Video Laryngoscope Group Research Articles

The impact of introducing a videolaryngoscope in the initial training of laryngoscopy for undergraduate medical students: a simulation randomized trial

IntroductionAdequate and continuous airway management by health professionals is fundamental to ensure patient safety and protection. Among several techniques, laryngoscopy for orotracheal intubation is considered a basic skill, so it is taught and learned in medical school and used during the future years of professional practice. However, in some clinical scenarios, physical and anatomical characteristics can make laryngoscopy exceedingly difficult. In the last decade, some new devices have emerged to apply indirect or video-assisted imaging systems, so-called videolaryngoscopes. They have shown great efficiency in difficult intubation cases and have improved teaching and training. Our study introduced a videolaryngoscope, the McGrath... MAC, in the regular laryngoscopy training rotation for 3rd-year undergraduate medical students and evaluated whether there was any associated optimization of the students... performance. MethodStudents from two different classes and years (2017 and 2018) were randomly divided into two groups and received theoretical and practical training in the techniques of Direct Laryngoscopy (DL) and Videolaryngoscopy (VL). The students in each group applied the manoeuvres and simulated three tracheal intubation attempts on mannequins. They were evaluated for their success rate on the first attempt, the time required to finalize the intubation, and the visualization of the glottic structures according to the classification of Cormack-Lehane (C&L). ResultsTwo hundred and four students with an average age of 21.ß...ß2 years participated in the study; the groups were similar. There was a significant difference between the VL and DL groups in the 1st attempt success rate (97% and 89.4%, respectively, p.ß=.ß0.0497 ... 95% CI), but such a difference was not seen for the other attempts or regarding the number of oesophageal intubations (3% and 7.7%). The students in the VL group were faster than those in the DL group in all intubation attempts; in parallel, the vast majority of the VL group reported excellent visualization conditions, with 75% of the attempts classified as Cormack-Lehane grade 1. ConclusionThe introduction of a videolaryngoscope in medical students... training improved the visualization of anatomical structures and allowed tracheal intubation maneuvers to be performed faster and with a higher success rate on the first attempt. Thus, under the conditions of this prospective study, the videolaryngoscope had a positive impact on training and proved to be a promising tool for teaching laryngoscopy.

Comparison of Video Laryngoscope and Macintosh Laryngoscope for Face-to-Face Intubation in Sitting Manikin Model With Limitation of Neck Motion by Unexperienced Personnel

Background: Trauma patients who entrapped in the accident vehicle are predispose to have cervical spine injuries and they needed to be intubated with face-to-face intubation technique using Macintosh laryngoscope. Nowadays, video laryngoscope has been introduced to improve the intubation technique.
 Objective: To compare the effectiveness of video laryngoscope and Macintosh laryngoscope for face-to-face intubation in sitting manikin model with limitation of neck motion.
 Methods: The study was performed in a randomized experimental study. Subjects were divided into 2 groups both did face-to-face intubation using video laryngoscope and Macintosh laryngoscope in a sitting manikin model with limitation of neck motion. The success rate of intubation, time to finish intubation, and vocal cord visualization were analyzed.
 Results: Of 41 subjects including 2nd and 3rd year paramedic students, 21 subjects went to video laryngoscope group, and 20 subjects went to Macintosh laryngoscopes group. The Macintosh laryngoscope intubation technique showed significantly better success rate compared to video laryngoscope (100% and 25%, P < .001). In addition, intubation time of Macintosh laryngoscope was significantly less than video laryngoscope (mean [SD], 27 [24.7] and 75 [66.3] seconds, P < .001). However, vocal cord visualization from both laryngoscope techniques showed no statistically significant (P = .08).
 Conclusions: Intubation training of Macintosh laryngoscope for in sitting model with neck motion limitation showed better success rate and less time than video laryngoscope, with the same vocal cord visualization.

Fiberoptic bronchoscopy versus video laryngoscopy guided intubation in patients with craniovertebral junction instability: A cinefluroscopic comparison.

