Video Laryngoscope Group Research Articles

Intubation of non-difficult airways using video laryngoscope versus direct laryngoscope: a randomized, parallel-group study

BackgroundThe video laryngoscope is recommended for intubating difficult airways. The present study aimed to determine whether the video laryngoscope can further improve intubation success rates compared with the direct laryngoscope in patients with non-difficult airways.MethodsIn total, 360 patients scheduled for elective abdominal surgeries were randomly assigned to undergo intubation using either a video laryngoscope (n = 179) or a direct laryngoscope (n = 181). The following parameters were measured: mouth opening; thyromental distance; sternomental distance; shape angle of the tracheal catheter; and glottic exposure grade.ResultsThe percentage of patients with level I-II of total glottic exposure in the video laryngoscope group was 100% versus 63.5% in the direct laryngoscope group (P < 0.001). The one-attempt success rate of intubation was 96.1% using a video laryngoscope versus 90.1% using a direct laryngoscope (P = 0.024). The intubation success rate using a video laryngoscope was 100% versus 94.5% using a direct laryngoscope (P = 0.004). Immediate oropharyngeal injury occurred in 5.1% of patients intubated using a direct laryngoscope versus 1.1% using a video laryngoscope (P = 0.033). On postoperative day 1, obvious hoarseness was exhibited by 7.9% of patients intubated using a direct laryngoscope versus 2.8% using a video laryngoscope (P = 0.035). The grade of glottic exposure and catheter shape angle were independent risk factors for tracheal intubation failure. Thyromental distance, shape angle, glottic exposure time, and surgical position were independent risk factors for postoperative complications. Thyromental distance and glottic exposure time were independent risk factors for complications lasting > 2 days.ConclusionsIntubation using a video laryngoscope yielded significantly higher intubation success rates and significantly fewer postoperative complications than direct laryngoscopy in patients with non-difficult airways.Trial registrationChinese Clinical Trial Registry. No: ChiCTR-IOR-16009023. Prospective registration.

A single-centre, randomised controlled feasibility pilot trial comparing performance of direct laryngoscopy versus videolaryngoscopy for endotracheal intubation in surgical patients

IntroductionMost trials comparing effectiveness of laryngoscopy technique use surrogate endpoints. Intubation success is a more appropriate endpoint for comparing effectiveness of techniques or devices. A large pragmatic clinical trial powered for intubation success has not yet been performed.MethodsWe tested the feasibility of a randomised controlled trial to compare the performance of direct laryngoscopy versus videolaryngoscopy for endotracheal intubation. The trial was conducted in the Department of Adult and Emergency Anaesthesia at the Auckland City Hospital, New Zealand. Patients over 18 years who required endotracheal intubation and were not known or predicted to be difficult to bag-mask ventilate were eligible for the study. Patients were excluded if they required rapid sequence induction, fibreoptic intubation or were unable to consent due to language barriers or cognitive impairment.Patients were permuted block randomised in groups of 8 to either direct laryngoscopy (DL) or videolaryngoscopy (VL) for the technique of endotracheal intubation. Patients were blinded to laryngoscopic technique; the duty anaesthetist, outcome assessors and statistician were unblinded.Feasibility was assessed on recruitment rate, adherence to group assignment and data completeness. Primary outcome was first-pass success rate, with secondary outcomes of time to intubation (seconds), Intubation Difficulty Score and complication rate.ResultsOne hundred and six patients were randomised and 100 patient results were analysed. Completed data from patients randomised to the DL group (n = 49) was compared with those in the VL group (n = 51). Group adherence and data completeness were 100% and 97%, respectively. First-pass success rate was 83.7% in the direct laryngoscopy group and 72.5% in the videolaryngoscopy group (p = 0.18). Median time to intubation was significantly shorter for direct laryngoscopy when compared to videolaryngoscopy (34 s v 43 s, p = 0.038). Complications included mucosal trauma and airway bleeding which are recognised complications of endotracheal intubation.ConclusionA large, pragmatic, multicentre, randomised controlled trial comparing the relative effectiveness of direct laryngoscopy and indirect videolaryngoscopy is feasible.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12615001267549

Intubation with King Vision® video laryngoscope and Macintosh laryngoscope in cervical spine injured: A randomized controlled trial

