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Maremanda KR, Jayaram K, Durga P. Comparison of Intubation Conditions Between Airtraq, McGrath Video Laryngoscopes, and Macintosh Under Conditions of Simulated Trauma Airway and Rapid Sequence Induction Intubation. J Emerg Med 2023; 64:271-281. [PMID: 36868945 DOI: 10.1016/j.jemermed.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/26/2022] [Accepted: 12/13/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND Patients arriving at the emergency department with a potential cervical spine injury and immobilized in a rigid cervical collar often require emergency airway management and rapid sequence induction intubation (RSII). There have been several advances in airway management with the advent of channeled (AirtraqⓇ; Prodol Meditec) and nonchanneled (McGrathⓇ; Meditronics) video laryngoscopes, which enable intubation without the removal of the cervical collar, but their efficacy and superiority over conventional laryngoscopy (Macintosh) in the presence of a rigid cervical collar and cricoid pressure have not been evaluated. OBJECTIVE Our aim was to compare the channeled (Airtraq [group A]) and nonchanneled (McGrath [Group M]) video laryngoscopes with a conventional laryngoscope (Macintosh [Group C]) in a simulated trauma airway. METHODS A prospective randomized controlled study was conducted in a tertiary care center. Participants were 300 patients requiring general anesthesia (American Society of Anesthesiologists class I or II), of both sexes, and aged 18-60 years. Airway management was simulated without removal of a rigid cervical collar and using cricoid pressure during intubation. After RSI, patients were intubated with one of the study techniques according to randomization. Intubation time and intubation difficulty scale (IDS) score were noted. RESULTS Mean intubation time was 42.2 s in group C, 35.7 s in group M, and 21.8 s in group A (p = 0.001). Intubation was easy in group M and group A (median IDS score of 0; interquartile range [IQR] 0-1 for group M and median IDS score of 1; IQR 0-2 for group A and group C; p < 0.001). A higher proportion (95.1%) of patients had an IDS score of < 1 in group A. CONCLUSIONS The performance of RSII with cricoid pressure in the presence of a cervical collar was easier and more rapid with channeled video laryngoscope than with other techniques.
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Affiliation(s)
- Krishna Rao Maremanda
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kavitha Jayaram
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Padmaja Durga
- Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Ho CH, Chen LC, Hsu WH, Lin TY, Lee M, Lu CW. A Comparison of McGrath Videolaryngoscope versus Macintosh Laryngoscope for Nasotracheal Intubation: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11092499. [PMID: 35566626 PMCID: PMC9101392 DOI: 10.3390/jcm11092499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background: In this study, it was shown that the routine use of McGrath videolaryngoscopy may improve intubation success rates. The benefits to using a videolaryngoscope in nasotracheal intubation were also demonstrated. However, no solid evidence concerning the effectiveness of the use of McGrath videolaryngoscopes in nasotracheal intubation has previously been reported. As a result, we questioned whether, in adult patients who underwent oral and maxillofacial surgeries with nasotracheal intubation (P), the use of a McGrath videolaryngoscope (I) compared with a Macintosh laryngoscope (C) could reduce the intubation time, improve glottis visualization to a score of classification 1 in the Cormack–Lehane classification system, and improve the first-attempt success rate (O). The secondary outcomes measured were the rate of the use of Magill forceps and the external laryngeal pressure (BURP) maneuver used. Methods: An extensive literature search was conducted using databases. Only randomized controlled trials that compared the McGrath videolaryngoscopy and Macintosh laryngoscopy techniques in nasotracheal intubation in adult patients were included. Results: Five articles met the inclusion criteria and were included in the final analysis (n = 331 patients). The results showed a significant decrease in intubation time and a higher rate of classification 1 scores in the Cormack–Lehane classification system, but no difference in the first-attempt success rates were found between the McGrath group and the Macintosh group. Decreases in the rate of the use of Magill forceps and the use of the external laryngeal pressure maneuver were also found in the pooled analysis. With regard to the overall risk of bias, the selected trials were classified to have at least a moderate risk of bias, because none of the trials could blind the operator to the type of laryngoscope used. Conclusions: Our analysis suggests that the use of a McGrath videolaryngoscope in nasotracheal intubation resulted in shorter intubation times, improved views of the glottis and similar first-success rates in adult patients who received general anesthesia for dental, oral, maxillofacial, or head and neck cancer surgery, and also reduced the use of Magill forceps and the BURP maneuver.
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Affiliation(s)
- Chia-Hao Ho
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Li-Chung Chen
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Wen-Hao Hsu
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Tzu-Yu Lin
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung University College of Medicine, Chiayi Chang Gung Memorial Hospital, Puzi City, Chiayi 613, Taiwan
- Correspondence: (M.L.); (C.-W.L.); Tel.: +886-2-89667000 (ext. 2383) (M.L. & C.-W.L.); Fax: +886-2-23680782 (M.L. & C.-W.L.)
| | - Cheng-Wei Lu
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
- Correspondence: (M.L.); (C.-W.L.); Tel.: +886-2-89667000 (ext. 2383) (M.L. & C.-W.L.); Fax: +886-2-23680782 (M.L. & C.-W.L.)
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Comparison of a New Video Intubation Stylet and McGrath® MAC Video Laryngoscope for Intubation in an Airway Manikin with Normal Airway and Cervical Spine Immobilization Scenarios by Novice Personnel: A Randomized Crossover Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4288367. [PMID: 34805400 PMCID: PMC8598342 DOI: 10.1155/2021/4288367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
The use of both a video laryngoscope and a video intubation stylet, compared with the use of a direct laryngoscope, is not only easier to learn but also associated with a higher success rate in performing endotracheal intubation for novice users. However, data comparing the two video devices used by novice personnel are rarely found in literature. Nondelayed intubation is an important condition to determine the prognosis in critically ill patients; hence, exploring intubation performance in various situations is of clinical significance. This study is aimed at comparing a video stylet and a video laryngoscope for intubation in an airway manikin with normal airway and cervical spine immobilization scenarios by novice personnel. We compared the performance of intubation by novices between the Aram Video Stylet and the McGrath® MAC video laryngoscope in an airway manikin. Thirty medical doctors with minimal experience of endotracheal intubation attempted intubation on a manikin five times with each device in each setting (normal airway and cervical spine immobilization scenarios). The order of use of the devices in each scenario was randomized for each participant. In the normal airway scenario, the Aram stylet showed a significantly higher rate of successful intubation than the McGrath® (98.7% vs. 92.0%; odds ratio (95% CI): 6.4 (1.4–29.3); p = 0.006). The intubation time was shorter using the Aram Stylet than that using the McGrath® video laryngoscope (p < 0.001). In the cervical immobilization scenario, successful endotracheal intubation was also more frequent using the Aram stylet than with the McGrath® (96.0% vs. 87.3%; odds ratio (95% CI): 3.5 (1.3–9.0); p = 0.007). The Aram Stylet intubation time was shorter (p < 0.001). In novice personnel, endotracheal intubation appears to be more successful and faster using the Aram Video Stylet than the McGrath® MAC video laryngoscope.
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Pujari VS, Thiyagarajan B, Annamalai A, Bevinaguddaiah Y, Manjunath AC, Parate LH. A Comparative Study in Airway Novices Using King Vision Videolaryngoscope and Conventional Macintosh Direct Laryngoscope for Endotracheal Intubation. Anesth Essays Res 2021; 15:57-61. [PMID: 34667349 PMCID: PMC8462408 DOI: 10.4103/aer.aer_72_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Objectives Tracheal intubation using laryngoscopy is a fundamental skill, for an anesthesiologist. However, teaching this skill is difficult since Macintosh direct laryngoscope (DL) allows only one individual to view the larynx during the procedure. Hence, this study aimed to determine whether King Vision® videolaryngoscope (KVL) provides any advantage over direct laryngoscopy in teaching this skill to airway novices. Materials and Methods In this prospective randomized crossover study, Ethical Committee clearance was obtained from the institutional review board (MSRMC/EC/2017) and the study was registered with Clinical Trial Registry. After informed consent, 53 medical students were allotted to perform laryngoscopy and endotracheal intubation on a manikin by using either KVL or Macintosh DL. The participants first performed laryngoscopy with either KVL or Macintosh DL following a brief instruction and then crossed over to the second arm of the study to perform laryngoscopy using the other scope. The primary outcome measure was the time for successful endotracheal intubation. The secondary outcome measures were incidence of esophageal intubation (EI), excess application of pressure on maxillary teeth excess maxillary pressure, and success rate. Results Mean time for endotracheal intubation was significantly faster using KVL than in DL (44.64 vs. 87.72 s; P < 0.001). No significant difference was found in the incidence of esophageal intubation 15.1% in KVL group versus 24.5% in DL group (P = 0.223). In the KVL group, 81.1% did not apply pressure on maxillary teeth versus 26.4% in the DL group (P < 0.001). The success rate of intubation was 100% in the KVL group versus 86.8% in the DL group (P = 0.006). Conclusion The KVL is a more effective tool to teach endotracheal intubation in comparison to Macintosh laryngoscope in airway novice medical students. Clinical trial registry India registration number: CTRI/2017/11/010491.
