Video Laryngoscope Group Research Articles

Preoperative bedside test indicators as predictors of difficult video laryngoscopy in obese patients: a prospective observational study.

The aim of this study was to identify factors associated with difficult video laryngoscopy in obese patients. A total of 579 obese patients undergoing elective laparoscopic weight loss surgery were intubated with a single-lumen endotracheal tube using a video laryngoscopy under general anesthesia, and the patients were divided into two groups based on the Cormack-Lehane classification (difficult video laryngoscopy defined as ≥ 3): the easy video laryngoscopy group and the difficult video laryngoscopy group. Record the general condition of the patient, bedside testing indicators related to the airway, Cormack-Lehane classification during intubation, and intubation failure rate. The findings of this study show that the incidence of difficult video laryngoscopy in obese patients is 4.8%. Multivariate logistic regression analysis indicated that body mass index was significantly associated with difficult video laryngoscopy (OR = 1.082, 95% CI [1.033-1.132], P<0.001). For Chinese obese patients without known difficult airways, the incidence of difficult video laryngoscopy is 4.8%. Body mass index is associated factors for the occurrence of difficult video laryngoscopy, with an increased risk observed as body mass index rise.

Video laryngoscopy improves ProSeal™ laryngeal mask airway position by anesthesia residents: A randomized controlled, double-blind study

BackgroundThe insertion of ProSeal laryngeal mask airway (LMA) using a blind digital technique is difficult for inexperienced performers and malpositioning of the device can impair ventilation and may lead to complications. AimThis study aimed to compare the proper ProSeal LMA position inserted by anesthesia residents between video laryngoscopy-assisted and blind digital insertion techniques. MethodsA total of 138 patients aged 18–80 years, ASA I and II undergoing elective surgery, were randomly allocated to the digital or video laryngoscopy-assisted group. Anesthesia residents performed ProSeal LMA insertion. The primary outcome was the proportion of a proper LMA position evaluated by a blinded assessor using the fiber-optic scores. Secondary outcomes included first attempt success rate, duration of insertion, incidence of desaturation during insertion, peak airway and oropharyngeal leak pressure, gastric tube placement difficulty, hemodynamic disturbance, and airway complications at 1 and 24 h after surgery. ResultsPatients in the video laryngoscopy group demonstrated a significantly higher proportion of proper LMA position than those in the digital group (53/68 [78 %] vs. 24/67 [36 %]; RR 2.18 [95%CI 1.54–3.07]; P < 0.001). Using the video laryngoscopy-guided insertion improved the fiber-optic scores by 7.11 folds (95%CI 3.53–14.32; P < 0.001) compared with the digital technique. Patients in the video laryngoscopy group showed higher sealing pressure, easier gastric tube placement, but longer insertion time. There was no significant difference in the peak airway pressure, first-attempt success rate, hemodynamic changes, and airway complications between groups. No desaturation occurred during the study. ConclusionUsing a Macintosh-shaped blade video laryngoscope facilitates novice anesthesiologists in achieving improved ProSeal LMA positioning without compromising airway or hemodynamic complications. The optimal ProSeal LMA position also provides a higher oropharyngeal sealing pressure and easier gastric tube placement.

Comparison of king vision video laryngoscope with macintosh laryngoscope for nasotracheal intubation: Randomized control study

Nasotracheal intubation is essential in oro-maxillofacial surgeries to provide a good operational field along with a secured airway. In this study, we aim to compare king vision video laryngoscope with conventional Macintosh laryngoscope for nasotracheal intubation in ear, nose throat and oro-maxillofacial surgeries under general anaesthesia. A total of 102 patients were posted for elective oro-maxillofacial surgeries under general anaesthesia with nasal intubation. Patients were randomized to two different groups. In group K nasotracheal intubation was done with king vision video laryngoscope (KVVL) and in group M with Macintosh laryngoscope. Primary objective was to compare total intubation time and each time intervals (time A: placement of the nasal tube from selected nostril to oropharynx; time B: use of devices to view the glottis, and time C: for nasal tube to be advanced from oropharynx into trachea and removal of the laryngoscope from oral cavity). Secondary objectives were to compare scores of Modified Naso Intubation Difficulty Scale (MNIDS) and haemodynamic responses.The mean total intubation time, and time C interval were noted in King Vision Video Laryngoscope group (37.29±7.83 s and 15.99±8.9 s) and Macintosh laryngoscope group (46.11±10.05 s and 19.86±9.96 s) respectively. There was significant difference between these two groups in terms of mean total intubation time, and time C interval (total time, p=0.001 and time C, p=0.041). The level of difficulty in intubation noted using MNIDS score which is zero in 52.9% patients in King Vision group and 23.5% in Macintosh group (p=0.011).As compared to Macintosh laryngoscope, the king vision laryngoscope requires lesser time for nasotracheal intubation. In addition, Intubation is easier with the king vision laryngoscope than with the Macintosh laryngoscope.