Background: Intubation of trachea with conventional laryngoscopy requires alignment of the oropharyngeal–laryngeal axis in a straight line. This causes significant movement of the cervical spine, which in case of any previous injury to the spinal cord, may be further damaged due to impingement of the cord between the broken vertebrae. King Vision® video laryngoscope due to its particular J shape and a channel to carry the tube, causes less movement of the spine and hence provides better and safer intubation conditions in patients who have cervical injury. Methods: The study was conducted in a tertiary-level orthopedic and spine center. It was a single-blind randomized control study. After obtaining permission from Hospital Ethics Committee and patient's consent, 60 patients of cervical spine injury of American Society of Anesthesiologists I-III, and normal airway anatomy, were assessed for ease and safety of intubation by – (a) King Vision® video laryngoscope and (b) Macintosh laryngoscope. The primary criteria were Intubation Difficulty Scale (IDS), while the secondary criteria were duration of intubation, heart rate, and mean arterial pressure. Results: Results were analyzed by Chi-square, Mann–Whitney, and Student t-test using SPSS software. P value was 0.05. The mean IDS in King Vision® video laryngoscope group was significantly less than Macintosh group. However, there was no statistical difference in duration of intubation and hemodynamic parameters. Conclusions: Intubation in cervical spine injury patients with neck immobilization is easier with King Vision® video laryngoscope, but duration of intubation, complication rate, and hemodynamic parameters remain the same as compared with Macintosh laryngoscope.

Surveying the Literature

Surveying the Literature

Comparison of video laryngoscopy versus direct laryngoscopy for intubation in emergency department patients with cardiac arrest: A multicentre study

AimTo compare the tracheal intubation performance between video laryngoscopy (VL) and direct laryngoscopy (DL) in patients with cardiac arrest in the ED. MethodsThis is an analysis of the data from a prospective, multicentre study of 15 EDs in Japan. We included consecutive adult patients with cardiac arrest who underwent intubation with VL or DL from 2012 through 2016. The primary outcome was first-attempt success. The secondary outcomes were glottic visualisation assessed with Cormack grade (1 vs. 2–4) and occurrence of oesophageal intubation. To examine the between-device difference in outcome risks, we analysed the whole data and 1:1 propensity score matched data. ResultsAmong 9694 patients who underwent intubation in the EDs, 3360 cardiac arrests (35%) were included in the analysis (90% were non-traumatic cardiac arrests). The first-attempt success rate was higher in the VL group compared to those in the DL (78% vs 70%; unadjusted OR 1.61 [95%CI 1.26–2.06] P < 0.001). This association remained significant after adjusting for six potential confounders and within-ED clustering (adjusted OR 1.33 [95%CI 1.03–1.73] P = 0.03). VL use was also associated with a better glottic visualisation (adjusted OR 3.84 [95%CI 2.81–5.26] P < 0.001) and lower rate of oesophageal intubation (adjusted OR 0.45 [95%CI 0.24–0.85] P = 0.01) compared to DL. These results were consistent in the propensity score matched analysis. ConclusionsBased on large multicentre prospective data of ED patients with cardiac arrest, the use of VL was associated with a higher first-attempt success rate compared to DL, with a better glottic visualisation and lower oesophageal intubation rate.

Direct vs. Video Laryngoscopy in a Helicopter Emergency Medical Service (HEMS) Setting: A Retrospective Comparison