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Affiliation(s)
- Vinayak Seenappa Pujari
- Department of Anaesthesiology, MS Ramaiah Medical College, Ramaiah Teaching Hospital, Bengaluru, Karnataka, India
| | | | - Alagu Annamalai
- Department of Anaesthesiology, SRM Medical College and Hospital, Tiruchirappalli, Tamil Nadu, India
| | - Yatish Bevinaguddaiah
- Department of Anaesthesiology, MS Ramaiah Medical College, Ramaiah Teaching Hospital, Bengaluru, Karnataka, India
| | - A C Manjunath
- Department of Anaesthesiology, MS Ramaiah Medical College, Ramaiah Teaching Hospital, Bengaluru, Karnataka, India
| | - Leena Harshad Parate
- Department of Anaesthesiology, MS Ramaiah Medical College, Ramaiah Teaching Hospital, Bengaluru, Karnataka, India
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Sbeghen V, Verdonck O, McDevitt J, Zaphiratos V, Brulotte V, Loubert C, Tanoubi I, Drolet P, Belanger ME, Fortier LP, Godin N, Guertin MC, Fortier A, Richebé P. A randomized controlled trial comparing nociception level (NOL) index, blood pressure, and heart rate responses to direct laryngoscopy versus videolaryngoscopy for intubation: the NOLint project. Can J Anaesth 2021; 68:855-867. [PMID: 33709262 DOI: 10.1007/s12630-021-01936-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The effect of direct laryngoscopy using a Macintosh blade (MAC) vs GlideScope™ videolaryngoscopy using a Spectrum LoPro blade (GVL) on nociceptive stimulation has not been quantitatively studied. This study used the new nociception level (NOL) index to compare the nociceptive response induced by GVL or MAC during laryngoscopy with or without intubation. METHODS Patients underwent two laryngoscopies at four-minute intervals (L1, L2), one with GVL and the other with MAC (first randomization). A third laryngoscopy (L3) followed by tracheal intubation was performed four minutes after L2 (GVL or MAC, second randomization). Nociception was quantitatively assessed by NOL and standard hemodynamic parameters (heart rate [HR] and mean arterial pressure). For the crossover design, blade comparisons accounted for sequence and blade type. A possible carryover effect between laryngoscopies was assessed. RESULTS In the 50 patients randomized, there was no carryover effect from one laryngoscopy to the next for all analyzed parameters. Nociception level index peak values were higher with MAC than GVL. Analysis of ΔNOL showed a lower nociceptive response with GVL for L1+L2 combined. Mean peak NOL values were significantly higher after L3+intubation than after L1+L2, for both GVL and MAC groups. Analysis of ΔHR values did not show a significant difference between GVL and MAC for any laryngoscopy. CONCLUSION Laryngoscopy alone with GVL induces less nociception than with MAC. The NOL was more sensitive than HR at detecting nociceptive responses to MAC vs GVL. Additionally, and irrespective of which technique/blade was used, the combination of laryngoscopy + tracheal intubation produced a much greater nociceptive response than the laryngoscopy alone. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03277872); registered 29 August 2017.
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Affiliation(s)
- Virginie Sbeghen
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Olivier Verdonck
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Jason McDevitt
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Valérie Zaphiratos
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Véronique Brulotte
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Christian Loubert
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Issam Tanoubi
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Pierre Drolet
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Marie-Eve Belanger
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Louis-Philippe Fortier
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Nadia Godin
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Marie-Claude Guertin
- Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, QC, Canada
| | - Annik Fortier
- Department of Statistics, Montreal Health Innovations Coordinating Center (MHICC), Montréal, QC, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine of University of Montreal, and the Department of Anesthesiology and Pain Medicine of Maisonneuve Rosemont Hospital, CIUSSS de l'Est de l'Ile de Montréal, University of Montreal, 5415, Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
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Ynineb Y, Boglietto E, Bonnet F, Quesnel C, Garnier M. Face-To-Face Double-Lumen Tube Intubation With the Airtraq Video Laryngoscope for Emergency Thoracic Surgery: A Case Report. Semin Cardiothorac Vasc Anesth 2021; 26:90-94. [PMID: 33840292 DOI: 10.1177/10892532211007664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Double-lumen intubation is commonly used for thoracic surgery as it allows rapid and effective one-lung ventilation. However, it is more difficult than single-lumen tube intubation, notably in the context of emergency surgery and/or in hypoxemic patients. We report the case of a 57-year-old patient requiring emergency revision surgery after an upper right lobectomy due to postoperative pneumothorax and pleuropneumonia. As rapid lung isolation was required due to a bronchopleural fistula, rapid sequence induction and double-lumen tube intubation were performed. In addition, as the patient was hypoxemic with incomplete pre-oxygenation and too uncomfortable to tolerate the recumbent position despite high-flow oxygen, intubation was performed in face-to-face position. The patient was successfully intubated in 22 seconds and the right lung immediately isolated, allowing the surgeon to clean the pleural cavity. This is the first report of a double-lumen tube intubation in face-to-face position. The expected difficulties related to this type of intubation were successfully prevented using an Airtraq laryngoscope. Although such a strategy cannot be recommended from this one case, this report is encouraging for future studies evaluating the potential advantages of Airtraq use for double-lumen face-to-face intubation for emergency thoracic surgery.
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Affiliation(s)
- Yacine Ynineb
- Sorbonne University, Paris, France.,Tenon Hospital, Paris, France
| | - Emilie Boglietto
- Sorbonne University, Paris, France.,Tenon Hospital, Paris, France
| | - Francis Bonnet
- Sorbonne University, Paris, France.,Tenon Hospital, Paris, France
| | | | - Marc Garnier
- Sorbonne University, Paris, France.,Tenon Hospital, Paris, France
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Kaur G, Gupta S, Mehta N, Dhingra JS. Comparative Evaluation of McGrath MAC, Truview Video Laryngoscopes and Macintosh Laryngoscope for Endotracheal Intubation in Patients Undergoing Surgery under General Anaesthesia. Anesth Essays Res 2020; 14:20-24. [PMID: 32843786 PMCID: PMC7428103 DOI: 10.4103/aer.aer_16_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Videolaryngoscopy is a newly developed technique to improve tracheal intubation success. It was made to bypass the need of directly visualising the glottic inlet. These devices are advantageous as there is no need of aligning the laryngeal, pharyngeal and oral axes for a clear view, thus making intubation easier and faster. Aim and Objectives: Primary objective of the study was to determine the duration of laryngoscopy and intubation and Cormack - Lehane grading when intubating with McGrath MAC, Truview video laryngoscope and Macintosh laryngoscope. Secondary objectives of the study were to determine the number of attempts and optimization manouveres required to intubate. Materials and Methods: This study was conducted on total of 120 patients in age 20-70 years, either sex, with American Society of Anaesthesiologists physical status classes I or II scheduled for elective surgery under general anaesthesia. They were randomly assigned equally to group 1, 2 and 3 (n = 40) to be intubated by Mcgrath MAC video laryngoscope, Truview video laryngoscope and Macintosh laryngoscope respectively. Parameters recorded were duration of laryngoscopy and intubation, Cormack Lahane grading, ease of intubation, number of attempts and optimisation manouveres required for intubation. Statistical Analysis: Comparison of mean value among the three groups was done using student t test and percentage comparison was done using chi square test. To compare more than two variables ANOVA test was used. The P values of less than 0.05 was considered statistically significant. Results: Duration of laryngoscopy was significantly less in McGrath MAC group when compared to Truview group (P = 0.02) and to Macintosh group (P < 0.001) and the duration of intubation was comparable among all three study groups (P > 0.05). The difference in Cormack - Lehane grading was not significant between McGgrath MAC and Trueview (P = 0.71) but was significant between McGrath MAC and Macintosh (P = 0.002) and Trueview and Macintosh (P = 0.002). Ease of intubation was better in McGrath MAC and Truview groups compared to Macintosh group (P < 0.05). Intubation was successful in the first attempt in 39 (97.50%) patients in McGrath MAC group, 40 (100%) patients in Truview group and 35 (87.50%) patients in Macintosh group. McGrath MAC and Truview groups performed better with respect to optimization manoeuvres compared to Macintosh group (P < 0.05). Trauma was observed in 2 (5%) patients in Truview group and 5 (12.50%) patients in Macintosh group. In McGrath MAC group, no patient underwent any trauma. Conclusion: Although duration of laryngoscopy was significantly shorter in McGrath as compared to Truview video laryngoscope and Macintosh laryngoscope but the duration of intubation was comparable between the three groups. Both these video laryngoscopes performed significantly better than Macintosh laryngoscope with respect to laryngoscopic view, requirement of optimization manoeuvre and need for second attempt for intubation.
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Affiliation(s)
- Gurleen Kaur
- Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sunana Gupta
- Department of Anaesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India
| | - Nandita Mehta
- Department of Anaesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India
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Yong SA, Chaou CH, Yu SR, Kuan JT, Lin CC, Liu HP, Chiu TF. Video Assisted Laryngoscope Facilitates Intubation Skill Learning in the Emergency Department. J Acute Med 2020; 10:60-69. [PMID: 32995157 DOI: 10.6705/j.jacme.202003_10(2).0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Up-to-date technology has been increasingly useful for learning resuscitation skills in the emergency and resuscitation settings. It improves the learning curve of the learners and helps them to avoid making mistakes on real patients. This study aimed to evaluate the educational efficiency for tracheal intubation by comparing Macintosh (direct) laryngoscope (DL) and video laryngoscope (VL) learning in novices. Methods This prospective randomized controlled study was conducted in an emergency department between 2013 and 2014. Fifth- and sixth-year medical students were enrolled and assigned to normal airway and difficult airway groups, respectively. They were then further randomized into using a VL or DL for tracheal intubation learning. Participants had three practices before proceeding to the post-course assessment. Our primary outcome was post-course assessment performance, which included intubation success rate, total intubation time and best glottic view. The secondary outcome was the sum of total intubation learning times during the three practices. Results We recruited 177 undergraduate students. Of these, 97 were assigned to the normal airway group (49 VL and 48 DL) and 80 were placed in the difficult airway group (40 each for VL and DL). VL significantly quickened the intubation learning time in both the normal airway and difficult airway groups (140 s vs. 158 s, 141 s vs. 221.5 s; both p < 0.05). The learning curve was much improved with VL when compared using time-to-event analysis (p < 0.001). VL also improved the glottic view performance during post-course assessments. Conclusions VL improves the learning curve in acquiring intubation skills compared with traditional DL. It shortens the time undergraduate students take to develop such skills and increased their first attempt success rates.