Macintosh-style videolaryngoscope use for tracheal intubation in elective surgical patients revisited: a sub-analysis of the 2022 Cochrane review data

The Cochrane systematic review and meta-analysis published in 2022 that compared videolaryngoscopy (VL) with direct laryngoscopy (DL) for facilitating tracheal intubation in adults found that all three types of VL device (Macintosh-style, hyper-angulated and channeled) reduced the risk of failed intubation and increased the likelihood of first-pass success. We report the findings of a subgroup re-analysis of the 2022 Cochrane meta-analysis data focusing on the Macintosh-style VL group. This was undertaken to establish whether sufficient evidence exists to guide airway managers in making purchasing decisions for their local institutions based upon individual device-specific performance. This re-analysis confirmed the superiority of Macintosh-style VL over Macintosh DL in elective surgical patients, with similar efficacy demonstrated between the Macintosh-style VL devices examined. Thus, when selecting which VL device(s) to purchase for their hospital, airway managers decisions are likely to remain focused upon issues such as financial costs, portability, cleaning schedules and previous device experience.

Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infants

BackgroundRepeated attempts at endotracheal intubation are associated with increased adverse events in neonates. When clinicians view the airway directly with a laryngoscope, fewer than half of first attempts are successful. The use of a video laryngoscope, which has a camera at the tip of the blade that displays a view of the airway on a screen, has been associated with a greater percentage of successful intubations on the first attempt than the use of direct laryngoscopy in adults and children. The effect of video laryngoscopy among neonates is uncertain.MethodsIn this single-center trial, we randomly assigned neonates of any gestational age who were undergoing intubation in the delivery room or neonatal intensive care unit (NICU) to the video-laryngoscopy group or the direct-laryngoscopy group. Randomization was stratified according to gestational age (<32 weeks or ≥32 weeks). The primary outcome was successful intubation on the first attempt, as determined by exhaled carbon dioxide detection.ResultsData were analyzed for 214 of the 226 neonates who were enrolled in the trial, 63 (29%) of whom were intubated in the delivery room and 151 (71%) in the NICU. Successful intubation on the first attempt occurred in 79 of the 107 patients (74%; 95% confidence interval [CI], 66 to 82) in the video-laryngoscopy group and in 48 of the 107 patients (45%; 95% CI, 35 to 54) in the direct-laryngoscopy group (P<0.001). The median number of attempts to achieve successful intubation was 1 (95% CI, 1 to 1) in the video-laryngoscopy group and 2 (95% CI, 1 to 2) in the direct-laryngoscopy group. The median lowest oxygen saturation during intubation was 74% (95% CI, 65 to 78) in the video-laryngoscopy group and 68% (95% CI, 62 to 74) in the direct-laryngoscopy group; the lowest heart rate was 153 beats per minute (95% CI, 148 to 158) and 148 (95% CI, 140 to 156), respectively.ConclusionsAmong neonates undergoing urgent endotracheal intubation, video laryngoscopy resulted in a greater number of successful intubations on the first attempt than direct laryngoscopy. (Funded by the National Maternity Hospital Foundation; VODE ClinicalTrials.gov number, NCT04994652.)

A prospective, pragmatic non-inferiority study of emergency intubation success with the single-use i-view versus standard reusable video laryngoscope.