Introduction In the prehospital setting, when caring for critically ill patients, the ability to quickly and effectively secure a definitive airway can be a matter of life of death. As such, all helicopter emergency medical service (HEMS) providers must be able to safely perform this procedure with speed and efficacy. Video laryngoscopy (VL) was invented and introduced as an improved technique for performing orotracheal intubation, and its use has become widespread amongst pre-hospital and HEMS organizations. Despite this, little information is available regarding the efficacy of VL when compared to standard direct laryngoscopy (DL) in this pre-hospital setting. As such, there is sparse evidence to guide the HEMS provider's decision on which to use when attempting to secure the airway of a critically ill patient. Provider preference often comes into play in this situation. In a preliminary survey, Nolen and Pokorney found that while the majority of Wisconsin Flight For Life (FFL) HEMS providers choose VL, variation does exist between providers in regards to VL vs DL preference. Self-reported success rates by providers suggested 100% first pass success with DL and 87.5 success with VL. This survey relied on provider recall, and further review of records is required to evaluate the accuracy of these reports. Currently, there is no protocol regarding which laryngoscopy modality to employ in the HEMS setting. This research aims to improving the quality of care received by patients who require orotracheal intubation by HEMS providers. To do this, we investigate whether the use of VL or DL increases successful orotracheal intubations by HEMS providers. We hypothesized that the first pass and overall success would be greater with VL and the overall complications would be less with VL when compared to DL. Methods A retrospective chart review was performed of all intubated patients transported by HEMS providers from January 2015 to July 2017. Inclusion Criteria Adult patients transported by HEMS providers that required orotracheal intubation and underwent at least one attempt at orotracheal intubation. Results When comparing the survey results, we found similar rates of DL vs VL attempts (15/21 vs 104/120). First pass success rates were overestimated for both modalities (100%/90.5% vs 87.5%/84.8%). First Pass Success Rate No statistically significant difference was found in 1st pass success rate. The top reported reason for failed DL attempts was inability to pass tube, while the top reported reason for failed VL attempts include blood/secretions on camera, followed by inability to pass tube. Overall Success Rate No statistically significant difference was found between the two modalities. However, there was notably no difference between 1st pass and overall success rate in the DL group, while the overall success improved over fist pass in the VL group. While not statistically significant, this trend results from more attempts and alterations by those performing VL prior to resorting to a rescue airway. The most common alteration made was change in VL blade, followed by changing from VL to DL. Complications DL and VL groups had nearly identical complication rates. In both groups, the primary complication was hypoxia, so BVM ventilation was utilized. There was one cardiac arrest in the DL group. Influencing Factors Overwhelmingly, the method of intubation favored by HEMS providers is video laryngoscopy (VL). In the survey by Pokorney and Nolan, provider preference was the most common reason for choosing a modality. Of the patient characteristics observed, no significant differences were found. Initial GCS showed near statistical significance, with lower initial GCS trending to VL. Perhaps VL is more utilized when indication for intubation is apparent immediately upon arrival on scene. Unresponsiveness as reason for intubation, however, did not vary significantly. Respiratory failure alone demonstrated a statistically significant difference with proportionally more VL intubations in these patients. No definition for what constitutes respiratory failure was present in the charts and the reason for this variance between modality used is unknown. Conclusion In the data reviewed, no significant differences were found in first pass or overall success rates for direct and video laryngoscopy. Additionally no significant difference was observed in the complication rates and no factors were found that influenced the decision to perform DL vs VL.

Video versus direct laryngoscopy on successful first-pass endotracheal intubation in ICU patients.

Airway management in intensive care unit (ICU) patients is challenging. The aim of this study was to compare the rate of successful first-pass intubation in the ICU by using the direct laryngoscopy (DL) and that by using the video laryngoscopy (VL). A randomized, non-blinded trial comparing first-pass success rate of intubation between VL and DL was performed. Patients were recruited in the period from August 2014 to August 2016. All physicians working at ICU received hands-on training in the use of the video and direct laryngoscope. The primary outcome measure was the first-pass intubation success. A total of 163 ICU patients underwent intubation during the study period (81 patients in VL group and 82 in DL group). The rate of successful first-pass intubation was not significantly different between the VL and the DL group (67.9% vs. 69.5%, P=0.824). Moreover, the overall intubation success and total number of attempts to achieve intubation success did not differ between the two groups. In patients with successful first-pass intubation, the median duration of the intubation procedure did not differ between the two groups. The Cormack-Lehane grades and the percentage of glottic opening score were similar, and no significant differences were found between the two groups. There were no statistical differences between the VL and the DL group in intubation complications (all P>0.05). Among ICU patients requiring intubation, there was no significant difference in the rate of successful first-pass intubation between VL and DL.

Advanced Airway Management for Traffic Accident Patients

This study aims to identify advantages in the speed and success rates of intubation with a supraglottic airway device and tracheal intubation into a simulated trauma patient in an automobile accident. Forty-two EMT-Paramedics (21 in LTS group, 21, in VL group) from Region “K” in Korea performed either laryngeal tube suction (LTS) using a supraglottic airway device (SAD) or tracheal intubation using a video laryngoscope (VL) on a manikin simulating a trauma patient in an overturned automobile, noting the success rate and speed. Among the two methods for advanced airway management used in the experiment, LTS using the SAD was found to have the fastest deployment speed; LTS was also found to have a higher degree of accuracy (p<.001). According to the study, the use of faster and more precise LTS is more effective for the airway management of emergency patients in an overturned vehicle.