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Affiliation(s)
- Su Ann Yong
- Chang Gung Memorial Hospital Department of Emergency Medicine Linkou, Taoyuan Taiwan
| | - Chung-Hsien Chaou
- Chang Gung Memorial Hospital Department of Emergency Medicine Linkou, Taoyuan Taiwan.,Chang Gung Memorial Hospital Chang Gung Medical Education Research Centre Taoyuan Taiwan.,Chang Gung University College of Medicine Taoyuan Taiwan
| | - Shiuan-Ruey Yu
- Chang Gung Memorial Hospital Chang Gung Medical Education Research Centre Taoyuan Taiwan
| | - Jen-Tse Kuan
- Chang Gung Memorial Hospital Department of Emergency Medicine Linkou, Taoyuan Taiwan
| | - Chih-Chung Lin
- Chang Gung University College of Medicine Taoyuan Taiwan.,Chang Gung Memorial Hospital Department of Anesthesiology Linkou, Taoyuan Taiwan
| | - Hung-Pin Liu
- Chang Gung Memorial Hospital Department of Anesthesiology Linkou, Taoyuan Taiwan
| | - Te-Fa Chiu
- China Medical University Department of Emergency Medicine, China Medical University Hospital and School of Medicine Taichung Taiwan
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Eberlein CM, Luther IS, Carpenter TA, Ramirez LD. First-Pass Success Intubations Using Video Laryngoscopy Versus Direct Laryngoscopy: A Retrospective Prehospital Ambulance Service Study. Air Med J 2019; 38:356-358. [PMID: 31578974 DOI: 10.1016/j.amj.2019.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/14/2019] [Accepted: 06/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE In emergency medicine, endotracheal intubation is the gold standard for airway management. First-pass intubation success is beneficial because it secures the patient airway more quickly and avoids complications associated with repeated attempts, such as bleeding and swelling of soft tissue. The key to first-pass success is the ability to visualize the laryngeal inlet. Visualization can be accomplished using traditional direct laryngoscopy or video laryngoscopy. The purpose of our study was to compare the rate of successful first-pass endotracheal intubations using a video laryngoscope with that using a direct visualization laryngoscope in a prehospital emergency setting. METHODS We retrospectively reviewed data that had been prospectively collected in our emergency department regarding patients who underwent endotracheal intubation performed by personnel from a single local ambulance service from January 1, 2014, through December 31, 2015. RESULTS One hundred eighty-one patients were intubated using video laryngoscopy and 115 using direct visualization laryngoscopy. The first-pass endotracheal intubation success rate using video laryngoscopy was 12.6% higher than with direct laryngoscopy. CONCLUSION This retrospective study shows that video laryngoscopy had a higher first-pass success rate than direct laryngoscopy. This is promising because decreasing failure rates provide better patient outcomes.
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Affiliation(s)
| | - Isidora S Luther
- Department of Emergency Medicine, Gundersen Health System, La Crosse, WI.
| | - Tom A Carpenter
- Department of Emergency Medical Services, Gundersen Health System, La Crosse, WI
| | - Luis D Ramirez
- Department of Medical Research, Gundersen Health System, La Crosse, WI
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Kim SH, Kwon J, Kim YJ, Lee HJ, Seo HC, Lim SB, Joo S, Seo DW, Kim WY, Hong SB. Impact of a custom-made 3D printed ergonomic grip for direct laryngoscopy on novice intubation performance in a simulated easy and difficult airway scenario-A manikin study. PLoS One 2018; 13:e0207445. [PMID: 30458013 PMCID: PMC6245686 DOI: 10.1371/journal.pone.0207445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/31/2018] [Indexed: 11/29/2022] Open
Abstract
Direct laryngoscopy using a Macintosh laryngoscope is the most widely used approach; however, this skill is not easy for novices and trainees. We evaluated the performance of novices using a laryngoscope with a three-dimensional (3D)-printed ergonomic grip on an airway manikin. Forty second-year medical students were enrolled. Endotracheal intubation was attempted using a conventional Macintosh laryngoscope with or without a 3D-printed ergonomic support grip. Primary outcomes were intubation time and overall success rate. Secondary outcomes were number of unsuccessful attempts, first-attempt success rate, airway Cormack-Lehane (CL) grade, and difficulty score. In the easy airway scenario, intubation time, and the overall success rate were similar between two group. CL grade and ease-of-use scores were significantly better for those using the ergonomic support grip (P < 0.05). In the difficult airway scenario, intubation time (49.7±37.5 vs. 35.5±29.2, P = 0.013), the first-attempt success rate (67.5% vs. 90%, P = 0.029), number of attempts (1.4±0.6 vs. 1.1±0.4, P = 0.006), CL grade (2 [2, 2] vs. 2 [1, 1], P = 0.012), and ease-of-use scores (3.5 [2, 4] vs. 4 [3, 5], P = 0.008) were significantly better for those using the ergonomic support grip. Linear mixed model analysis showed that the ergonomic support grip had a favorable effect on CL grade (P<0.001), ease-of-use scores (P<0.001), intubation time (P = 0.015), and number of intubation attempts (P = 0.029). Our custom 3D-printed ergonomic laryngoscope support grip improved several indicators related to the successful endotracheal intubation in the easy and difficult scenario simulated on an airway manikin. This grip may be useful for intubation training and practice.
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Affiliation(s)
- Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeonghoon Kwon
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Youn-Jung Kim
- Department of Emergent Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyung-Joo Lee
- Department of Emergent Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyo-Chang Seo
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Bok Lim
- Emergency Nursing Department, Asan Medical Center, Seoul, Korea
| | - Segyeong Joo
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- * E-mail: (SJ);(DWS)
| | - Dong-Woo Seo
- Department of Emergent Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Biomedical Informatics, University of California San Diego, School of Medicine, San Diego, United States of America
- * E-mail: (SJ);(DWS)
| | - Won-Young Kim
- Department of Emergent Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Bum Hong
- Department of Pulmonology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Nabecker S, Koennecke X, Theiler L, Riggenbach C, Greif R, Kleine-Brueggeney M. Effect of the tube-guiding channel on intubation success with videolaryngoscopes. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2017.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Yeung FSH, Lam RPK, Wong TW, Chan LW. Comparison of the GlideScope® with the Macintosh Laryngoscope in Endotracheal Intubation during Uninterrupted Mechanical Chest Compression: A Randomised Crossover Manikin Study. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The GlideScope® (GS) has been shown to improve the first-attempt success rate of endotracheal intubation during continuous mechanical chest compressions compared with the conventional Macintosh laryngoscope (ML) in inexperienced hands. Yet, its value for operators with experience of emergency airway management has remained uncertain. We set out to compare their performance in the hands of experienced operators in a manikin receiving continuous mechanical chest compressions delivered by LUCAS®. Method This was a randomised crossover study. Thirty-five emergency physicians and intensivists performed intubation using GS and ML in 3 different scenarios: (1) normal airway without chest compressions; (2) normal airway with uninterrupted mechanical chest compressions; and (3) normal airway with cervical spine (C-spine) immobilisation and uninterrupted mechanical chest compressions. The sequence of scenarios and devices used were randomised. The primary outcome was the first-attempt success rate of intubation. Other data including demographics, the time required for successful intubation, complications during intubation, the visual analog scale of perceived difficulty of intubation and the preference on devices in each scenario were also collected and analyzed. Results In scenario 1, the first-attempt success rate with both laryngoscopes was 100%. In scenario 2, there was a higher first-attempt success rate with ML but it was not statistically significant (GS 97.14% vs ML 100%, p=1.00). In scenario 3, one participant failed to intubate in the first attempt with each of the laryngoscopes (GS 97.14% vs ML 97.14%, p=0.754). More dental compression was noted with GS but the difference was not statistically significant (GS 42.86% vs ML 22.86%, p=0.126). Overall, the median time for intubation with GS was significantly longer in all 3 scenarios (Scenario 1: GS 18.5s; interquartile range [IQR] 13.8 -22.2s vs ML 11.2s, IQR 9.5-14.2s, p<0.001; Scenario 2: GS 18.7s, IQR 13.1-25.2s vs ML 13.4s, 10.3-15.8s, p<0.001; Scenario 3: GS 20.8s, IQR 16.5-29.2s vs ML 14.0s, IQR 10.5-18.0s, p<0.001). More participants preferred GS in scenario 3, while ML remained the device of choice in the other two scenarios. Conclusion: GS is not superior to ML in terms of the first-attempt success rate of intubation and it takes significantly longer to intubate for experienced operator. Yet more participants prefer its use when the C-spine motion is limited. Further studies are warranted to explore its role in trauma resuscitation. (Hong Kong j.emerg.med. 2016;23:159-167)
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Chan HKW, Wong OF, Kwan GWM. A Manikin Study Comparing McGrath Mac® and Airtraq® with Macintosh Laryngoscope in Tracheal Intubation by Intensive Care Unit Doctors. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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)
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Kriege M, Alflen C, Tzanova I, Schmidtmann I, Piepho T, Noppens RR. Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation in 2000 patients undergoing general anaesthesia: the randomised multicentre EMMA trial study protocol. BMJ Open 2017; 7:e016907. [PMID: 28827261 PMCID: PMC5724220 DOI: 10.1136/bmjopen-2017-016907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The direct laryngoscopy technique using a Macintosh blade is the first choice globally for most anaesthetists. In case of an unanticipated difficult airway, the complication rate increases with the number of intubation attempts. Recently, McGrath MAC (McGrath) video laryngoscopy has become a widely accepted method for securing an airway by tracheal intubation because it allows the visualisation of the glottis without a direct line of sight. Several studies and case reports have highlighted the benefit of the video laryngoscope in the visualisation of the glottis and found it to be superior in difficult intubation situations. The aim of this study was to compare the first-pass intubation success rate using the (McGrath) video laryngoscope compared with conventional direct laryngoscopy in surgical patients. METHODS AND ANALYSIS The EMMA trial is a multicentre, open-label, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath video laryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of successful first-pass intubation is 95% in the McGrath group and 90% in the Macintosh group. Each group must include a total of 1000 patients to achieve 96% power for detecting a difference at the 5% significance level. Successful intubation with the first attempt is the primary endpoint. The secondary endpoints are the time to intubation, attempts for successful intubation, the necessity of alternatives, visualisation of the glottis using the Cormack & Lehane score and percentage of glottic opening score and definite complications. ETHICS AND DISSEMINATION The project was approved by the local ethics committee of the Medical Association of the Rhineland Palatine state and Westphalia-Lippe. The results of this study will be made available in the form of manuscripts for publication and presentations at national and international meetings. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT 02611986; pre-results.