Video laryngoscope (VL) technology improves first-pass success. The novel i-view VL device is inexpensive and disposable. We sought to determine the first-pass intubation success with the i-view VL device versus the standard reusable VL systems in routine use at each site. We performed a prospective, pragmatic study at two major emergency departments (EDs) when VL was used. We rotated i-view versus reusable VL as the preferred device of the month based on an a priori schedule. An investigator-initiated interim analysis was performed. Our primary outcome was a first-pass success with a non-inferiority margin of 10% based on the per-protocol analysis. There were 93 intubations using the reusable VL devices and 81 intubations using the i-view. Our study was stopped early due to futility in reaching our predetermined non-inferiority margin. Operator and patient characteristics were similar between the two groups. The first-pass success rate for the i-view group was 69.1% compared to 84.3% for the reusable VL group. A non-inferiority analysis indicated that the difference (-15.1%) and corresponding 90% confidence limits (-25.3% to -5.0%) did not fall within the predetermined 10% non-inferiority margin. The i-view device failed to meet our predetermined non-inferiority margin when compared to the reusable VL systems with the study stopping early due to futility. Significant crossover occurred at the discretion of the intubating operator during the i-view month.

Videolaryngoscope versus conventional technique for insertion of a transesophageal echocardiography probe in intubated ICU patients (VIDLARECO trial): A randomized clinical trial

BackgroundTransesophageal echocardiogram probe insertion in intubated critically ill patients can be difficult, leading to complications, such as gastric bleeding or lesions in the oropharyngeal mucosa. We hypothesised that the use of a videolaryngoscope would facilitate the first attempt at insertion of the transesophageal echocardiogram probe and would decrease the incidence of complications compared to the conventional insertion technique. MethodsIn this clinical trial, patients were randomly assigned the insertion of a transesophageal echocardiogram probe using a videolaryngoscope or conventional technique. The primary outcome was the successful transesophageal echocardiogram probe insertion on the first attempt. The secondary outcomes included total success rate, number of insertion attempts, and incidence of pharyngeal complications. ResultsA total of 100 intubated critically ill patients were enrolled. The success rate of transesophageal echocardiogram probe insertion on the first attempt was higher in the videolaryngoscope group than in the conventional group (90% vs. 58%; absolute difference, 32%; 95% CI 16%–48%; p < 0.001). The overall success rate was higher in the videolaryngoscope group than in the conventional group (100% vs. 72%; absolute difference, 28%; 95% CI 16%–40%; p < 0.001). The incidence of pharyngeal mucosal injury was smaller in the videolaryngoscope group than in the conventional group (14% vs. 52%; absolute difference, 38%; 95% CI 21%–55%; p < 0.001). ConclusionsOur study showed that in intubated critically ill patients required transesophageal echocardiogram, the use of videolaryngoscope resulted in higher successful insertion on the first attempt with lower rate of complications when compared with the conventional insertion technique. Trial registrationClinicalTrials.gov Identifier: NCT04980976.

First-Pass Success of Intubations Using Video Versus Direct Laryngoscopy in Children With Limited Neck Mobility.

It is not clear whether video laryngoscopy (VL) is associated with a higher first-pass success rate in pediatric patients with limited neck mobility when compared with direct laryngoscopy (DL). We sought to determine the association between the laryngoscopy method and first-pass success. In this retrospective cohort study, we examined intubation data extracted from 2 prospectively collected, multicenter, airway management safety databases (National Emergency Airway Registry and the National Emergency Airway Registry for children), obtained during the years 2013-2018 in the emergency department. Intubations were included if patients were aged younger than 18 and had limited neck mobility. We compared first-pass success rates for ED intubations that were performed using VL versus DL. We built a structural causal model to account for potential confounders such as age, disease category (medical or trauma condition), other difficult airway characteristics, use of sedatives/paralytics, and laryngoscopist training level. We also analyzed adverse events as a secondary outcome. Of 34,239 intubations (19,071 in the National Emergency Airway Registry and 15,168 in the National Emergency Airway Registry for children), a total of 341 intubations (1.0%) met inclusion criteria; 168 were performed via VL and 173 were performed via DL. The median age of patients was 124 months (interquartile range, 48-204). There was no difference in first-pass success between VL and DL (79.8% vs 75.7%, P = 0.44). Video laryngoscopy was not associated with higher first-pass success (odds ratio, 1.11; 95% confidence interval 0.84-1.47, with DL as a comparator) when a structural causal model was used to account for confounders. There was no difference in the adverse events between VL and DL groups (13.7% vs 8.7%, P = 0.19). In children with limited neck mobility receiving tracheal intubation in the ED, neither VL nor DL was associated with a higher first-pass success rate.