A comparative evaluation of King Vision video laryngoscope (channelled blade), McCoy, and Macintosh laryngoscopes for tracheal intubation in patients with immobilized cervical spine

Background: Cervical spine immobilization results in a poor laryngeal view on direct laryngoscopy leading to difficulty in intubation. This randomized prospective study was designed to compare the laryngeal view and ease of intubation with the Macintosh, McCoy, and King Vision video laryngoscopes in patients with immobilized cervical spine. Method: Ninety adult patients of ASA grade I-II with immobilized cervical spine using manual inline axial cervical spine stabilization technique, undergoing elective cervical surgery were enrolled. The patients were randomly allocated into three groups to achieve tracheal intubation with Macintosh (MAC group n=30), McCoy (MCC group n=30), or King Vision video laryngoscopes (KVL group). When the best possible view of the glottis was obtained, the Cormack-Lehane laryngoscopy grade and the percentage of glottic opening (POGO) score were assessed. Other measurements included the intubation time, the intubation difficulty score, and the intubation success rate. Haemodynamic parameters and any airway complications were also recorded. Result: King Vision video laryngoscope reduced the intubation difficulty score, improved the Cormack and Lehane glottic view, and the POGO score compared with the McCoy and Macintosh laryngoscopes. The first attempt intubation success rate was also high in the King Vision video laryngoscope group. However, there were no statistically significant differences in the time required for successful intubation and the overall success rates between the devices tested. No dental injury or hypoxia occurred with either device. Conclusion: The use of a King Vision video laryngoscope resulted in better glottis visualization, easier tracheal intubation, and higher first attempt success rate as compared to Macintosh and McCoy laryngoscopes in immobilized cervical spine patients.

Clinical study of SMT-Ⅱ video laryngoscope with difficult airway intubation in emergency department

Objective: To observe the clinical feasibility and security of SMT-Ⅱ video laryngoscope in difficult airway intubation in emergency department. Methods: This study took 90 adults with difficult airway who were admitted to the rescue room of Jingxi court of Beijing Chao-Yang Hospital, Capital Medical University from January 2015 to December 2016.The patients were randomly divided into 2 groups(SMT-Ⅱ video laryngoscope group: n=45, Macintosh direct laryngoscope group: n=45), which were treated with endotracheal intubation and ventilator assisted ventilation.The evaluation of difficult mask ventilation(DMV) independent risk factor score, Wlison score, Cormack-Lehane grade, mouth opening, thyromental distance, visualization of the glottis, time for laryngoscopy, time for tracheal intubation, first-pass success rate of intubation, complications, mean arterial pressure(MAP) and heart rate(HR) before induction, after laryngoscopy, after induction, after intubation 5 minutes, 10 minutes were recorded.ANOVA, t-test, Chi-square test was used to analyze differences data, respectively. Results: There was no significant difference between the two groups in terms of gender, age, height, weight and other general data, mouth opening, DMV independent risk factor score, Wlison score, and thyromental distance(χ(2)=0.045, t=-0.367, t=0.684, t=0.511, t=0.330, t=-0.724, t=1.219, t=1.034, all P>0.05). A Cormack-Lehane grade Ⅰ or Ⅱ view were 44 cases in SMT-Ⅱ video laryngoscope group and 14 cases in Macintosh direct laryngoscope group. It significantly improved with the use of SMT- Ⅱ video laryngoscope, compared with Macintosh direct laryngoscope(χ(2)=52.096, P<0.01). The time to best view was shorter in SMT-Ⅱ video laryngoscope group compared to that in Macintosh direct laryngoscope group with (15.0±1.0) seconds vs. (24.2±3.4) seconds(t=-26.319, P<0.05). The tube passage time was shorter with SMT-Ⅱ video laryngoscope (31.6±4.3) seconds vs. (12.7±0.9) seconds(t=-21.698, P<0.05)). The first -pass success rates in SMT-Ⅱ video laryngoscope group and Macintosh direct laryngoscope group were 100% and 84.4%, respectively(χ(2)=5.577, P<0.05). For complications, pharyngorrhagia at intubation occurred in 1 case in SMT-Ⅱ video laryngoscope group and 9 cases in Macintosh direct laryngoscope group(χ(2)=5.513, P<0.05), dislocation of tooth at intubation occurred in 0 case in SMT- Ⅱ video laryngoscope group and 6 cases in Macintosh direct laryngoscope group (χ(2)=4.464, P<0.05). The mean arterial pressure values before induction, after laryngoscopy, after induction and after intubation 5 minutes, 10 minutes were (84.8±3.3), (89.2±3.6), (90.8±3.6), (86.6±3.4), (85.4±3.6) mmHg(1 mmHg=0.133 kPa) in SMT-Ⅱ video laryngoscope group and (85.8±3.1), (91.9±3.4), (96.1±2.9), (90.0±2.5), (86.5±2.9) mmHg in Macintosh direct laryngoscope group. There was a significant difference between the two groups at the 5-time points of MAP (F=16.619, P=0.000). The heart rate values before induction, after laryngoscopy, after induction and after intubation 5 minutes, 10 minutes were(77.4±4.3), (80.8±4.3), (83.3±4.9), (78.8±4.2), (76.9±4.2) rate/minutes in SMT-Ⅱ video laryngoscope group and (75.7±4.0), (85.3±4.4), (90.7±4.4), (84.3±4.1), (78.3±4.2) rate/minutes in the Macintosh direct laryngoscope group.There was a significant difference between the two groups at the 5-time points of HR(F=15.857, P=0.000). Conclusions: SMT-Ⅱ video laryngoscope uesd in difficult ariway enable better visualization of the glottic opening, short opertive time, enhance the success rate of intubation.It indicucates that SMT-Ⅱ video laryngoscope is safer than Macintosh direct laryngoscope in patients with difficult airway.

Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis

Endotracheal intubation (EI) in ICU patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in the expertise of operators. The goal of this study was to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI. We searched for relevant studies in PubMed, Embase, and the Cochrane database from inception through January 30, 2017. Randomized controlled trials were included if they reported data on any of the predefined outcomes in ICU patients requiring EI and managed with VL or DL. Results were expressed as risk ratios (RRs) or mean differences (MDs) with accompanying 95%CIs. Five randomized controlled trials with 1,301 patients were included. Despite better glottic visualization with VL (RR= 1.24; 95%CI, 1.07 to 1.43; P= .003), use of VL did not result in a significant increase in the first-attempt success rate (RR= 1.08; 95%CI, 0.92-1.26; P= .35) compared with DL. In addition, time to intubation (MD= 4.12 s; 95%CI, -15.86-24.09; P= .69), difficult intubation (RR= 0.72; 95%CI, 0.30-1.70; P= .45), mortality (RR= 1.02; 95%CI, 0.84-1.25; P= .83), and most other complications were similar between the VL and DL groups. The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.

A comparison of direct laryngoscopy to video laryngoscopy by paramedic students in manikin-simulated airway management scenarios.

IntroductionWe compare the effectiveness of direct laryngoscopy (DL) to video laryngoscopy (VL) in simulated, difficult airway scenarios in a cohort of novice, prehospital, emergency care providers.MethodsForty-five (45) students were randomised to DL or VL groups and then tasked to perform intubation on a manikin in three simulated airway scenarios. The scenarios included an uncomplicated intubation, intubation with manual in-line neck stabilisation (MILNS), and a simulated motor vehicle entrapment, with C-Spine held from behind, using a face-to-face intubation technique. The primary outcome was time taken to intubate, with secondary outcomes including first pass success rate, number of intubation attempts, Cormack-Lehane (CL) view grade obtained, adverse event rate, and self-reported laryngoscopist comfort.ResultsTwenty-seven participants (VL n = 15, DL n = 12) completed the study. Mean time to intubate was not statistically different between VL and DL groups in any scenario. VL was associated with an increased frequency of intubation attempts (p = 0.043) and failed intubations (RR 6.4, 95% CI 0.92–44.33, p = 0.0175) in the face-to-face intubation scenario, VL was associated with a reduced incidence of poor CL view (RR 0.06, 95% CI 0.004–0.997, p = 0.0497) in the face-to-face intubation scenario, and a reduction in the frequency of dental damage (RR 0.13, 95% CI 0.02–0.96, p = 0.0165) in the supine MILNS scenario.DiscussionIn our small sample, we found DL to be superior to VL in relation to a reduced risk of failed intubation and frequency of intubation attempts despite VL being superior in obtaining a good view of the vocal cords in a face-to-face intubation scenario. We found no statistically significant difference in the time taken to intubate in any scenarios. A larger study is required to inform practice and education around prehospital use of VL.