Background: Manipulation during endotracheal intubation in patients with craniovertebral junction (CVJ) anomalies may cause neurological deterioration due to underlying instability. Fiberoptic-bronchoscopy (FOB) is better than video laryngoscope (VL) for minimizing cervical spine movement during intubation. However, evidence suggesting superiority of FOB in patients with CVJ instability is lacking. We prospectively compared dynamic movements of the upper cervical spine during intubation using FOB with VL in patients with CVJ anomalies.Methods: A prospective, randomized, and clinical trial was conducted in 62 patients of American Society of Anaesthesiologist Grade I-II aged between 12 and 65 years with CVJ anomalies. Patients were randomized for intubation under general anesthesia with either VL or FOB. The intubation process was done with application of skeletal traction and recorded cinefluroscopically. The dynamic interrelationship of bony landmarks (horizontal, vertical, and diagonal distances between fixed points on posterior C1 and C2) was analyzed to indirectly calculate alteration of the upper cervical spinal canal diameter (at CVJ). Atlanto-dental interval (ADI) was calculated wherever possible.Results: The alteration in canal diameter (using bony landmarks) at CVJ during intubation was not significant with the use of either VL or FOB (P > 0.05). In 41 patients, where ADI could be measured, ADI was reduced (increased spinal canal diameter) in a greater number of patients in VL group when compared to FOB group (P < 0.05).Conclusion: Using rigid skull traction, intubation under general anesthesia with VL offers similar advantage as FOB in terms of the spinal kinematics in patients with CVJ anomalies/instability. Nevertheless, greater number of patients intubated with VL may have an advantage of increased cervical spinal canal diameter when compared to FOB.

Video Laryngoscopy Improves Intubation Times With Level C Personal Protective Equipment in Novice Physicians: A Randomized Cross-Over Manikin Study.

The use of video laryngoscopes by novice physicians may improve first-pass success rates compared with direct laryngoscopy. The aim of the present study was to assess whether time to intubation, number of laryngoscopy attempts, and first-pass success rate during laryngoscopy with the video laryngoscope or conventional Macintosh laryngoscope are affected by personal protective equipment (PPE) donning. Seventy inexperienced physicians were randomly assigned to video laryngoscope or Macintosh groups and were instructed to perform intubation with both devices on a manikin, using PPE or a standard uniform. The primary outcomes were insertion time, number of laryngoscopy attempts, and first-pass success rates for each device with or without donning PPE. In the Macintosh group, significantly less time was needed for the first successful intubation without PPE vs. with PPE (12.17±3.69s vs. 24.07±5.09s, respectively; p<0.0001). On the other hand, such difference was not observed in the video laryngoscope group (14.99±3.01s vs. 14.01±3.35s, respectively; p=0.07). With PPE, the first-pass success rate was significantly higher in the video laryngoscope group [41 (58.6%) vs. 66 (94.3%), p<0.001]. The use of the video laryngoscope resulted in a significant decrease in insertion time compared with the Macintosh blade (14.01±3.35s vs. 24.07±5.09s, respectively; p<0.0001). First-pass success and insertion time with the video laryngoscope were not affected by PPE donning. However, both were negatively affected with the Macintosh laryngoscope.

The Efficacy of Using Video Laryngoscopy on Tracheal Intubation by Novice Physicians.

Introduction:The first successful attempt at tracheal intubation with minimal complications is crucial for emergency physicians. The aim of this study was to compare endotracheal intubation using video laryngoscopy versus direct laryngoscopy in the emergency department by emergency medicine residents.Materials and Methods:In this randomized clinical trial, 70 patients requiring laryngeal intubation were randomly enrolled in direct and video laryngoscopy groups. The first attempt success rate, frequency of attempts, complications, and hemodynamic changes after laryngoscopy were assessed. The data were analyzed using the Chi-square, independent t-test, and Fisher's exact test.Results:The results showed a significant increase in heart rate, as well as systolic and diastolic blood pressure after both direct and video laryngoscopy (P<0.001). However, this increase was more severe in the video laryngoscopy group (P<0.001).Conclusion:Although the use of both devices had similar success rate, if orotracheal intubation is performed by a novice emergency medicine residents, direct laryngoscopy causes fewer hemodynamic effects on patients, compared to video laryngoscopy.