Comparison of video laryngoscope, video stylet, and flexible videoscope for transoral endotracheal intubation in patients with difficult airways: a randomized, parallel-group study

BackgroundThe 2022 ASA guidelines recommend the video laryngoscope, video stylet, and flexible videoscope as airway management tools. This study aims to compare the efficacy of three airway devices in intubating patients with difficult airways.MethodsA total of 177 patients were selected and randomized into the following three groups: the video laryngoscope group (Group VL, n = 59), video stylet group (Group VS, n = 59), and flexible videoscope group (Group FV, n = 59). The success rate of the first-pass intubation, time of tracheal intubation, level of glottic exposure, and occurrence of intubation-related adverse events were recorded and analyzed.ResultsAll patients were successfully intubated with three devices. The first-pass intubation success rate was significantly higher in Groups VS and FV than in Group VL (96.61% vs. 93.22% vs. 83.05%, P < 0.01), but it was similar in the first-pass intubation success rate between Groups VS and FV(P > 0.05). The number of patients categorized as Wilson-Cormack-Lehane grade I-II was fewer in Group VL than in Groups VS and FV (77.97% vs. 98.30% vs. 100%, P = 0.0281). The time to tracheal intubation was significantly longer in Group FV(95.20 ± 4.01) than in Groups VL(44.56 ± 4.42) and VS(26.88 ± 4.51) (P < 0.01). No significant differences were found among the three groups in terms of adverse intubation reactions (P > 0.05).ConclusionsIn patients with difficult airways requiring intubation, use of the video stylet has the advantage of a relatively shorter intubation time, and the flexible videoscope and video stylet yield a higher first-pass intubation success rate and clearer glottic exposure than the use of the video laryngoscope.Trial registrationChinese Clinical Trial Registry. No: ChiCTR2200061560, June 29, 2022.

A randomized comparison of the performance of Airtraq videolaryngoscope versus Macintosh laryngoscope in simulated rapid sequence induction of anaesthesia

Application of cricoid pressure during rapid sequence induction (RSI) of anaesthesia leads to difficult airway. No channeled videolaryngoscope (VL) has been compared with the Macintosh laryngoscope for facilitating intubation in RSI. Thus, we compared Airtraq® VL with Macintosh laryngoscope for simulated RSI in patients scheduled for elective surgeries.Following approval from Institutional Ethics Committee-Human Research, this randomized study was conducted. Patients of either sex, aged 18-65yr, ASA grade I/II, scheduled for elective surgeries under GA were included. 'Group DL' underwent direct laryngoscopy (DL) using Macintosh laryngoscope and Group VL with Airtraq® videolaryngoscope. Time taken for intubation, Cormack-Lehane (CL) grade of laryngeal view, number of intubation attempts, and haemodynamic parameters were noted. Student t-test and chi square test were used for statistical analysis.A total of 140 patients with 70 in each group were included. The mean time taken for intubation was significantly higher in VL group (84.70 ± 28.05s) than DL group (23.90 ± 6.67s). The optimal laryngeal view (i.e. CL grade I or II) was significantly improved in VL group than DL group i.e. 97% vs 94%. In group DL, 99% (n=69) were intubated in first attempt; whereas 60% (n=42) in Group VL (p&amp;#60;0.001). Hemodynamics was better in group VL.Airtraq® VL is better than conventional Macintosh laryngoscope for endotracheal intubation during RSI in terms of optimal glottic view, ease of intubation and haemodynamics. On the contrary, the “time taken to intubation” and the first attempt intubation rate were higher with Airtraq® VL.

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.

Non-channeled Video Laryngoscopy as an Alternative to Conventional Laryngoscopy for Intubating Adult Patients in the Intensive Care Unit.