Video Laryngoscopy vs. Direct Laryngoscopy in Teaching Neonatal Endotracheal Intubation: A Simulation-Based Study.

BackgroundNeonatal endotracheal intubation is a life-saving procedural skill where best practices have been developed from expert opinion. Few empirical studies have examined how this skill should be taught.ObjectiveTo determine whether a video laryngoscope (VL) assisted intubation training curriculum compared to a traditional direct laryngoscope (DL) assisted curriculum improves neonatal intubation performance of novice intubators in a simulated setting.MethodsA randomized trial of novice intubators was conducted at the University of Texas-Houston from 6/2013–8/2013. Eligible candidates were randomly assigned to control group (DL curriculum) or intervention group (VL curriculum). Those in the intervention group received instruction with VL videos and practice with Storz C-MAC® VL (Karl Storz, Tuttlingen, Germany) in addition to a traditional curriculum. Intubation performance was evaluated in a simulated setting using a SimNewB® (Laerdal, NY, USA) manikin and traditional intubation equipment. The number of intubation attempts, outcome of each attempt, and time to successful intubation were recorded. The data was analyzed using Fisher's exact test and logistic regression where appropriate.ResultsOne hundred twenty-three trainees were enrolled, 62 (50%) in DL group and 61 (50%) in the VL group. Intubation success on first attempt was achieved by 69% (43/62) of the DL group vs. 61% (37/61) of the VL group, P=0.35. Time to successful intubation was 25 sec (interquartile range (IQR) 18, 32) in the DL group and 26.5 sec (IQR 20, 43) in the VL group, P=0.27. Those in the VL group were more likely to need more than two attempts to achieve intubation success, OR=3.09 (95% CI 1.03–9.28).ConclusionsIn a simulated setting, teaching with a VL curriculum did not improve intubation performance compared to teaching with DL. Further studies are needed to determine if VL-based teaching has an impact on clinical intubation performance.

Comparative Evaluation of Performance of Videolaryngoscope vs Fastrach Intubating Laryngeal Mask Airway

ABSTRACTIntroductionThis prospective randomized study aimed to compare the effectiveness of the intubating laryngeal maskairway(ILMA) with the King Vision Video laryngoscope in aiding endotracheal intubation in Asian patients with normal airway. King Vision Video laryngoscope is a two-piece design. It has a reusable monitor that attaches to disposable blades. The ILMA is a device specifically designed to be an effective ventilatory device and blind intubating guide in patients with normal and abnormal airways.Materials and methodsAfter ethics committee approval and obtaining patient's written informed consent, 60 American Society of Anesthesiologists grade I and II adult patients undergoing elective surgery requiring intubation were randomly allocated into either the ILMA group (Group L) or the King Vision Video laryngoscope group (Group V).• Thorough preanesthetic checkup was done. Patient was premedicated. Induction was done with propofol 2.5 mg/kg and succinylcholine 1.5 mg/kg. In Group L, ILMA was inserted using a single-handed rotational technique. In the King Vision Video laryngoscope group, intubation was done with videolaryngoscope. Placement was confirmed with auscultation and capnography.• An independent observer recorded the following:– Time taken for successful intubation– Success or failure of the tracheal intubation– Number of attempts needed for successful tracheal intubation– Complication associated with tracheal intubation: bleeding or postoperative sore throat– Hemodynamic response to intubationResults and conclusionKing Vision Video laryngoscope is the more effective technique in aiding endotracheal intubation in patients with normal airways.How to cite this articleHanjura S, Agrawal AP, Agrawal M, Singh V, Vinay V, Ahmed R. Comparative Evaluation of Performance of VideolaryngoscopevsFastrach Intubating Laryngeal Mask Airway. Int J Adv Integ Med Sci 2017;2(1):1-7.

Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients

BackgroundNasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. Material and methods200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. ResultsSuccess rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. ConclusionUse of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.