Post operative sore throat: Comparison between Macintosh versus Video Laryngoscope in patients intubated by trainee anaesthetists - A Randomised Control Trial.

Objectives:Postoperative sore throat (POST) is a common complication related to endotracheal intubation. The aim of this study was to compare the incidence of POST in patients intubated by trainee anaesthetist using Video Laryngoscope™ (VDL) or Conventional Macintosh Laryngoscope (CL).Methods:Total 110 patient scheduled for elective laparoscopic cholecystectomy were included from main operating room of Aga Khan University Hospital between June 2017-2018. The standardized perioperative protocol was used for general anaesthesia. Selected patients were randomly allocated into conventional laryngoscopy (CL) group or video laryngoscopy (VDL) group. The evaluation of sore throat was done at 1st, 12th and 24th hour postoperatively using a ten-point visual analogue scale.Results:The demographic characteristics, including intubation time, related complications or any other maneuver required were similar between the groups. The incidence of POST at 1st hour was 47% patients in CL group and 38% in VDL group (p=0.335). At 12th hour, 34.5% patients in CL and 38% in VDL reported POST (p=0.692). Similarly at 24th hour, 25% patients in CL and 16% in VDL group reported POST (p=0.669).Conclusions:There was no significant difference in incidence of POST for patients intubated by trainee anaesthetists using either CL or VDL. Objective evidence of training and laryngoscope technique can impact of POST.

First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial

Orotracheal intubation of infants using direct laryngoscopy can be challenging. We aimed to investigate whether video laryngoscopy with a standard blade done by anaesthesia clinicians improves the first-attempt success rate of orotracheal intubation and reduces the risk of complications when compared with direct laryngoscopy. We hypothesised that the first-attempt success rate would be higher with video laryngoscopy than with direct laryngoscopy. In this multicentre, parallel group, randomised controlled trial, we recruited infants without difficult airways abnormalities requiring orotracheal intubation in operating theatres at four quaternary children's hospitals in the USA and one in Australia. We randomly assigned patients (1:1) to video laryngoscopy or direct laryngoscopy using random permuted blocks of size 2, 4, and 6, and stratified by site and clinician role. Guardians were masked to group assignment. The primary outcome was the proportion of infants with a successful first attempt at orotracheal intubation. Analysis (modified intention-to-treat [mITT] and per-protocol) used a generalised estimating equation model to account for clustering of patients treated by the same clinician and institution, and adjusted for gestational age, American Society of Anesthesiologists physical status, weight, clinician role, and institution. The trial is registered at ClinicalTrials.gov, NCT03396432. Between June 4, 2018, and Aug 19, 2019, 564 infants were randomly assigned: 282 (50%) to video laryngoscopy and 282 (50%) to direct laryngoscopy. The mean age of infants was 5·5 months (SD 3·3). 274 infants in the video laryngoscopy group and 278 infants in the direct laryngoscopy group were included in the mITT analysis. In the video laryngoscopy group, 254 (93%) infants were successfully intubated on the first attempt compared with 244 (88%) in the direct laryngoscopy group (adjusted absolute risk difference 5·5% [95% CI 0·7 to 10·3]; p=0·024). Severe complications occurred in four (2%) infants in the video laryngoscopy group compared with 15 (5%) in the direct laryngoscopy group (-3·7% [-6·5 to -0·9]; p=0·0087). Fewer oesophageal intubations occurred in the video laryngoscopy group (n=1 [<1%]) compared with in the direct laryngoscopy group (n=7 [3%]; -2·3 [-4·3 to -0·3]; p=0·028). Among anaesthetised infants, using video laryngoscopy with a standard blade improves the first-attempt success rate and reduces complications. Anaesthesia Patient Safety Foundation, Society for Airway Management, and Karl Storz Endoscopy.

The effect of laryngoscope types on hemodynamic response and optic nerve sheath diameter. McCoy, Macintosh, and C-MAC video-laryngoscope.