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Affiliation(s)
- Marc Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes, Gutenberg University, Mainz, Germany
| | - Christian Alflen
- Department of Anaesthesiology, University Medical Centre of the Johannes, Gutenberg University, Mainz, Germany
| | - Irene Tzanova
- Department of Anaesthesiology, Christophorus Hospital, Coesfeld, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Tim Piepho
- Department of Anaesthesiology, University Medical Centre of the Johannes, Gutenberg University, Mainz, Germany
| | - Ruediger R Noppens
- Department of Anaesthesiology, University Medical Centre of the Johannes, Gutenberg University, Mainz, Germany
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
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Owada G, Mihara T, Inagawa G, Asakura A, Goto T, Ka K. A comparison of the Airtraq®, McGrath®, and Macintosh laryngoscopes for difficult paediatric intubation: A manikin study. PLoS One 2017; 12:e0171889. [PMID: 28187213 PMCID: PMC5302788 DOI: 10.1371/journal.pone.0171889] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/29/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The efficacy of devices for difficult intubation in paediatric patients, especially with a Cormack-Lehane grade 4 view, has yet to be established. We compared intubating parameters among three devices (the Airtraq®, McGrath®, and Macintosh laryngoscopes). METHODS This study is a randomised cross-over trial. Participants were 20 anaesthetists. Each device was tested three times using a paediatric manikin with a Cormack-Lehane grade 4 view. The order to use each device was randomised by a computer-generated random sequence. The primary endpoint was the rate of successful intubation. Secondary endpoints included the time taken to intubate, percentage of glottic opening score, and severity of potential dental trauma. RESULTS The successful intubation rates of the Airtraq®, McGrath®, and Macintosh laryngoscopes were 100%, 72%, and 45%, respectively. The risk ratio of the success rates of Airtraq® compared with McGrath® and Macintosh laryngoscopes were 1.40 (95% CI; 1.19-1.64, P < 0.001) and 2.22 (95% CI; 1.68-2.94, P < 0.001), respectively. The modified Cormack-Lehane grade and percentage of the glottic opening score were better for the Airtraq® than for the other devices. The dental trauma score was lower for the Airtraq® than for the other devices. There were no significant differences in the intubation time among the groups. CONCLUSIONS The Airtraq® had higher success rate, had better visibility, and was associated with less dental trauma than the other devices in a difficult paediatric intubation model with a Cormack-Lehane grade 4 view.
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Affiliation(s)
- Gen Owada
- Department of Anaesthesiology, Kanagawa Children’s Medical Centre, Yokohama, Japan
| | - Takahiro Mihara
- Department of Anaesthesiology, Kanagawa Children’s Medical Centre, Yokohama, Japan
- Department of Anaesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Gaku Inagawa
- Department of Anaesthesiology, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
| | - Ayako Asakura
- Department of Anaesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takahisa Goto
- Department of Anaesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Koui Ka
- Department of Anaesthesiology, Kanagawa Children’s Medical Centre, Yokohama, Japan
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Video Laryngoscopy Improves Odds of First-Attempt Success at Intubation in the Intensive Care Unit. A Propensity-matched Analysis. Ann Am Thorac Soc 2016; 13:382-90. [PMID: 26653096 DOI: 10.1513/annalsats.201508-505oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
RATIONALE Urgent tracheal intubation is performed frequently in intensive care units and incurs higher risk than when intubation is performed under more controlled circumstances. Video laryngoscopy may improve the chances of successful tracheal intubation on the first attempt; however, existing comparative data on outcomes are limited. OBJECTIVES To compare first-attempt success and complication rates during intubation when using video laryngoscopy compared with traditional direct laryngoscopy in a tertiary academic medical intensive care unit. METHODS We prospectively collected and analyzed data from a continuous quality improvement database of all intubations in one medical intensive care unit between January 1, 2012, and December 31, 2014. Propensity matching and multivariable logistic regression were used to reduce the risk of bias and control for confounding. MEASUREMENTS AND MAIN RESULTS A total of 809 intubations took place over the study period. Of these, 673 (83.2%) were performed using video laryngoscopy and 136 (16.8%) using direct laryngoscopy. First-attempt success with video laryngoscopy was 80.4% (95% confidence interval [CI], 77.2-83.3%) compared with 65.4% (95% CI, 56.8-73.4%) for intubations performed with direct laryngoscopy (P < 0.001). In a propensity-matched analysis, the odds ratio for first-attempt success with video laryngoscopy versus direct laryngoscopy was 2.81 (95% CI, 2.27-3.59). The rate of arterial oxygen desaturation events during the first intubation attempt was significantly lower for video laryngoscopy than for direct laryngoscopy (18.3% vs. 25.9%; P = 0.04). The rate of esophageal intubation during any attempt was also significantly lower for video laryngoscopy (2.1% vs. 6.6%; P = 0.008). CONCLUSIONS Video laryngoscopy was associated with significantly improved odds of first-attempt success at tracheal intubation by nonanesthesiologists in a medical intensive care unit. Esophageal intubation and oxygen desaturation occurred less frequently with the use of video laryngoscopy. Randomized clinical trials are needed to confirm these findings.
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McGRATH MAC video laryngoscope for insertion of a transoesophageal echocardiography probe: A randomised controlled trial. Eur J Anaesthesiol 2016; 33:263-8. [PMID: 26575010 PMCID: PMC4780480 DOI: 10.1097/eja.0000000000000367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transoesophageal echocardiography (TOE) probe insertion in anaesthetised patients can cause pharyngeal and oesophageal injuries. Kim et al. have shown that insertion assisted by a Macintosh laryngoscope can reduce such complications but it may sometimes be difficult to observe the passage of a TOE probe. The McGRATH MAC (McGRATH) has been shown to provide a better view of the glottis, piriform fossa and oesophageal inlet during tracheal intubation than the Macintosh. OBJECTIVE We hypothesised that the McGRATH provided better visualisation of the oesophageal inlet and was useful as an aid to TOE probe placement, possibly reducing the incidence of pharyngeal injury related to insertion, compared with the Macintosh. DESIGN A randomised controlled trial. SETTING The study was conducted in a university hospital from February to December 2014. PATIENTS One hundred patients undergoing elective surgery under intraoperative TOE monitoring were randomised to either a Macintosh group or a McGRATH group. INTERVENTIONS Macintosh and McGRATH were used to visualise the passage of the TOE probe and guide its insertion. MAIN OUTCOME MEASURES Visibility of the oesophageal inlet, the number of TOE insertion attempts and incidence of pharyngeal mucosal injury after the TOE probe had been removed were assessed. RESULTS The percentage of patients in whom the oesophageal inlet was visible was higher in the McGRATH group (88%) than in the Macintosh group (41%) (P < 0.01). The number of TOE probe insertion attempts was significantly smaller in the McGRATH group than in the Macintosh group (P = 0.039). The incidence of pharyngeal mucosal injury was significantly smaller in the McGRATH group (4%) than in the Macintosh group (16%; P = 0.042). CONCLUSION The McGRATH provided a better view of the oesophageal inlet and was useful as an aid to TOE probe placement, possibly reducing the incidence of pharyngeal injury related to its insertion. TRIAL REGISTRATION University Hospital Medical Information Network in Japan (UMIN) 000012970.
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Wan L, Liao M, Li L, Qian W, Hu R, Chen K, Zhang C, Yao W. McGrath Series 5 videolaryngoscope vs Airtraq DL videolaryngoscope for double-lumen tube intubation: A randomized trial. Medicine (Baltimore) 2016; 95:e5739. [PMID: 28002347 PMCID: PMC5181831 DOI: 10.1097/md.0000000000005739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many studies have shown Airtraq videolaryngoscope provided faster tracheal intubation and a higher success rate than other videolaryngoscopes. Recently, different types of videolaryngoscopes have been reported for use in double-lumen tube (DLT) intubation. However, the advantages and disadvantages between them remain undetermined for DLT intubation. In this study, we compared the Airtraq DL videolaryngoscope with the McGrath Series 5 videolaryngoscope for DLT intubation by experienced anesthesiologists. METHODS Ninety patients with expected normal airways were randomly allocated to either the Airtraq or McGrath group. The primary outcome was DLT intubation time. The secondary outcomes were glottic view, success rate, subjective ease of intubation (100-mm visual analog scale, 0 = easy; 100 = difficult), incidence of DLT malposition, and postoperative intubation-related complication. RESULTS The airway characteristics were comparable between the 2 groups. Cormack and Lehane grades significantly improved with the use of the McGrath and Airtraq videolaryngoscopes, compared with the Macintosh laryngoscope. The intubation success rate on the first attempt was 93% in the Airtraq group and 95% in the McGrath group (P > 0.05). The intubation time in the McGrath group is longer than that in the Airtraq group (39.9 [9.1]s vs 28.6 [13.6]s, P < 0.05). But intubation difficulty score, the incidence of DLT malposition and intubation-related complication were comparable between groups (P > 0.05). CONCLUSIONS When using videolaryngoscopes for DLT intubation, the Airtraq DL is superior to the McGrath Series 5 in intubation time, but it does not decrease intubation difficulty.
