually case reports about the mortal forms in childhood. We wanted to share our anesthesia experience in an adult patient with DS who underwent orthopedic surgery. We used videolaryngoscopy for intubation with coronavirus precautions. Adult patients with DS can be managed safely with adequate difficult airway preparation.

Comparing S-Guide® and Gliderite® Times to Assist Video laryngoscopic Intubation in Patients with Simulated Difficult Airways: A Single-Blinded Randomized Prospective Study.

Objective:Gliderite®, one of the first stylets designed specifically to assist tracheal intubation with non-channeled curved blades video laryngoscopes, can cause injury. The S-Guide® is a new, malleable, intubating guide allowing oxygenation. Its soft tip is designed to prevent trauma. We aimed to compare the duration of tracheal intubation with S-Guide compared to Gliderite using a C-MAC® D-Blade® video laryngoscope in patients with simulated difficult airways. Methods:We performed a single-blinded prospective randomized study, with 50 adult patients requiring orotracheal intubation under general anaestheesia in Lausanne University Hospital. A cervical collar was fitted around the patient’s neck to simulate difficult intubation conditions. Exclusion criteria were American Society of Anesthesiologists (ASA) >3, BMI > 35 kg m2, known or at risk of difficult intubation, and risk of aspiration of gastric content. We recorded T1: time of identification of the glottis; T2: time to inflate the cuff, and T3: total intubation time (capnography curve appearance). Secondary outcomes were the presence of arytenoid contact during intubation and postoperative airway discomfort.Results:There were no significant differences between T1 and T2 (seconds) while using the S-Guide or Gliderite, respectively: 14.6 [9.6-18.6] vs 16.5 [11.0-20.6]; P = .368 and 43.3 [33.2-49.3] vs 46.3 [35.6-61.5], P = .308. T3 was significantly shorter in the S-Guide group: 58.1 [50.2-61.8] vs 65.3 [57.6-78.7], P = .044. Fewer arytenoid contact occurred during intubation using the S-Guide (P = .032), without difference in postoperative airway discomfort.Conclusion:S-Guide-assisted tracheal intubation, with a C-MAC D-Blade in simulated difficult airways, allows successful and faster intubation than with the Gliderite Stylet.

Initial clinical experience of the MedAn videolaryngoscope with the Nishikawa blade

BackgroundThe MedAn videolaryngoscope with the Nishikawa blade has been designed to make videolaryngoscopy and tracheal intubation safer and more successful. AimWe aimed to preliminarily evaluate the performance of this new videolaryngoscope system for routine tracheal intubation at a teaching hospital. MethodsA total of 243 patients with apparently normal airways scheduled for elective surgery under general anesthesia were randomly assigned to the consultant or trainee group according to the actual operation schedule. Video clips of videolaryngoscopic intubation were recorded to analyze the relevant parameters. The primary outcome was the first-attempt intubation success rate. The secondary outcomes included the total time to successful intubation (laryngoscopy and intubation times) on the first attempt and recorded soft tissue injury. ResultsThe first-attempt intubation success rate was 98.8% (240/243). The median total time to intubation on the first attempt was 26.0 s, and it was longer in the trainee group than in the consultant group (median, 28.0 vs. 23.0 s, p < 0.001). Soft tissue injury was not observed. ConclusionThe MedAn videolaryngoscope with the Nishikawa blade can provide an excellent laryngeal view and sufficient intubation pathway for safe, easy, and effective intubation in patients with apparently normal airways.

Lateral position for difficult intubation in a patient with history of hemiglossectomy and flap reconstruction: a case report

BackgroundReconstructive head and neck surgery can alter upper airway anatomy. We report a difficult intubation in a patient with a history of hemiglossectomy and reconstruction.Case presentationA 65-year-old female patient, who had undergone hemiglossectomy with the flap reconstruction, underwent video-assisted thoracoscopic esophagectomy for esophageal cancer. After the loss of consciousness during anesthesia induction, we failed to perform direct and oral fiberoptic intubation using a video laryngoscope and nasal fiberoptic intubation without or with video laryngoscope assistance in the supine position. Finally, shifting the patient to the left-lateral position allowed successful nasal fiberoptic intubation. Postoperatively, we were informed that she was unable to sleep in the supine position because of airway obstruction and therefore always slept on her side.ConclusionPreanesthetic evaluation of the influence of body position on the airway patency during sleep or sedation may aid in airway management.

Abstract No.: ABS0322: COMPARISON OF PROPOFOL AND DEXMEDETOMIDINE SEDATION FOR AWAKE C-MAC D-BLADE VIDEO-LARYNGOSCOPIC INTUBATION IN DIFFICULT AIRWAY CASES