Objectives:This study aims to investigate the effect of McCoy, Macintosh laryngoscope, and C-MAC video-laryngoscopes on optic nerve sheath diameter (ONSD) and hemodynamic responses to laryngoscopy and intubation.Methods:This prospective randomized study was conducted in Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey, between July 2019 and January 2020. Informed written consent was obtained from all patients. Patients with previous intracranial/ocular surgery or glaucoma were excluded from the study. The patients were randomized to use McCoy, Macintosh, and C-MAC (30 per group). Intubations were performed by the same person. Mean arterial pressure, heart rate (HR), and ONSD were recorded before the induction and repeated in 1, 3, 5, and 10 minutes after the intubation.Results:The effects of laryngoscopy and intubation on hemodynamic responses and ONSD were similar between groups (p>0.05). While the comparison within groups showed ONSD increase in McCoy group and HR and ONSD increase in the Macintosh group compared to baseline 1 min after the intubation, no change was observed in hemodynamic responses and ONSD measurements in the C-MAC® group (p>0.05).Conclusions:In this study, there was no significant difference between the groups in terms of ONSD and hemodynamic responses to laryngoscopy and intubation. It was observed that there were no significant changes in ONSD values just in C-MAC® video-laryngoscope group. Therefore, intubations with C-MAC® video-laryngoscope are thought to be more appropriate for patients with an increase in intracranial pressure.

Comparison of Videolaryngoscopy and Direct Laryngoscopy for Nasogastric Tube Placement

Background: Nasogastric tube (NGT) placement can be accomplished using a blind technique, but the failure rate is high, especially in anesthetized and tracheally intubated patients. Practically, mouth opening with a direct laryngoscopy is the alternative method attempted for guiding the NGT under direct visualization. However, limitations of this approach include the narrowing of the oral space and limited periglottic view, which should be resolved by using videolaryngoscope. Objective: To compare the success rate of a videolaryngoscope (C-MAC D-Blade; Karl Storz, Tuttlingen, Germany) with a direct laryngoscope for NGT insertion. Materials and Methods: Eighty-four adult patients were enrolled in the study and randomized into two groups, the videolaryngoscopy group and the direct laryngoscopy group. After induction of anesthesia and tracheal intubation, the participants in the videolaryngoscopy group and direct laryngoscopy group underwent laryngoscopy using a C-MAC D-Blade and Macintosh blade, respectively. The time from entrance of the NGT into the nostril until confirmation of the proper tip position was recorded and defined as successful insertion. The number of attempts was defined as the number of times the tube was withdrawn from the nostril and reinserted. Placement more than three times was defined as procedure failure. Bleeding was also observed. Results: The videolaryngoscopy group had a significantly higher success rate at the first attempt than the direct laryngoscopy group (78.57% versus 30.95%, respectively; p&lt;0.001). The mean time for NGT insertion in the videolaryngoscopy group was significantly shorter than in the direct laryngoscopy group (80 versus 170 seconds, respectively, p&lt;0.01). Direct laryngoscopy failed in five cases, however, all were successful by subsequent videolaryngoscopy. Videolaryngoscopy failed in two cases, but tube insertion was eventually successful by placement of a guide wire in the NGT. Bleeding occurred in 40.48% and 4.76% of patients in the direct laryngoscopy and videolaryngoscopy groups, respectively. The difference was statistically significant. Conclusion: Videolaryngoscopy is easier and faster for NGT placement and is associated with a lower incidence of bleeding complications and a higher success rate. Therefore, this method should be considered as an alternative option when encountering difficulty inserting the NGT using the conventional technique. Keywords: Videolaryngoscopy, Direct aryngoscopy, Nasogastric tube placement

Why USB-endoscope laryngoscopy is as effective as video laryngoscopy.