Background Endotracheal intubation in the intensive care unit (ICU) is often a risky procedure due to the emergency situation, unstable condition of the patient, and technical problems such as inadequate positioning. Several new techniques, such as video laryngoscopy, have been developed recently to improve the success rate of first-pass intubations and reduce complications. We conducted this study to compare a non-channeled reusable video laryngoscope BPL VL-02 (manufactured by BPL Medical Technologies, Bangalore, India) with a conventional laryngoscope for intubation of adult patients in the ICU. Methodology A total of 72 ICU patients were randomly allocated to be intubated with either conventional direct laryngoscopy via Macintosh blade (group A) or video laryngoscopy with BPL VL-02 (group B). All patients were intubated by the primary investigator and the assistant noted the following parameters: the total number of intubation attempts, total duration of intubation, assistance or alternative technique required, Cormack Lehane grading, and any complications. Results There was no significant difference in the Cormack Lehane grading, number of attempts, or complications between the two groups. On comparing the assistance required during intubation in patients, it was observed that four (11.11%) patients in group A and seven (19.44%) patients in group B needed backward, upward, and rightward pressure on the larynx assistance during intubation. In five (13.89%) patients in group B, Stylet was required during intubation. The difference was statisticallysignificant (p = 0.0308). The video laryngoscopy group (group B) had a longer mean duration of intubation (64.36 ± 6.28 seconds) compared to group A (45.72 ± 11.45 seconds), and the difference was statistically significant (p < 0.0001). Conclusions Non-channeled video laryngoscope (BPL VL-02) is not a suitable alternative to conventional direct laryngoscopy with a Macintosh blade in terms of successful first-pass intubation, total duration of intubation, and assistance required.

Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults

BackgroundWhether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain.MethodsIn a multicenter, randomized trial conducted at 17 emergency departments and intensive care units (ICUs), we randomly assigned critically ill adults undergoing tracheal intubation to the video-laryngoscope group or the direct-laryngoscope group. The primary outcome was successful intubation on the first attempt. The secondary outcome was the occurrence of severe complications during intubation; severe complications were defined as severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death.ResultsThe trial was stopped for efficacy at the time of the single preplanned interim analysis. Among 1417 patients who were included in the final analysis (91.5% of whom underwent intubation that was performed by an emergency medicine resident or a critical care fellow), successful intubation on the first attempt occurred in 600 of the 705 patients (85.1%) in the video-laryngoscope group and in 504 of the 712 patients (70.8%) in the direct-laryngoscope group (absolute risk difference, 14.3 percentage points; 95% confidence interval [CI], 9.9 to 18.7; P<0.001). A total of 151 patients (21.4%) in the video-laryngoscope group and 149 patients (20.9%) in the direct-laryngoscope group had a severe complication during intubation (absolute risk difference, 0.5 percentage points; 95% CI, −3.9 to 4.9). Safety outcomes, including esophageal intubation, injury to the teeth, and aspiration, were similar in the two groups.ConclusionsAmong critically ill adults undergoing tracheal intubation in an emergency department or ICU, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt than the use of a direct laryngoscope. (Funded by the U.S. Department of Defense; DEVICE ClinicalTrials.gov number, NCT05239195.)

A Comparative Study of Video Laryngoscopy to Direct Laryngoscopy for Endotracheal Intubation in Pediatric Patients.

Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways. We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requiring airway management. The glottic view and the first pass success rate were compared and analyzed. An observational cross-sectional study was conducted with 120 children between 2 - 8 years with normal airways. They were divided into video laryngoscopy (Group V) and direct laryngoscopy (Group D). The primary outcome measures included time taken for intubation, number of attempts required, Cormack-Lehane glottic view, use of optimization maneuvers, the requirement of tube repositioning, and hemodynamic parameters before and after intubation. The time taken for intubation was longer in the video laryngoscopy group (group D, 24.28 sec vs. group V, 27.65 seconds (P = 0.01). The Cormack-Lehane glottic view was grade 1 in all the patients in the video laryngoscopy group, while only 35 children showed grade 1 in the direct laryngoscopy group. (P < 0.001). We observed a significant increase in both heart rate and mean arterial pressure in the video laryngoscopy group at 1, 3, 5, and 10 min after intubation (P < 0.001, P < 0.05). The time taken for intubation was more in group V, but the glottic view was much better, and the requirement for external maneuvers was also less. Pressure response to intubation was more in group V compared to group D.