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Affiliation(s)
- Li Wan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Mingfeng Liao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Li Li
- Department of Physiology, Hubei University of Chinese Medicine, Wuhan, China
| | - Wei Qian
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Rong Hu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Kun Chen
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Chuanhan Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Wenlong Yao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
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Comparing McGRATH® MAC, C-MAC®, and Macintosh Laryngoscopes Operated by Medical Students: A Randomized, Crossover, Manikin Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8943931. [PMID: 27703983 PMCID: PMC5040779 DOI: 10.1155/2016/8943931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 12/21/2022]
Abstract
We hypothesized that the McGRATH MAC would decrease the time of intubation compared to C-MAC for novices. Thirty-nine medical students who had used the Macintosh blade to intubate a manikin fewer than 3 times were recruited. The participants performed sequential intubations on the manikin in two simulated settings that included a normal airway and a difficult airway (tongue edema). The intubation time, success rate of intubation, Cormack-Lehane grade at laryngoscopy, and difficulty using the device were recorded. Each participant was asked to identify the device that was most useful. The intubation time decreased significantly and by a similar amount to the McGRATH MAC and C-MAC compared to the Macintosh blade (P < 0.001 and P = 0.017, resp.). In the difficult airway, the intubation times were similar among the three devices. The McGRATH MAC and C-MAC significantly increased the success rate of intubation, improved the Cormack-Lehane grade, and decreased the difficulty score compared to the Macintosh blade in both airway settings. The majority of participants selected the McGRATH MAC as the most useful device. The McGRATH MAC and C-MAC may offer similar benefits for intubation compared to the Macintosh blade in normal and difficult airway situations.
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Hunter I, Ramanathan V, Balasubramanian P, Evans DA, Hardman JG, McCahon RA. Retention of laryngoscopy skills in medical students: a randomised, cross-over study of the Macintosh, A.P. Advance(™) , C-MAC(®) and Airtraq(®) laryngoscopes. Anaesthesia 2016; 71:1191-7. [PMID: 27530359 DOI: 10.1111/anae.13589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/28/2022]
Abstract
In addition to being effective and easy to learn how to use, the ideal laryngoscope should be associated with minimal reduction in skill performance during gaps in practice over time. We compared the time taken to intubate the trachea of a manikin by novice medical students immediately after training, and then after 1 month, with no intervening practice. We designed a two-period, four-group, randomised, cross-over trial to compare the Macintosh, Venner(™) A.P. Advance(™) with difficult airway blade, C-MAC(®) with D-Blade and Airtraq(®) with wireless video-viewer. A bougie was used to aid intubation with the Macintosh and the C-MAC. After training, there was no significant difference in median (IQR [range]) intubation time using the videolaryngoscopes compared with the Macintosh, which took 30 (26.5-35 [12-118])s. One month later, the intubation time was longer using the C-MAC (41 (29.5-52 [20-119])s; p = 0.002) and A.P. Advance (40 (28.5-57.5 [21-107])s; p = 0.0003)m compared with the Macintosh (27 (21-29 [16-90])s); there was no difference using the Airtraq (27 (20.5-32.5 [15-94])s; p = 0.258) compared with the Macintosh. While skill acquisition after a brief period of learning and practice was equal for each laryngoscope, performance levels differed after 1 month without practice. In particular, the consistency of performance using the C-MAC and A.P. Advance was worse compared with the Macintosh and the Airtraq. While the clinical significance of this is doubtful, we believe that reliable and consistent performance at laryngoscopy is desirable; for the devices that we tested, this requires regular practice.
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Affiliation(s)
| | - V Ramanathan
- East Midlands School of Anaesthesia, Nottingham, UK
| | - P Balasubramanian
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D A Evans
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J G Hardman
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Anaesthesia and Critical Care Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - R A McCahon
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK. .,Anaesthesia and Critical Care Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
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Hafner JW, Perkins BW, Korosac JD, Bucher AK, Aldag JC, Cox KL. Intubation Performance of Advanced Airway Devices in a Helicopter Emergency Medical Service Setting. Air Med J 2016; 35:132-7. [PMID: 27255874 DOI: 10.1016/j.amj.2015.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 12/27/2015] [Accepted: 12/30/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study attempts to determine if newer indirect laryngoscopes or intubating devices are superior to a standard laryngoscope for intubation success among helicopter emergency medical service (HEMS) personnel. METHODS Flight nurses and paramedics intubated standardized mannequins with a normal airway, a trauma airway, and a difficult airway using a standard laryngoscope, a gum elastic bougie, the Airtraq laryngoscope (King System Corp, Noblesville, IN), the Glidescope Ranger laryngoscope (Verathon Inc, Bothell, WA), and the S.A.L.T. device (Microtek Medical, Inc, Lehmberg, IN) in grounded helicopters wearing helmets and flight gear. Participant demographics, time to glottic view, the modified Cormack-Lehane score, total intubation time, number of attempts, and overall successful intubation were recorded for each type of airway. RESULTS Two-hundred thirty-six subjects were initially enrolled across 107 bases in 15 states, and 177 completed the study. First-attempt success rates did not vary by device for the normal airway (P = .203), but the Airtraq laryngoscope and the S.A.L.T. device were highest in the difficult airway (82.0% and 85.0%, respectively; P < .0001). The time to first-attempt success in the difficult airway was lowest for the S.A.L.T. device and the Airtraq laryngoscope (mean = 9.72 seconds and 19.70 seconds, respectively; P < .0001). CONCLUSION Using HEMS providers, the Airtraq laryngoscope and the S.A.L.T. device showed the fastest and highest intubation success on the first attempt in difficult simulated HEMS airway scenarios.
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Affiliation(s)
- John W Hafner
- University of Illinois College of Medicine at Peoria, Peoria, IL, USA; Department of Emergency Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA.
| | - Blake W Perkins
- Department of Anesthesiology, University of Chicago, Chicago, IL, USA
| | - Joshua D Korosac
- Department of Emergency Medicine, Mercy Clinic, Springfield, MO, USA
| | - Alayna K Bucher
- University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Jean C Aldag
- University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Kelly L Cox
- Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA; Air Evac Lifeteam, Air-Evac, Inc, O'Fallon, MO, USA
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Yumul R, Elvir-Lazo OL, White PF, Sloninsky A, Kaplan M, Kariger R, Naruse R, Parker N, Pham C, Zhang X, Wender RH. Comparison of three video laryngoscopy devices to direct laryngoscopy for intubating obese patients: a randomized controlled trial. J Clin Anesth 2016; 31:71-7. [DOI: 10.1016/j.jclinane.2015.12.042] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/03/2015] [Accepted: 12/28/2015] [Indexed: 02/05/2023]
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Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli G, Nabecker S, Theiler L. Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. Br J Anaesth 2016; 116:670-9. [DOI: 10.1093/bja/aew058] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 12/22/2022] Open
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Arslan Zİ, Turna C, Gümüş NE, Toker K, Solak M. Intubation of a Paediatric Manikin in Tongue Oedema and Face-to-Face Simulations by Novice Personnel: a Comparison of Glidescope, Airtraq and Direct Laryngoscopy. Turk J Anaesthesiol Reanim 2016; 44:71-5. [PMID: 27366561 DOI: 10.5152/tjar.2016.09582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/02/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Glidescope and Airtraq were designed for facilitating intubation and for teaching regarding the airway anatomy. We aimed to evaluate their efficacy in normal airway, tongue oedema and face-to-face orotracheal intubation models when used by novice personnel. METHODS After the local human research ethics committee approval, 36 medical students who were in the beginning of their third year were enrolled in this study. After watching a video regarding intubation using one of these devices, the students intubated a paediatric manikin with a Glidescope or Airtraq via the normal airway, tongue oedema and face-to-face approach. RESULTS Although the insertion and intubation times were similar among the groups, the intubation success rate of the Glidescope was higher in the normal airway (100% vs 67%) and tongue oedema (89% vs. 50%) compared with the Airtraq (p=0.008 and p=0.009). The success rates with the paediatric manikin by the face-to-face approach were similar among the groups (50%) (p=0.7). The need for manoeuvres in the Glidescope was lower in the normal and tongue oedema models (p=0.02 and p=0.002). In addition, oesophageal intubation was low in the control and tongue oedema models with the Glidescope (p=0.03 and p<0.001). CONCLUSION Novice personnel could more easily intubate the trachea with the Glidescope than with the Airtraq. Intubation with the Glidescope was superior to that with the Airtraq in the normal and tongue oedema models. The face-to-face intubation success rates were both low with both the Glidescope and Airtraq groups.
