Clinical application of a novel video camera laryngoscope: a case series venturing beyond the normal airway

Evolution of videolaryngoscopy in pediatric population

Direct laryngoscopy has remained the sole method for securing airway ever since the inception of endotracheal intubation. The recent introduction of video-laryngoscopes has brought a paradigm shift in the pratice of airway management. It is claimed that they improve the glottic view and first pass success rates in adult population. The airway management in children is more challenging than adults. The role of videolaryngoscopy for routine intubation in children is not clearly proven. This review attempts to discuss various videolaryngosocpes available for use in pediatric patients.

A Manikin Study Comparing McGrath Mac® and Airtraq® with Macintosh Laryngoscope in Tracheal Intubation by Intensive Care Unit Doctors

Objective

To compare the performance of the McGrath Mac® and the Airtraq® with the Macintosh laryngoscope for tracheal intubation.

Design

A manikin study with different simulated difficult airway scenarios.

Methods

Thirty intensive care unit (ICU) doctors (10 specialists and 20 non-specialists) performed intubation by using the 3 airway devices in the manikin with (i) normal airway, (ii) cervical rigidity, and (iii) tongue oedema. The intubation time, success rate, oesophageal intubation and number of episodes of dental injury were measured and compared.

Results

The mean intubation time was significantly less by using the Airtraq® comparing to the McGrath Mac® in the manikin with normal airway (12.77 sec vs. 24.23 sec; p<0.001). Similarly, the mean intubation time was less by using Airtraq® when comparing to the McGrath Mac® in the manikin with cervical rigidity (12.73 sec vs. 17.5 sec; p=0.013). In the scenario of simulated tongue oedema, the mean intubation time of Airtraq® was shorter than Macintosh laryngoscope (24.83 sec vs. 34.20 sec; p=0.011) while there was no difference between Airtraq® and the McGrath Mac®. Less dental injury was noted when using the Airtraq® compared to the Macintosh laryngoscope in simulated cervical rigidity (p=0.005) and tongue oedema (p<0.001). Less dental injury was also noted when using the McGrath Mac® compared to the Macintosh laryngoscope in simulated tongue oedema (p<0.001).

Conclusion

Even with prior limited experience in using the McGrath Mac®, the performance of tracheal intubation by using this new device is comparable with the Airtraq®. The McGrath Mac® can be a good alternative for tracheal intubation in difficult airway situations. (Hong Kong j.emerg.med. 2015;22:337-344)