Intraocular pressure changes: the McGrath video laryngoscope vs the Macintosh laryngoscope; a randomized trial

Study ObjectiveTo determine the effects of the McGrath Series 5 video laryngoscope on intraocular pressure (IOP) during laryngoscopy. DesignProspective, randomized, double blind. SettingOperating room. PatientsEighty adult patients of American Society of Anesthesiologist physical status 1 scheduled for nonophthalmic elective surgery under general anesthesia. InterventionsThe endotracheal intubation was provided using McGrath series 5 video laryngoscope in MG group (n=40) or Macintosh laryngoscope in M group (n=40). MeasurementsThe IOP of the right and left eyes was measured before and after the laryngoscopic process. Main ResultsThe mean arterial blood pressure values just before laryngoscopy and intubation and after intubation were 77.38±6.18 and 97.38±12.77 in the McGrath video laryngoscope group and 75.85±7.88 and 99.12±14.30 in the Macintosh laryngoscope group, respectively. The IOP values of the left eye after intubation and at the 5th and the 10th minutes in the Macintosh laryngoscope group were found to be significantly higher than those in the McGrath video laryngoscope group (P=.019, P=.019, and P=.007, respectively). In addition, the IOP values of the right eye were found to be higher after intubation and at the 5th and the 10th minutes in the Macintosh laryngoscope group, compared to the McGrath video laryngoscope group (P=.009, P=.021, and P=.011, respectively). The mean IOP values for the left eye just before laryngoscopy and intubation and after intubation were 10.65±2.52 and 15.57±3.62 in the McGrath video laryngoscope group, and for the right eye, they were 10.60±1.64 and 17.17±2.38 in the Macintosh laryngoscope group, respectively. ConclusionThe McGrath Series 5 video laryngoscope may provide a lower IOP level compared to the Macintosh laryngoscope in an otherwise healthy, young patient population.

Use of McGrath MAC Videolaryngoscope to Assist Transesophageal Echocardiography Probe Insertion in Intubated Patients.

Transesophageal echocardiography (TEE) probe insertion with the conventional blind insertion technique may be difficult in anesthetized and intubated patients. The use of a videolaryngoscope may facilitate the insertion of the TEE probe. The aim of this study was to compare the conventional technique with the use of the McGrath MAC videolaryngoscope for TEE probe insertion in terms of success rate, duration of insertion, and complications in patients undergoing cardiovascular surgery. A prospective, randomized study. Training and research hospital. Eighty-six adult patients undergoing cardiovascular surgery were included. Eighty-six adult patients were randomized into 2 groups: conventional group (n = 43) and McGrath videolaryngoscope group (n = 43). Success rates, duration of insertion, complications, and hemodynamic changes during insertion were recorded. The success rate of TEE probe insertion at the first attempt was higher in the McGrath videolaryngoscope group (90.5%) than in the conventional group (43.9%) (p = 0.012). The mean duration for successful insertion of the TEE probe at the first attempt was longer in the McGrath videolaryngoscope group (24 s v 11 s) (p = 0.016). The total time for successful insertion of the TEE probe was similar in both groups. Pharyngeal injuries were observed more frequently in the conventional group (17.1% v 2.4%) (p = 0.037). The rate of blood presence on the probe tip in the conventional group was higher than in the McGrath group (21.9% v 4.8%). There were no statistical differences between the 2 groups in systolic blood pressure, mean arterial pressure, diastolic blood pressure, and heart rate before and after TEE insertion. The use of the McGrath MAC videolaryngoscope for TEE insertion in cardiovascular surgery patients increases the success rate and reduces pharyngeal injuries compared to the conventional technique. The use of the McGrath MAC videolaryngoscope for TEE insertion causes similar hemodynamic changes as in the conventional blind insertion technique.

Direct Versus Video Laryngoscopy Using the C‐MAC for Tracheal Intubation in the Emergency Department, a Randomized Controlled Trial