To compare the efficacy of a low-cost custom-made universal serial bus (USB) endoscope laryngoscope for intubation with a direct laryngoscope and a high-cost video laryngoscope in a mannequin study. We used one intubation simulator model (mannequin) in our study. A USB endoscope was mounted to the direct laryngoscope as a custom-made USB endoscope laryngoscope (USB-L). We used a video laryngoscope (Glidescope®, Verathon, USA) and a direct laryngoscope (Macintosh) for comparison. Intubation time and the correct placement of the tube were measured. Intubations were performed by two operators and results were compared. We found a statistically significant difference between the video and direct laryngoscope groups (p < 0.001), as well as between the USB-L and direct laryngoscope groups (p = 0.001) for Operator 1. For Operator 2, there was a statistically significant difference between the video laryngoscope group and the direct laryngoscope group (p = 0.022); however, we did not find a significant difference between the USB-L group and the direct laryngoscope group (p = 0.154). Furthermore, there were no significant differences between the USB-L and video laryngoscope groups for either operator (p=0.347 for Operator 1 and p>0.999 for Operator 2). Our study showed that USB endoscope laryngoscope provided similar intubation time to video laryngoscopy at a fraction of the cost; and both had superior times in comparison with direct laryngoscopy.

The Comparison of Direct Laryngoscopy and Video Laryngoscopy in Pediatric Airways Management for Congenital Heart Surgery: A Randomized Clinical Trial.

BackgroundAirway management in patients with hereditary heart disease is an important therapeutic intervention.ObjectivesThe purpose of this study was to compare direct laryngoscopy (DL) with video laryngoscopy (VL) in pediatric airways management for congenital heart surgery.MethodsThis study was designed as a prospective randomized clinical trial. Two consecutive groups of 30 patients undergoing elective noncyanotic congenital heart surgery. The patients were divided into direct laryngoscopy versus video laryngoscopy for intubation of the trachea. The main outcomes were the number of success rate in the first attempt, and the secondary outcomes were the duration of successful intubation and complications, such as desaturation and bradycardia.ResultsIntubation procedure time was measured as 51.13 ± 17.88 seconds for the group with direct laryngoscopy and 59.66 ± 45.91 seconds for group with VL that was significant (P = 0.006). In DL group, 22 patients were intubated on the first attempt, 8 patients on the second attempt, and 6 patients on the third attempt, compared to 24, 6, and 2 respectively, in VL group. The differences were significant only in the third attempt between groups (P = 0.033). The important difference established in heart rate (HR) and SpaO2 amounts between the two groups at any time (P < 0.05).ConclusionsVL can produce better visualization for intubation of trachea in congenital heart disease, but this is time-consuming. Indeed, training in the use of the VL should be increased to reduce the time required for performance. Moreover, further studies are recommended to approve these helpful findings.

Comparison of C-MAC D-blade videolaryngoscope and McCoy laryngoscope efficacy for nasotracheal intubation in simulated cervical spinal injury: a prospective randomized comparative study

BackgroundImmobilization with cervical spine worsens endotracheal intubation condition. Though various intubation devices have been demonstrated to perform well in oral endotracheal intubation, limited information is available concerning nasotracheal intubation (NTI) in patients with cervical spine immobilization. The present study compared the performance of the C-MAC D-Blade videolaryngoscope with the McCoy laryngoscope for NTI in patients with simulated cervical spine injuries.MethodsThis was a prospective, randomized, controlled, study done in a tertiary hospital. Ninety-five patients requiring NTI were included in data analysis: McCoy group (group M, n = 47) or C-MAC D-Blade videolaryngoscope group (group C, n = 48). A Philadelphia neck collar was applied before anesthetic induction to immobilize the cervical spine. Single experienced anesthesiologist performed NTI. The primary outcome was duration of intubation divided by three steps: nose to oropharynx; oropharynx into glottic inlet; and glottic inlet to trachea. Secondary outcomes included glottic view as percentage of glottis opening (POGO) score and Cormack-Lehance (CL) grade, modified nasal intubation-difficulty scale (NIDS) rating, hemodynamic changes before and after intubation, and complications.ResultsTotal intubation duration was significantly shorter in group C (39.5 ± 11.4 s) compared to group M (48.1 ± 13.9 s). Group C required significantly less time for glottic visualization and endotracheal tube placement in the trachea. More patients in group C had CL grade I and higher POGO scores (P < 0.001, for both measures). No difficulty in NTI (modified NIDS = 0) was more in group C than group M. Hemodynamic changes and incidence of complications were comparable between groups.ConclusionThe C-MAC D-Blade videolaryngoscope is an effective tool for NTI in a simulated difficult airway, which improves glottic visualization and shortens intubation time relative to those with McCoy laryngoscope.Trial registrationClinical Research Information Service of the Korea National Institute of Health, Identification number: KCT 0004535, Registered December 10, 2019, Retrospectively registered, http://cris.nih.go.kr.