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Affiliation(s)
- Zehra İpek Arslan
- Department of Anaesthesiology and Reanimation, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Canan Turna
- Department of Anaesthesiology and Reanimation, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Nevin Esra Gümüş
- Department of Anaesthesiology and Reanimation, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Kamil Toker
- Department of Anaesthesiology and Reanimation, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Mine Solak
- Department of Anaesthesiology and Reanimation, Kocaeli University School of Medicine, Kocaeli, Turkey
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Shim JH, Jeon WJ, Cho SY, Choe GH. Comparison of the GlideScope and the McGrath method using vascular forceps and a tube exchanger in cases of simulated difficult airway intubation. Korean J Anesthesiol 2016; 69:133-7. [PMID: 27066203 PMCID: PMC4823407 DOI: 10.4097/kjae.2016.69.2.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/25/2015] [Accepted: 11/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background A "difficult airway" can be simulated with an extrication collar, which restricts cervical motion and mouth opening. The purpose of this study is to compare the efficacy of the GlideScope and the McGrath in difficult airway simulation. Methods Patients were randomized using computer-generated numbers and were placed into the GlideScope group or the McGrath group. The total intubation time was defined as the time measured from when the anesthesiologist picks up the device to the time at which three successive end-tidal CO2 values are acquired after intubation. Results There was no significant difference in total intubation time between the two groups (73.0 ± 25.3 sec vs. 72.3 ± 20.9 sec, P = 0.92). The success rates of the first intubation attempt did not differ between the two groups (82.8% vs. 83.3%, P = 0.95). Conclusions Our results suggest that there are no significant differences in the intubations with GlideScope and McGrath using vascular forceps and tube exchangers in difficult intubation scenarios.
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Affiliation(s)
- Jae-Hang Shim
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Woo Jae Jeon
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Sang Yun Cho
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Gyu Ho Choe
- Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea
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Hwang SM. A good laryngeal view does not guarantee perfectly successful tracheal intubation. Korean J Anesthesiol 2016; 69:111-2. [PMID: 27066199 PMCID: PMC4823403 DOI: 10.4097/kjae.2016.69.2.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sung Mi Hwang
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Gómez-Ríos MÁ, Pinegger S, de Carrillo Mantilla M, Vizcaino L, Barreto-Calvo P, Paech MJ, Gómez-Ríos D, López-Calviño B. [A randomised crossover trial comparing the Airtraq(®) NT, McGrath(®) MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin]. Rev Bras Anestesiol 2016; 66:289-97. [PMID: 26993409 DOI: 10.1016/j.bjan.2016.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/28/2014] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Several devices can aid nasotracheal intubation when managing difficult airways. The McGrath MAC and Airtraq NT were compared with a Macintosh laryngoscope when studying the performance of anaesthetists with different levels of experience, in a manikin model of easy or difficult airway scenarios. METHODS Sixty-three anaesthetists were recruited into a randomised trial in which each performed nasotracheal intubation with all laryngoscopes, in both scenarios. The main endpoint was intubation time. Additional endpoints included laryngoscopic view, intubation success, number of optimisation manoeuvres, audible dental clicks and the force applied to the upper airway. RESULTS Intubation time was significantly shorter using the McGrath MAC in both scenarios and using the Airtraq in the difficult scenario, when compared with the Macintosh laryngoscope. Both devices gave more Cormack and Lehane grade 1 or 2 views than the Macintosh in the difficult scenario (p<0.001). The McGrath MAC had the best first-attempt success rate (98.4% vs. 96.8% and 95.8%, p<0.001 for the Airtraq NT and Macintosh laryngoscopes respectively). The number of optimisation manoeuvres, audible dental clicks and subjective assessment of the degree of force applied were significantly lower for indirect laryngoscopes versus the Macintosh laryngoscope (p<0.001). CONCLUSION In a manikin, the Airtraq and the McGrath laryngoscopes appeared superior to the Macintosh laryngoscope when dealing with simulated airway scenarios. Both devices were associated with better views, intubation times and rates of success, especially in a simulated "difficult airway". Overall satisfaction was highest with the McGrath laryngoscope. Similar clinical studies are needed.
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Affiliation(s)
- Manuel Ángel Gómez-Ríos
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha.
| | - Stephan Pinegger
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - María de Carrillo Mantilla
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - Lucia Vizcaino
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - Purísima Barreto-Calvo
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - Michael J Paech
- Unidade de Farmacologia, Farmácia e Anestesiologia, Faculdade de Medicina e Farmacologia, Universidade da Austrália Ocidental, Perth, Austrália
| | - David Gómez-Ríos
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
| | - Beatriz López-Calviño
- Departamento de Anestesiologia e Medicina Pré-Operatória, Complexo Hospitalar Universitário da Corunha, Corunha, Espanha
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Nekhendzy V. Primus Inter Pares? The Angle of View Varies. Anesth Analg 2016; 122:597-600. [PMID: 26891386 DOI: 10.1213/ane.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Vladimir Nekhendzy
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Tracheal Intubation with a McGrath® Series 5 Video Laryngoscope by Novice Personnel in a Cervical-immobilized Manikin. J Emerg Med 2016; 50:61-6. [DOI: 10.1016/j.jemermed.2015.06.079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/25/2015] [Accepted: 06/12/2015] [Indexed: 11/20/2022]
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Tempe DK, Chaudhary K, Diwakar A, Datt V, Virmani S, Tomar AS, Mohandas A, Mohire VB. Comparison of hemodynamic responses to laryngoscopy and intubation with Truview PCD™, McGrath® and Macintosh laryngoscope in patients undergoing coronary artery bypass grafting: A randomized prospective study. Ann Card Anaesth 2016; 19:68-75. [PMID: 26750677 PMCID: PMC4900407 DOI: 10.4103/0971-9784.173023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT We hypothesized that reduced oropharyngolaryngeal stimulation with video laryngoscopes would attenuate hemodynamic response to laryngoscopy and intubation. AIM Comparison of hemodynamic response to laryngoscopy and intubation with video laryngoscopes and Macintosh (MC) laryngoscope. SETTING AND DESIGN Superspecialty tertiary care public hospital; prospective, randomized control study. METHODS Sixty adult patients undergoing elective coronary artery bypass grafting (CABG) were randomly allocated to three groups of 20 each: MC, McGrath (MG), and Truview™. Hemodynamic parameters were serially recorded before and after intubation. Laryngoscopic grade, laryngoscopy, and tracheal intubation time, ST segment changes, and intra-/post-operative complications were also recorded and compared between groups. STATISTICAL ANALYSIS SPSS version 17 was used, and appropriate tests applied. P < 0.05 was considered significant. RESULTS Heart rate and diastolic arterial pressure increased at 0 and 1 min of intubation in all the three groups (P < 0.05) while mean arterial pressure increased at 0 min in the MG and TV groups and at 1 min in all three groups (P < 0.05). A significant increase in systolic arterial pressure was only observed in TV group at 1 min (P < 0.05). These hemodynamic parameters returned to baseline by 3 min of intubation in all the groups. The intergroup comparisons of all hemodynamic parameters were not significant at any time of observation. Highest intubation difficulty score was observed with MC (2.16 ± 1.86) as compared with MG (0.55 ± 0.88) and TV (0.42 ± 0.83) groups (P = 0.003 and P = 0.001, respectively). However, duration of laryngoscopy and intubation was significantly less in MC (36.68 ± 16.15 s) as compared with MG (75.25 ± 30.94 s) and TV (60.47 ± 27.45 s) groups (P = 0.000 and 0.003, respectively). CONCLUSIONS Video laryngoscopes did not demonstrate any advantage in terms of hemodynamic response in patients with normal airway undergoing CABG.
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Affiliation(s)
- Deepak K Tempe
- Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Lok Nayak Hospital, GB Pant and GNEC Hospitals, New Delhi, India
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Strøm C, Barnung S, Kristensen MS, Bøttger M, Tvede MF, Rasmussen LS. Tracheal intubation in patients with anticipated difficult airway using Boedeker intubation forceps and McGrath videolaryngoscope. Acta Anaesthesiol Scand 2015; 59:1154-60. [PMID: 25982220 DOI: 10.1111/aas.12543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Videolaryngoscopes with sharp angulated blades improve the view of the vocal cords but this does not necessarily result in higher success rates of intubation The aim of this study was to evaluate the efficacy of using Boedeker intubation forceps in conjunction with McGrath Series 5 Videolaryngoscope (MVL) in patients with predictors for difficult intubation. METHODS The study was conducted at the Department of Anaesthesia, Copenhagen University Hospital from September to December 2013. Patients with one or more predictors of difficult intubation scheduled for general anaesthesia were assessed for eligibility. Patients were intubated using Boedeker intubation forceps and MVL. The primary endpoint was time to intubation. The secondary endpoints were intubation success rate, number of intubation attempts, intubation conditions and post-operative hoarseness. RESULTS Thirty-three patients were assessed for eligibility, and 25 patients were included in the study with a median SARI score of 3 (IQR 3-4). Twenty-two (88%, 95% confidence interval [74-100%]) of the patients were successfully intubated by the method with a median time to intubation of 115 s (IQR 78-247). Steering and advancement of the tube were reported as acceptable in 21 (84%) and 22 cases (88%), respectively, and excellent in 10 cases (45%) for both measures. Ten cases (40%) were intubated on the first attempt. There were three cases (12%) of failed intubation; in these cases, successful intubation was obtained by using a styletted tube. CONCLUSION(S) Most patients with anticipated difficult intubation can be successfully intubated with Boedeker intubation forceps and MVL. However, endotracheal tube placement failed in 3/25 patients despite a good laryngeal view.