Laryngoscopy and Tracheal Intubation: Does Use of a Video Laryngoscope Facilitate Both Steps of the Procedure?

To compare the effect of the use of a video laryngoscope versus a direct laryngoscope on each step of emergency intubation: laryngoscopy (step 1) and intubation of the trachea (step 2). In a secondary observational analysis of data from 2 multicenter, randomized trials that enrolled critically ill adults undergoing tracheal intubation but did not control for laryngoscope type (video laryngoscope vs direct laryngoscope), we fit mixed-effects logistic regression models examining the 1) the association between laryngoscope type (video laryngoscope vs direct laryngoscope) and the Cormack-Lehane grade of view and 2) the interaction between grade of view, laryngoscope type (video laryngoscope vs direct laryngoscope), and the incidence of successful intubation on the first attempt. We analyzed 1,786 patients: 467 (26.2%) in the direct laryngoscope group and 1,319 (73.9%) in the video laryngoscope group. The use of a video laryngoscope was associated with an improved grade of view as compared with a direct laryngoscope (adjusted odds ratio for increasingly favorable grade of view 3.14, 95% confidence interval [CI] 2.47 to 3.99). Successful intubation on the first attempt occurred in 83.2% of patients in the video laryngoscope group and 72.2% of patients in the direct laryngoscope group (absolute difference 11.1%, 95% CI 6.5% to 15.6%). Video laryngoscope use modified the association between grade of view and successful intubation on the first attempt such that intubation on the first attempt was similar between video laryngoscope and direct laryngoscope at a grade 1 view and higher for video laryngoscope than direct laryngoscope at grade 2 to 4 views (P<.001 for interaction term). Among critically ill adults undergoing tracheal intubation, the use of a video laryngoscope was associated both with a better view of the vocal cords and with a higher probability of successfully intubating the trachea when the view of the vocal cords was incomplete in this observational analysis. However, a multicenter, randomized trial directly comparing the effect of a video laryngoscope with a direct laryngoscope on the grade of view, success, and complications is needed.

POSTOPERATIVE SORE THROAT AFTER LARYNGOSCOPY WITH MACINTOSH VERSUS VIDEOLARYNGOSCOPE BLADE

Introduction: Direct laryngoscopy guided by a Macintosh curved blade, is the standard traditional method of endotracheal intubation in patients under general anaesthesia. Post Operative Sore Throat [POST] is a common problem faced. With the advent of newer technology, various videolaryngoscopes have come into usage. To know the incidence of sore throat after Aim: intubation with the Macintosh versus videolaryngoscope. To compare the incidence of hoarseness, hemodynamic response and time taken for intubation by two methods. A prospective, randomized study was conducted on 110 patient Method: s with normal airway undergoing general anaesthesia for elective surgeries. Patients were enrolled into two groups randomly by Systemic Randomization Technique. All patients underwent thorough pre-anaesthestic evaluation with general and systemic examination. In the operation theatre, baseline vital parameters were recorded. The standard anaesthetic regimen and surgical procedures was followed. Postoperative sore throat was assessed with 10 point score at 0,6,12,24 hours post extubation. The mean incidence of sore throat at 0,6,12 and 24 hours Result: post extubation was 6.67, 5.44, 4.91 and 3.93 in the Macintosh group whereas 4.18, 3.09, 1.22 and 1.25 in the videolaryngoscope group. The mean time taken for intubation was 19.5 sec in Macintosh group and 36.6 sec in videolaryngoscope group. All patients were haemodynamically stable throughout the procedure. Conclusion: The incidence of postoperative sore throat was more with Macintosh blade whereas the time taken for intubation and the hemodynamic stability was more with the videolaryngoscope blade

Airway management during the COVID-19 pandemic: macintosh laryngoscopy vs. video laryngoscopy.