Intubation in the Intensive Care Unit: C-MAC video laryngoscope versus Macintosh laryngoscope

PurposeVarious modifications of the Macintosh blade and direct laryngoscopy have been incorporated into practice to improve the intubation success rate and avoid complications while ensuring patient safety. This study evaluates the usefulness of two different direct laryngoscopy methods used by operators with various level of experience in the Intensive Care Unit. Material and methodsIn a single centre prospective study, C-MAC and Macintosh laryngoscopes were compared in terms of laryngoscopy and intubation outcomes such as glottic visualization, number of intubation attempts, intubation success and satisfaction score. ResultsDuring the one-year study period, 263 patients were evaluated and data of 218 patients were analyzed. The rate of successful first attempt intubation was higher in the video laryngoscope group (VL) (84% vs 57%; P<0.001). A significantly greater number of patients in the Macintosh laryngoscopy group had difficult visualization of the glottis in terms of the modified Cormack and Lehane classification and Percentage of Glottic Opening scale. ConclusionThe use of video laryngoscope for intubation in ICU settings results in better visualization of the glottis and a higher incidence of successful intubation attempts.

First attempt success of video versus direct laryngoscopy for endotracheal intubation by ambulance nurses: a prospective observational study

PurposeThe aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS) of 3 using video laryngoscopy versus direct laryngoscopy.MethodsA prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation.ResultsThe first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001).ConclusionAlthough no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.

Video Laryngoscopy Compared to Augmented Direct Laryngoscopy in Adult Emergency Department Tracheal Intubations: A National Emergency Airway Registry (NEAR) Study.

The objective was to compare first-attempt intubation success using direct laryngoscopy augmented by laryngeal manipulation, ramped patient positioning, and use of a bougie (A-DL) with unaided video laryngoscopy (VL) in adult emergency department (ED) intubations. This study was a secondary analysis of a multicenter prospective observational database of ED intubations from the National Emergency Airway Registry (NEAR). We compared all VL procedures to seven exploratory permutations of A-DL using multivariable regression models. We further stratified by blade shape into hyperangulated VL (HA-VL) and standard-geometry VL (SG-VL). We report differences in first-attempt intubation success and peri-intubation adverse events with cluster-adjusted odds ratios (ORs) with 95% confidence intervals (CIs). We report univariate comparisons in patient characteristics, difficult airway attributes, and intubation methods using descriptive statistics and OR with 95% CI. We analyzed 11,714 intubations performed from January 1, 2016, through December 31, 2017. Of these encounters, 6,938 underwent orotracheal intubation with either A-DL or unaided VL on first attempt. A-DL was used first in 3,936 (56.7%, 95% CI= 46.9 to 66.5) versus unaided VL in 3,002 (43.3%, 95% CI= 33.5 to 53.1). Of the A-DL first intubations 1,787 (45.4%) employed ramped positioning alone, 1,472 (37.4%) had external laryngeal manipulation (ELM), and 365 (9.3%) used a bougie. Rapid sequence intubation (RSI) was the most common method used in 5,602 (80.8%, 95% CI= 77.0 to 84.5) cases. First-attempt success was significantly higher with all VL (90.9%, 95% CI= 88.7 to 93.1) versus all A-DL (81.1%, 95% CI= 78.7 to 83.5) despite the VL group having more patients with reduced mouth opening, neck immobility, and an initial impression of airway difficult. Multivariable regression analyses controlling for indication, method, operator specialty and year of training, center clustering, and all registry-recorded difficult airway predictors revealed first-attempt success was higher with all unaided VL compared with any A-DL (adjusted OR [AOR]= 2.8, 95% CI= 2.4 to 3.3), DL with bougie (AOR= 2.7, 95% CI= 2.1 to 3.5), DL with ELM (AOR= 1.8, 95% CI= 1.5 to 2.2), DL with ramped positioning (AOR= 2.8, 95% CI= 2.3 to 3.3), or DL with ELM plus bougie (AOR= 2.8, 95% CI= 2.3 to 3.3). Subgroup analyses of HA-VL and SG-VL compared with any A-DL yielded similar results (AOR= 3.2, 95% CI= 2.6 to 3.0; and AOR= 2.4, 95% CI= 1.9 to 3.0, respectively). The propensity score-adjusted odds for first-attempt success with VL was also 2.8 (95% CI= 2.4 to 3.3). Fewer esophageal intubations were observed in the VL cohort (0.4% vs. 1.3%, AOR= 0.2, 95% CI= 0.1 to 0.5). Video laryngoscopy used without any augmenting maneuver, device, or technique results in higher first-attempt success than does DL that is augmented by use of a bougie, ELM, ramping, or combinations thereof.