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Affiliation(s)
- C. Strøm
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - S. Barnung
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. S. Kristensen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. Bøttger
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. F. Tvede
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - L. S. Rasmussen
- Department of Anaesthesia; Centre of Head and Orthopaedics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Bakshi SG, Vanjari VS, Divatia JV. A prospective, randomised, clinical study to compare the use of McGrath(®), Truview(®) and Macintosh laryngoscopes for endotracheal intubation by novice and experienced Anaesthesiologists. Indian J Anaesth 2015; 59:421-7. [PMID: 26257415 PMCID: PMC4523963 DOI: 10.4103/0019-5049.160946] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background and Aims: Video laryngoscopy has been recommended as an alternative during difficult conventional direct laryngoscopy using the Macintosh blade (MAC). However, successful visualisation of the larynx and tracheal intubation using some of the indirect laryngoscopes or video laryngoscopes (VL) requires hand-eye coordination. We conducted this study to determine whether non-channel VLs are easy to use for novices and whether there is any association between expertise with MAC and ease of tracheal intubation with VLs. Methods: Anaesthesiologists participating in the study were divided into three groups: Group novice to intubation (NTI), Group novice to videoscope (NVL)- experienced with MAC, novice to VLs and Group expert (EXP) experienced in all. Group NTI, NVL received prior mannequin training. VLs- Truview® and McGrath series 5 (MGR) were compared with MAC. One hundred and twenty six adult patients with normal airway were randomised to both, the intubating anaesthesiologist and laryngoscope. The time taken to intubate (TTI) and participants’ rating of the ease of use was recorded on a scale of 1–10 (10-most difficult). Results: In Group NTI, there was no difference in mean TTI with the three scopes (P = 0.938). In Group NVL, TTI was longer with the VLs than MAC (P < 0.001). In Group EXP, TTI with VL took 20 s more (P < 0.001). There was significant difference in participants’ rating of ease of use of laryngoscope in Group NVL (P = 0.001) but not in the NTI (P = 0.205), EXP (P = 0.529) groups. A high failure was seen with MGR in Group NTI and NVL. Conclusion: In Group NTI, TTI and the ease of use were similar for all scopes. Expertise with standard direct laryngoscopy does not translate to expertise with VLs. Separate training and experience with VLs is required.
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Affiliation(s)
- Sumitra G Bakshi
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vinayak S Vanjari
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
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The AirView Study: Comparison of Intubation Conditions and Ease between the Airtraq-AirView and the King Vision. BIOMED RESEARCH INTERNATIONAL 2015; 2015:284142. [PMID: 26161393 PMCID: PMC4486309 DOI: 10.1155/2015/284142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/10/2015] [Indexed: 11/17/2022]
Abstract
We conducted a study assessing the quality and speed of intubation between the Airtraq with its new iPhone AirView app and the King Vision in a manikin. The primary endpoint was reduction of time needed for intubation. Secondary endpoints included times necessary for intubation. 30 anaesthetists randomly performed 3 intubations with each device on a difficult airway manikin. Participants had a professional experience of 12 years: 60.0% possessed the Airtraq in their hospital, 46.7% the King Vision, and 20.0% both. Median time difference [IQR] to identify glottis (1.1 [-1.3; 3.9] P = 0.019), for tube insertion (2.1 [-2.6; 9.4] P = 0.002) and lung ventilation (2.8 [-2.4; 11.5] P = 0.001), was shorter with the Airtraq-AirView. Median time for glottis visualization was significantly shorter with the Airtraq-AirView (5.3 [4.0; 8.4] versus 6.4 [4.6; 9.1]). Cormack Lehane before intubation was better with the King Vision (P = 0.03); no difference was noted during intubation, for subjective device insertion or quality of epiglottis visualisation. Assessment of tracheal tube insertion was better with the Airtraq-AirView. The Airtraq-AirView allows faster identification of the landmarks and intubation in a difficult airway manikin, while clinical relevance remains to be studied. Anaesthetists assessed the intubation better with the Airtraq-AirView.
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Gómez-Ríos MÁ, Pinegger S, de Carrillo Mantilla M, Vizcaino L, Barreto-Calvo P, Paech MJ, Gómez-Ríos D, López-Calviño B. A randomised crossover trial comparing the Airtraq(®) NT, McGrath(®) MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin. Braz J Anesthesiol 2015; 66:289-97. [PMID: 27108827 DOI: 10.1016/j.bjane.2014.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/08/2014] [Accepted: 10/28/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Several devices can aid nasotracheal intubation when managing difficult airways. The McGrath MAC and Airtraq NT were compared with a Macintosh laryngoscope when studying the performance of anaesthetists with different levels of experience, in a manikin model of easy or difficult airway scenarios. METHODS Sixty-three anaesthetists were recruited into a randomised trial in which each performed nasotracheal intubation with all laryngoscopes, in both scenarios. The main endpoint was intubation time. Additional endpoints included laryngoscopic view, intubation success, number of optimisation manoeuvres, audible dental clicks and the force applied to the upper airway. RESULTS Intubation time was significantly shorter using the McGrath MAC in both scenarios and using the Airtraq in the difficult scenario, when compared with the Macintosh laryngoscope. Both devices gave more Cormack and Lehane grade 1 or 2 views than the Macintosh in the difficult scenario (p<0.001). The McGrath MAC had the best first-attempt success rate (98.4% vs. 96.8% and 95.8%, p<0.001 for the Airtraq NT and Macintosh laryngoscopes respectively). The number of optimisation manoeuvres, audible dental clicks and subjective assessment of the degree of force applied were significantly lower for indirect laryngoscopes versus the Macintosh laryngoscope (p<0.001). CONCLUSION In a manikin, the Airtraq and the McGrath laryngoscopes appeared superior to the Macintosh laryngoscope when dealing with simulated airway scenarios. Both devices were associated with better views, intubation times and rates of success, especially in a simulated "difficult airway". Overall satisfaction was highest with the McGrath laryngoscope. Similar clinical studies are needed.
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Affiliation(s)
- Manuel Ángel Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - Stephan Pinegger
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - María de Carrillo Mantilla
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Lucia Vizcaino
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Purísima Barreto-Calvo
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Michael J Paech
- Pharmacology, Pharmacy and Anaesthesiology Unit, School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - David Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Beatriz López-Calviño
- Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Yi J, Gong Y, Quan X, Huang Y. Comparison of the Airtraq laryngoscope and the GlideScope for double-lumen tube intubation in patients with predicted normal airways: a prospective randomized trial. BMC Anesthesiol 2015; 15:58. [PMID: 25927657 PMCID: PMC4419514 DOI: 10.1186/s12871-015-0037-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Airtraq laryngoscope and the GlideScope are commonly used in many airway scenarios. However, their features have not been fully described for double-lumen tube intubation. A prospective randomized study was designed to compare their intubation performances in thoracic surgery patients. METHODS Seventy ASA physical status I and II patients with predicted normal airway were scheduled for thoracic surgeries with double-lumen tube intubation. They were randomly assigned to one of two groups and intubated with either the Airtraq laryngoscope (group A, n = 35) or the GlideScope (group G, n = 35). Airway assessments were performed prior to anesthesia, and all patients were induced with a standard anesthetic regimen. The Cormack-Lehane grades were initially evaluated with a Macintosh laryngoscope and subsequently with the group-specific laryngoscope before intubation. Intubation time was recorded as the primary outcome. The Cormack-Lehane grade, the success of the first intubation attempt, the intubation difficulty scales and ease of tube advancement were noted. Hemodynamic variables during intubation and incidence of post-operative sore throat were documented as well. RESULTS The intubation time of group A was shorter than that of group G (36.6 ± 20.2 s vs. 54.6 ± 25.7 s, p = 0.002). The Cormack-Lehane grade (I/II/III/IV) was significantly better in group A (33/2/0/0 vs. 28/7/0/0, p = 0.042). The mean arterial pressure and heart rate rose to higher levels during intubation with the GlideScope than with the Airtraq laryngoscope. The success of the first intubation attempt and the intubation difficulty scales were comparable between the two groups. The numbers of patients who experienced postoperative sore throat were similar (6 vs. 8) in the two groups. CONCLUSIONS Compared with the GlideScope, the specially designed Airtraq laryngoscope might be more suitable for double-lumen tube intubations in patients with predicted normal airway. TRIAL REGISTRATION www.chictr.org Identifier: ChiCTR-TRC-11001628.
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Affiliation(s)
- Jie Yi
- Department of Anesthesiology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street, Beijing, 100730, P.R of China.
| | - Yahong Gong
- Department of Anesthesiology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street, Beijing, 100730, P.R of China.
| | - Xiang Quan
- Department of Anesthesiology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street, Beijing, 100730, P.R of China.
| | - Yuguang Huang
- Department of Anesthesiology, Chinese Academy of Medical Science, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street, Beijing, 100730, P.R of China.
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[Comparison of GlideScope® Cobalt and McGrath® Series 5 video laryngoscopes with direct laryngoscopy in a simulated regurgitation/aspiration scenario]. Med Klin Intensivmed Notfmed 2015; 110:218-24. [PMID: 25575716 DOI: 10.1007/s00063-014-0434-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/28/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Video laryngoscopy has become increasingly important in airway management in the pre- and intrahospital settings. However, using video laryngoscopes in the presence of body fluids can make visualization of the airway difficult. A simulated regurgitation model was used to compare two video laryngoscopes (VL) with direct laryngoscopy. MATERIALS AND METHODS A total of 72 physicians participated in this randomized trial. The hypopharynx from an Airway Management Trainer was filled with artificially warmed turbid liquid. In addition, the cervical spine of the manikin was immobilized. The VL GlideScope® (GS) and McGrath® Series 5 (McG) were examined with the laryngoscope with Macintoshspatel (DL). Fogging of the camera optics in percent (0 %= clear view, 100 %= no view), the visibility of the glottis by Cormack and Lehane classification (C&L), and the POGO Score (percentage of glottic opening), the time until the endotracheal tube placement, and the success rate were evaluated. RESULTS No fogging (median 0 %) was present using the GS (interquartile range [IQR]: 0-4), in contrast 45 % fogging was found in the McG group (IQR: 30-60; p < 0.001). Glottic visualization using C&L was better using VL (p < 0.001). A similar result was observed using the POGO Scale: GS 90 % (IQR: 76-100), McG 80 % (IQR: 70-90), and DL 20 % (IQR: 0-50). The time for correct placement was in the DL with 27.6 s (IQR: 22.5-35) faster (p < 0.001), with the GS 48.5 s (IQR: 34.3-65.1) and the McG 66.3 s (IQR: 45.4-90). Successful placement was possible with GS in all cases (72/72), with DL in 71/72 cases, and with the McG in 70/72 cases. CONCLUSION Using a video laryngsocope with an "anti-fogging" system improved visualization in a simulated aspiration model. In this scenario, VL showed no advantage to direct laryngoscopy in terms of success rate and speed of intubation.