Background & Aims:Safest method for securing difficult airway is awake intubation. Aim is to compare propofol and dexmedetomidine for C-MAC D-blade guided difficult intubation under conscious sedation. A prospective, interventional, two arm, randomised study including 60 American Society of Anesthesiologists (ASA )grade I-III patients.Methods:After nasal packing, local anaesthesia, IV midazolam 0.03mg.kg-1and IV fentanyl 1µg.kg-1, in Group-P, propofol was infused at rate of 250 µg.kg.-1min-1, and in Group-D, dexmedetomidine 1 µg g.kg-1 over 10 min, then 0.5 µg .kg.-1h-1, till BIS values 65-70. Patients underwent C-MAC D-blade video-laryngosope guided intubation. Quantitative variables were compared using unpaired t-test/Mann-Whitney Test between groups and paired t-test/Wilcoxon ranked sum test across follow- up within the group. Qualitative variables were correlated using Chi-Square test/Fisher`s exact test. A p-value of <0.05 was considered statistically significant. Data was analysed by Statistical Package for Social Sciences (SPSS) version 24.Results:The mean intubation score was higher in the dexmedetomidine group (4.4) [propofol group (3.6)]. Patient reaction to intubation and haemodynamic parameters were more favourable in the propofol group. Coughing and vocal cord movementwas comparable. Time to achieve desired BIS-value was 4 times longer and time to intubate was six seconds longer indexmedetomidine group. Percentage of Glottic Opening (POGO)scores were slightly better in the propofol group. Propofol group was comparatively complication free.Conclusion:Successful awake video-laryngoscopic intubation using the C-MAC D-blade can be performed in patients in both groups.Propofol gives a better intubation score and haemodynamic stability than dexmedetomidine.

Comparison between C-MAC and King Vision video laryngoscope (channelled blade) for tracheal intubation in aerosol-prevention intubation box for COVID-19 patients: A manikin-based study.

Background and Aims:The risk of contracting infection while intubating a coronavirus disease 2019 (COVID-19)-positive patient can be reduced by the use of personal protective equipment (PPE), video laryngoscope (VL) and aerosol-preventing intubation box. We compared two VLs (C-MAC and King Vision laryngoscope [KVL]) for ease of intubation and time taken to intubate the manikin using an intubation box.Methods:This randomised study involved healthcare workers having experience in using both C-MAC and KVL. After explaining the study and five practice sessions, a total of 63 volunteers were included; 61 participants gave consent and were enroled. The participants were allowed to intubate initially with one VL as per random sequence. Each participant performed three tracheal intubations with each device (C-MAC VL and KVL) on a manikin using an aerosol-prevention box over the head end at the time of intubation.Results:Time taken, percentage of glottic opening (POGO) score and the number of attempts taken for successful intubation with C-MAC and KVL were comparable in any of the three attempts (P > 0.05). The participants reported more difficulty in using KVL compared to C-MAC, and insertion of laryngoscope blade into the mouth of manikin for intubation was easy in group C-MAC compared to KVL in all three intubations (P < 0.01).Conclusion:C-MAC and KVL take comparable time for successful intubation under COVID-19 simulation conditions. But C-MAC is more user-friendly.

Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial.

We hypothesized that external laryngeal manipulation would reduce cervical spine motion during video laryngoscopic intubation under manual in-line stabilization by reducing the force required to lift the videolaryngoscope. In this randomized crossover trial, 27 neurointerventional patients underwent two consecutive videolaryngoscopic intubation attempts under manual in-line stabilization. External laryngeal manipulation was applied to all patients in either the first or second attempt. In the second attempt, we tried to reproduce the percentage of glottic opening score obtained in the first attempt. Primary outcomes were cervical spine motion during intubation at the occiput-C1, C1–C2, and C2–C5 segments. The intubation success rate (secondary outcome measure) was recorded. Cervical spine motion during intubation at the occiput-C1 segment was significantly smaller with than without external laryngeal manipulation (7.4° ± 4.6° vs. 11.5° ± 4.8°, mean difference −4.1° (98.33% confidence interval −5.8° to −2.3°), p < 0.001), showing a reduction of 35.7%. Cervical spine motion during intubation at the other segments was not significantly different with versus without external laryngeal manipulation. All intubations were achieved successfully regardless of the application of external laryngeal manipulation. External laryngeal manipulation is a useful method to reduce upper cervical spine motion during videolaryngoscopic intubation under manual in-line stabilization.

Factors That Contribute to Provider Decision Between Direct and Video Laryngoscopy in a Helicopter Emergency Medical Services System: A Survey

ObjectiveIn caring for critically ill patients in the prehospital setting, rapid, definitive airway management is a high-risk, crucial procedure. All helicopter emergency medical services (HEMS) providers must proficiently and safely perform this procedure. Little information is available about the preference and efficacy of video laryngoscopy (VL) compared with direct laryngoscopy (DL). Additionally, there is a paucity of research investigating which method of intubation is more successful in the HEMS setting. The objective of this study was to delineate factors that contribute to provider decision regarding the method of orotracheal intubation and compare the frequency of use for each method. MethodsAn anonymous online survey was distributed to all providers in a single HEMS program. The survey results were deidentified and blinded to the researchers. ResultsThe survey was sent to 40 HEMS providers; 29 responded, and 119 total intubations were reported. Method familiarity and patient condition were the most commonly cited reasons for choosing both DL and VL for intubation. DL accounted for 15 intubation attempts, whereas 104 attempts were completed by VL. ConclusionFor both laryngoscopy techniques, the top reasons cited for selecting an intubation technique were being comfortable with that technique and patient presentation. Further investigation with chart review would help confirm the reported data.