A comparison of direct laryngoscopy versus videolaryngoscopy using aerosol box for intubation in emergency surgeries during Covid-19 pandemic: A pilot study

Background and Aims: This study was planned to compare intubating conditions with aerosol box, while attempting intubation with either direct laryngoscope (DL) using Macintosh blade or McGrath MAC™, videolaryngoscope (VL). Methodology: Sixty adult patients coming for the emergency surgeries during COVID-19 pandemic were divided equally by consecutive sampling into either Group 1 (DL) or Group 2 (VL). General anesthesia was administered with aerosol box covering the head and trunk of the patient. The laryngoscopy was attempted based on the group allocation with either VL or DL through aerosol box. Following observations were noted, total intubation time, number of attempts, Cormack–Lehane (CL) view, intubation difficulty scale (IDS), use of airway adjuncts, and external laryngeal maneuver. Results: Mean (standard deviation) time taken to intubate was 25.36 (6.22) sec in DL group and 21.9 (5.56) sec in VL group. Median IDS scoring was 1 in DL group and 0 in VL group indicating toward ease of intubation with the videolaryngoscope. Improved glottic view (CL Grade 1) was attained commonly with VL group and higher CL grades (2b) were common with DL group (23.3%). No intubation aids were required in VL group although 30% in DL required bougie for the intubation. External laryngeal maneuver was applied in 40% subjects undergoing DL with no maneuvers needed in VL group. First pass success of intubation was comparable in both the groups. Conclusion: Intubating conditions are favorable with VL when aerosol box is included which requires acquisition of the skills depending on its availability. However, the intubation should be attempted with the technique the clinician has the expertise during this pandemic.

A randomized controlled trial comparing McGRATH series 5 videolaryngoscope with the Macintosh laryngoscope for nasotracheal intubation.

Background and Aims:The aim of this study was to compare the efficacy of McGRATH series 5 videolaryngoscope (VL) with Macintosh laryngoscope for nasotracheal intubation (NTI) in patients without anticipated difficult airways undergoing head and neck cancer surgeries.Material and Methods:We randomized 60 adult patients for NTI by experienced anesthetists with either Macintosh laryngoscope or McGRATH series 5 VL (VL group). The primary objective was to compare time taken for intubation (TTI). The secondary objectives included success rates, number of attempts, need for optimization maneuvers, Cormack and Lehane (CL) grade, and percentage of difficult intubations.Results:The mean TTI in the VL group was 43 (±10.6) versus 75 (±38.0) s in the Macintosh group (99% CI: 12.5; –51.6 s; P < 0.001). The overall intubation success rate was 100% in both groups. All 29 (100%) patients in the VL group were intubated in the first attempt versus 26 (86%) patients in the Macintosh group (99% CI –5; 33%; P = 0.11). In the Macintosh group, 20 (66%) patients needed optimization maneuver versus none in the VL group (99% CI 40; 91%; P < 0.001). In the VL group, 28 (96%) patients had a CL grade 1 view versus 9 (31%) in Macintosh group (99% CI 38; 92%; P < 0.001). There were no difficult intubations in the VL group versus 3 (10%) in the Macintosh group (99% CI: 7; 28%; P = 0.237). There was no trauma to oropharyngeal structures in either group.Conclusion:The McGRATH series 5 VL has faster TTI, better glottic visualization, and less need for optimization maneuvers than the Macintosh laryngoscope for NTI in patients with unanticipated difficult airways, when performed by experienced anesthetists.