Our study aimed to compare video laryngoscopy (VL) vs. direct laryngoscopy (DL) for tracheal intubation in adult patients receiving general anesthesia for elective surgery during the COVID-19 pandemic. The study included 150 patients 18-65 years old, ASA I-II (American Society of Anesthesiologists), and negative PCR tests before the operation was scheduled for elective surgery under general anesthesia. Patients were subdivided into two groups considering the intubation method: the video laryngoscopy group (Group VL, n=75) and the Macintosh laryngoscopy group (Group ML, n: 75). Demographic data, operation type, intubation comfort, and field of view, intubation times, complications were recorded. Both groups' demographic data, complications, and hemodynamic parameters were similar. In Group VL, Cormack-Lehane Scoring values were higher (p<0.001), the field of view was better (p<0.001), and the intubation was more comfortable (p<0.002). The duration for the vocal cord appearance was significantly shorter in the VL group than in the ML group (7.55±1.00 vs. 8.31±2.20 sec, p=0.008, respectively). The beginning of intubation to full ventilation of the lungs was significantly shorter in the VL group than the ML group (12.71±2.72 vs. 17.48±6.8, p<0.001, respectively). Using VL in endotracheal intubation may be more reliable in reducing intervention times and the risk of suspected transmission during the COVID-19 pandemic.

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

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

Airway management during ongoing chest compressions-direct vs. video laryngoscopy. A randomised manikin study.

Tracheal intubation is used for advanced airway management during cardiac arrest, particularly when basic airway techniques cannot ensure adequate ventilation. However, minimizing interruptions of chest compressions is of high priority. Video laryngoscopy has been shown to improve the first-pass success rate for tracheal intubation in emergency airway management. We aimed to compare first-pass success rate and time to successful intubation during uninterrupted chest compression using video laryngoscopy and direct laryngoscopy. A total of 28 anaesthetists and 28 anaesthesia nurses with varied clinical and anaesthesiological experience were recruited for the study. All participants performed a tracheal intubation on a manikin simulator during ongoing chest compressions by a mechanical resuscitation device. Stratified randomisation (physicians/nurses) was performed, with one group using direct laryngoscopy and the other using video laryngoscopy. First-pass success rate was 100% (95% CI: 87.9% - 100.0%) in the video laryngoscopy group and 67.8% (95% CI: 49.3% - 82.1%) in the direct laryngoscopy group [difference: 32.2% (95% CI: 17.8% - 50.8%), p<0.001]. The median time for intubation was 27.5 seconds (IQR: 21.8-31.0 seconds) in the video laryngoscopy group and 30.0 seconds (IQR: 26.5-36.5 seconds) in the direct laryngoscopy group (p = 0.019). This manikin study on tracheal intubation during ongoing chest compressions demonstrates that video laryngoscopy had a higher first-pass success rate and shorter time to successful intubation compared to direct laryngoscopy. Experience in airway management and professional group were not significant predictors. A clinical randomized controlled trial appears worthwhile.

A comparative study of Video laryngoscope vs Macintosh laryngoscope for prehospital tracheal intubation in Hiroshima, Japan

BackgroundIn Japan, there are no studies comparing endotracheal intubation performed by emergency medical technicians (EMTs) during out-of-hospital cardiac arrest (OHCA) using a Macintosh laryngoscope and a video laryngoscope. ObjectiveThe purpose of this study was to compare the success rate, complication rate, return of spontaneous circulation (ROSC), neurological prognosis (CPC1-2) and regional differences between Video laryngoscope (VL) and Macintosh laryngoscope (ML) for OHCA patients. MethodThis study is a retrospective cohort study using 10,067 OHCA data extracted from the national Utstein Form and emergency medical transport data. The primary endpoint was the success rate of tracheal intubation and the complication rate and the secondary endpoints were the incidence of ROSC and CPC1-2. ResultsA total of 885 tracheal Intubated OHCA patients were enrolled in this study. The success rate was 94.1% (490/521) in the VL group and 89.3% (325/364) in the ML group (RR, 1.05; 95%CI, 1.01–1.10, P = 0.01), the VL group shows significantly higher success rate than that of the ML group. In the complication rates, oesophageal intubation occurred in 0.2% (1/521) of in the VL group and in 6.0% (22/364) in the ML group, Indicating significantly higher complication rates in the ML group compared with the VL group (RR, 1.06; 95% CI, 1.03–1.09, P < 0.001). The ROSC rate and CPC1-2 rate are similar among the groups. ConclusionOur data suggest that using VL had a little advantage with a higher success rate and lower complication rate. Further discussion is necessary for the future development of Emergency Medical Services (EMS) intubation devices.