Videolaryngoscopes for Intubation of Difficult Airways
Videolaryngoscopes for Intubation of Difficult Airways
Background Difficult and failed intubations, although rarely encountered, are major causes of morbidity and mortality in the current anaesthetic practice. To reduce the incidence of difficult and failed intubations, several devices including the recently developed videolaryngoscopes are available. This randomized controlled study aims to compare the use of the McGrath videolaryngoscope with the C-MAC videolaryngoscope in adult patients with potential difficult airways.
Methods A total of 130 patients with the Mallampati grade of ≥3, requiring orotracheal intubation, were randomized to either having intubation with the McGrath videolaryngoscope or the C-MAC videolaryngoscope. The primary outcome was time to intubation. The laryngoscopic view, the number of intubation attempts, the proportion of intubation success, the ease of intubation, the haemodynamic responses to intubation, and the incidence of any complications were also recorded.
Results Time to successful intubation with the C-MAC videolaryngoscope was shorter when compared with the McGrath videolaryngoscope {50 s [inter-quartile range (IQR) 38–70] vs 67 s (IQR 49–108), P<0.001}, despite the McGrath videolaryngoscope providing significantly more grade 1 laryngoscopic views. The C-MAC videolaryngoscope also resulted in significantly fewer intubation attempts and greater ease of intubation when compared with the McGrath videolaryngoscope. There were no statistically significant differences in the proportion of intubation success, the number of complications, and the changes in haemodynamic responses between the two videolaryngoscopes.
Conclusions The C-MAC videolaryngoscope allowed a quicker intubation time, fewer intubation attempts, and greater ease of intubation compared with the McGrath videolaryngoscope when used in patients with the Mallampati grade of ≥3.
Airway management is an essential skill for anaesthetists. Although major airway complications during anaesthesia are rare, the adverse consequences can be serious. In the Fourth National Audit Project of the Royal College of Anaesthetists, there were 133 reports of major airway complications related to general anaesthesia, which led to 16 deaths and three patients with persistent brain damage. In order to minimize significant perioperative morbidity and mortality, it is important for anaesthetists to be well versed in different airway management techniques.
In recent years, videolaryngoscopes have gained in popularity. Videolaryngoscopes are relatively new devices available for intubation, which provide a view of the glottis from a video-camera or video-chip positioned close to the tip of the laryngoscope blade. Of the various videolaryngoscopes available, each is unique in design. They can be categorized into three main types: one with the standard Macintosh-shaped blade, one with the angulated blade, and one with a channel for tube passage. Each design has its own advantages and disadvantages. Recent systematic review and meta-analysis have shown that videolaryngoscopes can offer better views of the glottis when compared with standard direct laryngoscopy and are alternative options for the management of difficult airways. However, there have been limited studies comparing different types of videolaryngoscopes. The majority of the studies available were manikin studies. There is currently a paucity of clinical research comparing different types of videolaryngoscopes, particularly when used in patients with potential difficult airways.
The objective of this study is to compare the McGrath Series 5 videolaryngoscope with the C-MAC videolaryngoscope in intubating adult patients with potentially difficult airways. The McGrath Series 5 videolaryngoscope is a portable, lightweight unit with a disposable angulated acrylic blade. It requires a pre-curved styletted tracheal tube and insertion along the midline of the oral cavity. The C-MAC videolaryngoscope on the other hand has the same shaped blade as a standard Macintosh blade. It is inserted in the oral cavity using the standard direct laryngoscopic technique. We hypothesize that the C-MAC videolaryngoscope would allow a faster tracheal intubation time compared with the McGrath videolaryngoscope in adult patients with the Mallampati grade of ≥3.
Abstract and Introduction
Abstract
Background Difficult and failed intubations, although rarely encountered, are major causes of morbidity and mortality in the current anaesthetic practice. To reduce the incidence of difficult and failed intubations, several devices including the recently developed videolaryngoscopes are available. This randomized controlled study aims to compare the use of the McGrath videolaryngoscope with the C-MAC videolaryngoscope in adult patients with potential difficult airways.
Methods A total of 130 patients with the Mallampati grade of ≥3, requiring orotracheal intubation, were randomized to either having intubation with the McGrath videolaryngoscope or the C-MAC videolaryngoscope. The primary outcome was time to intubation. The laryngoscopic view, the number of intubation attempts, the proportion of intubation success, the ease of intubation, the haemodynamic responses to intubation, and the incidence of any complications were also recorded.
Results Time to successful intubation with the C-MAC videolaryngoscope was shorter when compared with the McGrath videolaryngoscope {50 s [inter-quartile range (IQR) 38–70] vs 67 s (IQR 49–108), P<0.001}, despite the McGrath videolaryngoscope providing significantly more grade 1 laryngoscopic views. The C-MAC videolaryngoscope also resulted in significantly fewer intubation attempts and greater ease of intubation when compared with the McGrath videolaryngoscope. There were no statistically significant differences in the proportion of intubation success, the number of complications, and the changes in haemodynamic responses between the two videolaryngoscopes.
Conclusions The C-MAC videolaryngoscope allowed a quicker intubation time, fewer intubation attempts, and greater ease of intubation compared with the McGrath videolaryngoscope when used in patients with the Mallampati grade of ≥3.
Introduction
Airway management is an essential skill for anaesthetists. Although major airway complications during anaesthesia are rare, the adverse consequences can be serious. In the Fourth National Audit Project of the Royal College of Anaesthetists, there were 133 reports of major airway complications related to general anaesthesia, which led to 16 deaths and three patients with persistent brain damage. In order to minimize significant perioperative morbidity and mortality, it is important for anaesthetists to be well versed in different airway management techniques.
In recent years, videolaryngoscopes have gained in popularity. Videolaryngoscopes are relatively new devices available for intubation, which provide a view of the glottis from a video-camera or video-chip positioned close to the tip of the laryngoscope blade. Of the various videolaryngoscopes available, each is unique in design. They can be categorized into three main types: one with the standard Macintosh-shaped blade, one with the angulated blade, and one with a channel for tube passage. Each design has its own advantages and disadvantages. Recent systematic review and meta-analysis have shown that videolaryngoscopes can offer better views of the glottis when compared with standard direct laryngoscopy and are alternative options for the management of difficult airways. However, there have been limited studies comparing different types of videolaryngoscopes. The majority of the studies available were manikin studies. There is currently a paucity of clinical research comparing different types of videolaryngoscopes, particularly when used in patients with potential difficult airways.
The objective of this study is to compare the McGrath Series 5 videolaryngoscope with the C-MAC videolaryngoscope in intubating adult patients with potentially difficult airways. The McGrath Series 5 videolaryngoscope is a portable, lightweight unit with a disposable angulated acrylic blade. It requires a pre-curved styletted tracheal tube and insertion along the midline of the oral cavity. The C-MAC videolaryngoscope on the other hand has the same shaped blade as a standard Macintosh blade. It is inserted in the oral cavity using the standard direct laryngoscopic technique. We hypothesize that the C-MAC videolaryngoscope would allow a faster tracheal intubation time compared with the McGrath videolaryngoscope in adult patients with the Mallampati grade of ≥3.
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