Comparing Video and Direct Laryngoscopy for Nasotracheal Intubation.

This parallel group randomized controlled clinical trial compared intubation duration and success using video laryngoscopy (VL) versus direct laryngoscopy (DL) during routine nasotracheal intubation. Fifty patients undergoing oral and maxillofacial surgery under general anesthesia were randomly assigned into 2 groups receiving either VL or DL to facilitate nasotracheal intubation. The primary outcome was the amount of time required to complete nasotracheal intubation. The secondary outcomes included the success of first attempt at intubation and the use of Magill forceps. Results demonstrated a mean time to intubation of 142 seconds in the DL group and 94 seconds in the VL group (p = .011). First attempt intubation success was 92.0% in the VL group and 84.0% in the DL group (p = .34). The use of Magill forceps was significantly increased in the DL group (p = .007). VL for routine nasotracheal intubation in oral and maxillofacial surgery procedures results in significantly faster intubation times and decreased use of Magill forceps compared with traditional DL.

Comparison of haemodynamic responses to orotracheal intubation in anaesthetised and paralysed patients with simulated cervical spine injury: Airtraq® video laryngoscope versus Fibreoptic bronchoscope

Background: Endotracheal intubation may produce haemodynamic fluctuations which may be deleterious in patients with cardiovascular and neurological disorders. This is further worsened in patients with difficult airway. This study was conducted to compare haemodynamic fluctuations produced when intubation was done using Airtraq and fibreoptic bronchoscopy which are used in patients with anticipated difficult airway. Methodology: Prospective randomized study. Eighty patients, ASA PS 1 and 2 undergoing elective surgery were randomized into two groups – Group A and Group F. After routine induction and muscle relaxation, orotracheal intubation was done using Airtraq in Group A and fibreoptic bronchoscope in Group F. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded at regular intervals. Duration and number of attempts for intubation were also noted Results: There was no significant difference in the average of variation in HR (p=0.384), SBP (p=0.179), DBP (p=0.746) and MAP (p=0.057) from the baseline between the two groups. Duration of intubation in FOB group (mean value of 56.98 s) was more than Airtraq® video laryngoscope group (mean value of 37.38 s) which was statistically significant. Conclusion: Use of fibreoptic bronchoscope offer no added advantage over Airtraq video laryngoscope in terms of haemodynamic response for intubation in difficult airway situation such as cervical spine injury.

Hemodynamic changes during orotracheal intubation using Airtraq video laryngoscope and direct laryngoscope: A randomized comparative study

Introduction: Direct laryngoscopy is associated with sympathetic stimulation and altered hemodynamics. A long intubation time may result in a greater in stress response. Alternative techniques using video laryngoscopes have been developed that do not require direct vocal cord visualization and may decrease the hemodynamic response. This study aimed to compare the difference between hemodynamic changes and intubation time with Airtraq video laryngoscope and conventionl Macintosh direct laryngoscope.&#x0D; Methods: A prospective randomized comparative study was conducted involving 100 adult patients who were undergoing elective surgeries under general anesthesia and endotracheal intubation. The patients were randomly assigned to group V (Video laryngoscope) or group D (Direct laryngoscope). In addition to the baseline vitals and vitals at various time intervals, intubation time was also recorded. We considered a difference in Heart Rate and Mean Arterial pressure of 20% to be clinically significant and statistical significance was p-value &lt;0.05.&#x0D; Results: Significant difference was found in heart rates immediately after laryngoscopy (110.40 vs. 105.02 beats/minute; p&lt;0.01) and 1 minute after intubation (109.30 vs. 106.20 beats/minute; p&lt;0.01) with attenuation seen in video laryngoscopy group. Blood pressures were similar in both the groups at all times. Time for intubation was prolonged in video laryngoscopy group than that for direct laryngoscopy group (26.54 vs. 22.80 seconds; p&lt;0.05). There were no adverse events associated with either of the techniques. &#x0D; Conclusions: The Airtraq video laryngoscopy resulted in lesser change in heart rate and longer intubation time. However, clinical impact of such a difference seemed to be insignificant.