Direct laryngoscopy (DL) has long been the most common approach for emergency endotracheal intubation, although the use of video laryngoscopy (VL) is becoming more widespread. Current observational data suggest that VL has higher first-pass success, although randomized trials are lacking. The objective was to compare first-pass success in patients undergoing emergency intubation with DL or VL using a C-MAC device. This was an open-label, prospective, randomized, controlled trial in an academic emergency department of patients undergoing emergency intubation with a plan of DL for the first attempt. Patients were randomly assigned in a 1:1 ratio to either DL or VL using a C-MAC device for the first intubation attempt. The primary outcome was first-pass success. Secondary outcomes included time to intubation, development of aspiration pneumonia, and hospital length of stay (LOS). The study was registered at Clinicaltrials.gov, number NCT01710891. A total of 198 patients were enrolled and intubated with either DL (n=95) or VL (n=103). First-attempt success was 86 and 92% for the DL and VL groups, respectively (difference=-5.9%, 95% confidence interval=-14.5% to 2.7%, p=0.18). Time to intubation, rates of aspiration pneumonia, and hospital LOS were not different between the two groups. In patients undergoing emergency intubation in whom DL was planned for the first attempt, we did not detect a difference between VL or DL using the C-MAC device in first-pass success, duration of intubation attempt, aspiration pneumonia, or hospital LOS.

Comparative effectiveness of McCoy laryngoscope and CMAC(®) videolaryngoscope in simulated cervical spine injuries.

Background:Videolaryngoscopes are increasingly being used in potentially difficult airway. McCoy laryngoscope provides definitive advantage over conventional laryngoscopes in cervical spine patients. The aim of this study was to compare the performance of the CMAC® videolaryngoscope with the McCoy Laryngoscope in patients with a cervical collar.Material and Methods:Sample size of at least 22 patients in each group was calculated using Intubation Difficulty Scale (IDS) score as the primary outcome. 60 American Society of Anesthesiologists I and II patients requiring tracheal intubation for elective surgery were randomly allocated into the McCoy group (n = 30) and the CMAC® videolaryngoscope group (n = 30). Anesthesia was induced with fentanyl 2 mcg/kg, propofol 2-3 mg/kg and rocuronium 0.6 mg/kg. A rigid collar was applied to immobilize the cervical spine. Comparative data on the IDS scale, Cormack-Lehane (CL) laryngoscopic view, time taken for glottis visualization, time taken to pass endotracheal tube, total time to intubate, number of optimizing maneuvers and hemodynamic variables were recorded in the two groups.Results:IDS score was significantly less in the CMAC® group compared to the McCoy group (median [interquartile range (IQR)], 1 [0-1] vs. 4 [3-6], P < 0.05). CMAC® videolaryngoscope required significantly less time for glottic visualization with median (IQR), 5 (5-7) versus 14 (8-15), P = 0.000 in McCoy laryngoscope, 29 (96.7%) patients in the CMAC® group had Modified CL Grade I compared with 16 (53.3%) patients in McCoy group. The hemodynamic variables, number of optimizing maneuvers and incidence of side effects were comparable in the two groups.Conclusion:CMAC® videolaryngoscope forms an effective tool for the airway management of cervical spine patients with a cervical collar.

A Comparison of Cervical Spine Movement during Tracheal Intubation when Using a Pentax Airway Scope or the GlideScope Video Laryngoscopy with Fluoroscopy

Background: Cervical spine movement does occur during intubation and in patients with cervical spine injuries; the result can have devastating neurologic outcomes. Video laryngoscopes provide a better view of the glottis and less cervical spine movement. Objective: The purpose of this study is a comparison of cervical spine motion during tracheal intubation between the GlideScope video laryngoscopy and the Pentax Airway Scope. The primary outcome is the difference in cervical spine motion. The cervical spine motion was recorded using fluoroscopic video and the angular displacement of the spine was measured by a radiologist. The secondary outcome is the hemodynamic changes after intubation. Methods: Into Pentax Airway Scope and GlideScope video laryngoscopy groups, we randomly allocated two hundred and one patients who underwent elective non-cardiac surgery and require general anesthesia with tracheal intubation. All patients underwent general anesthesia with the same induction medications, muscle relaxant and narcotics. During airway maneuvers, a fluoroscopy was used to record cervical spine movements from the occiput down to C5 level. Vital signs were recorded after successful intubation. All images were measured by the radiologist consultant. Using the classic AutoCAD program and the angles between adjacent levels were calculated and shown as a number. Results: The Pentax Airway Scope and GlideScope induced the greatest cervical spine movement in the C1-C2 segments, during each stage of the laryngoscopies. Cervical spine motion was not statistically different using either video laryngoscope at the five segments studied. The hemodynamic changes after intubation showed after the first and second minutes and there were significantly less systolic blood pressure and diastolic blood pressure changes in the Pentax group. Conclusion: Cervical spine movement during tracheal intubation is not significant difference between the Pentax Airway Scope and the GlideScope.