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Cruz P, Alarcón L, Del Castillo T, Cabrerizo P, Díaz S. [Effectiveness of the GlideScope video laryngoscope in a case of unexpected difficult airway due to lingual tonsil hypertrophy]. ACTA ACUST UNITED AC 2014; 62:289-92. [PMID: 25487764 DOI: 10.1016/j.redar.2014.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/15/2014] [Accepted: 09/25/2014] [Indexed: 12/17/2022]
Abstract
Lingual tonsil hypertrophy can cause varying degrees of airway obstruction and is considered a risk factor for difficult mask ventilation and tracheal intubation. We report a case of unexpected difficult airway in a patient with unknown lingual tonsil hypertrophy that was solved with the use of the GlideScope video laryngoscope.
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Affiliation(s)
- P Cruz
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - L Alarcón
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - T Del Castillo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Cabrerizo
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - S Díaz
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
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Comparison of the Macintosh, McCoy, Airtraq laryngoscopes and the intubating laryngeal mask airway in a difficult airway with manual in-line stabilisation: a cross-over simulation-based study. Eur J Anaesthesiol 2014; 30:544-9. [PMID: 23685784 DOI: 10.1097/eja.0b013e3283615b80] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Patients with multisystem trauma undergoing intubation with manual in-line stabilisation (MILS) have a higher incidence of difficult or failed intubations. OBJECTIVE To compare the effectiveness of the Macintosh laryngoscope with three other intubating devices in a high fidelity simulation model. DESIGN Cross-over, simulation-based study. SETTING Tertiary referral and level 1 trauma centre between June and November 2011. PARTICIPANTS Thirty-five experienced airway physicians. INTERVENTION Each participant performed tracheal intubations on a Laerdal SimMan manikin in both a normal airway and a difficult airway scenario with MILS. The devices utilised in a randomised order were the Macintosh, McCoy, Airtraq laryngoscopes and the intubating laryngeal mask airway (iLMA). MAIN OUTCOME MEASURES The primary outcome was time to intubation. Success rates, grade of laryngoscopy and force of intubation were also measured. RESULTS One hundred and forty intubations were attempted by 35 participants in both the normal and MILS scenarios. In the normal airway, there was no difference in success rates and time to intubation. In the difficult airway with MILS, there was no difference in success rates. However, the Airtraq was associated with a longer time to intubation than the Macintosh, McCoy and iLMA, 39.3, 26.7, 23.3, 39.3, 22.8 s, respectively (P < 0.0001). The Airtraq delivered the best glottic view and lowest force of intubation in both scenarios (P < 0.0001), but was associated with the only failed intubation in the study. The McCoy was associated with a significant improvement in the glottic visualisation (P < 0.05) and reduction in the force of intubation (P <0.0001) compared with the Macintosh. CONCLUSION In this manikin study, the McCoy demonstrated multiple advantages over the Macintosh. The iLMA was associated with the fastest time to intubation and minimum force of insertion.
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Michailidou M, O’Keeffe T, Mosier JM, Friese RS, Joseph B, Rhee P, Sakles JC. A Comparison of Video Laryngoscopy to Direct Laryngoscopy for the Emergency Intubation of Trauma Patients. World J Surg 2014; 39:782-8. [DOI: 10.1007/s00268-014-2845-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios: a randomised controlled manikin study. Eur J Anaesthesiol 2014; 31:131-6. [PMID: 24145800 DOI: 10.1097/eja.0b013e32836590a7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy. OBJECTIVE The aim of the study was to compare the performance of the McGrath series 5 videolaryngoscope (McGrath videolaryngoscope) and the FFE for tracheal intubation in manikins with a simulated difficult airway, hypothesizing that the McGrath videolaryngoscope intubation would prove faster than FFE intubation. DESIGN A randomised controlled study. SETTING The Danish Institute for medical simulation between December 2009 and June 2010. PARTICIPANTS Twenty-eight anaesthesia residents participating in the Danish mandatory 3-day airway management course. INTERVENTIONS All participants received instructions and training in the use of the McGrath videolaryngoscope and FFE. The participants then performed tracheal intubation on a SimMan manikin once with the McGrath videolaryngoscope and once with the FFE in three difficult airway scenarios: (1) pharyngeal obstruction; (2) pharyngeal obstruction and cervical rigidity; (3) tongue oedema. MAIN OUTCOME MEASURES We measured successful intubations, defined as intubation within 120 s, and time to tracheal intubation. RESULTS The trachea was intubated within 120 s with the McGrath videolaryngoscope in 25 out of 27 (93%), 25 out of 28 (89%) and 18 out of 28 (64%) occasions compared with 11 out of 28 (40%), 11 out of 28 (40%) and 16 out of 28 (57%) with the FFE in scenarios (1), (2) and (3), respectively. Time to tracheal intubation was shorter with the McGrath videolaryngoscope in scenarios (1) and (2) than with the FFE (Wilcoxon signed rank sum test, P < 0.0001). CONCLUSION The McGrath videolaryngoscope is a valuable device with higher success rate and a quicker performance in simulated difficult airways. In patients, videolaryngoscopy may have a role in difficult airway algorithms, but the optimal device has yet to be found.
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Wadman MC, Dierks TW, Branecki CE, Barthold CL, Hoffman LH, Lander L, Lomneth CS, Walker RA. Comparison of Airtraq optical laryngoscope and Storz video laryngoscope in a cadaver model. World J Emerg Med 2014; 2:175-8. [PMID: 25215005 DOI: 10.5847/wjem.j.1920-8642.2011.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 08/19/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Airway management in the emergency department is a critical intervention that requires both standard techniques and rescue techniques to ensure a high rate of success. Recently, video laryngoscope (VL) systems have become increasingly common in many large urban EDs, but these systems may exceed the budgets of smaller rural EDs and EMS services and the Airtraq optical laryngoscope (OL) may provide an effective, low-cost alternative. We hypothesized that laryngeal view and time to endothracheal tube placement for OL and VL intubations would not be significantly different. METHODS This was a prospective, crossover trial. SETTING University-based emergency medicine residency program procedure laboratory utilizing lightly embalmed cadavers. SUBJECTS PGY1-3 emergency medicine residents. The study subjects performed timed endotracheal intubations alternately using the OL and VL. The subjects then rated the Cormack-Lehane laryngeal view for each device. STATISTICAL ANALYSIS Mean time to intubation and the mean laryngeal view score were calculated with 95% confidence intervals and statistical significance was determined by Student's t test. RESULTS Fourteen subjects completed the study. The average laryngeal view achieved with the OL vs. the VL was not significantly different, with Cormack-Lehane grade of 1.14 vs. 1.07, respectively. Time to endotracheal intubation, however, was significantly different (P<0.001) with the average time to intubation for the OL 25.49 seconds (95% CI: 17.95-33.03) and the VL 13.41 seconds (10.27-16.55). CONCLUSION The Airtraq OL and the Storz VL yielded similar laryngeal views in the lightly embalmed cadaver model. Time to endotracheal tube placement, however, was less for the VL.
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Affiliation(s)
- Michael C Wadman
- Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, Nebraska(Wadman MC, Branecki CE, Barthold CL, Hoffman LH, Walker RA); Deaconess Medical Center, Spokane, Washington, USA (Dierks TW); Department of Epidemiology, University of Nebraska College of Public Health, Omaha, Nebraska, USA (Lander L); Department of Genetics, Cell Biology, and Anatomy, University of Nebraska College of Medicine, Omaha, Nebraska, USA (Lomneth CS)
| | - Travis W Dierks
- Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, Nebraska(Wadman MC, Branecki CE, Barthold CL, Hoffman LH, Walker RA); Deaconess Medical Center, Spokane, Washington, USA (Dierks TW); Department of Epidemiology, University of Nebraska College of Public Health, Omaha, Nebraska, USA (Lander L); Department of Genetics, Cell Biology, and Anatomy, University of Nebraska College of Medicine, Omaha, Nebraska, USA (Lomneth CS)
| | - Chad E Branecki
- Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, Nebraska(Wadman MC, Branecki CE, Barthold CL, Hoffman LH, Walker RA); Deaconess Medical Center, Spokane, Washington, USA (Dierks TW); Department of Epidemiology, University of Nebraska College of Public Health, Omaha, Nebraska, USA (Lander L); Department of Genetics, Cell Biology, and Anatomy, University of Nebraska College of Medicine, Omaha, Nebraska, USA (Lomneth CS)
| | - Claudia L Barthold
- Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, Nebraska(Wadman MC, Branecki CE, Barthold CL, Hoffman LH, Walker RA); Deaconess Medical Center, Spokane, Washington, USA (Dierks TW); Department of Epidemiology, University of Nebraska College of Public Health, Omaha, Nebraska, USA (Lander L); Department of Genetics, Cell Biology, and Anatomy, University of Nebraska College of Medicine, Omaha, Nebraska, USA (Lomneth CS)
| | - Lance H Hoffman
- Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, Nebraska(Wadman MC, Branecki CE, Barthold CL, Hoffman LH, Walker RA); Deaconess Medical Center, Spokane, Washington, USA (Dierks TW); Department of Epidemiology, University of Nebraska College of Public Health, Omaha, Nebraska, USA (Lander L); Department of Genetics, Cell Biology, and Anatomy, University of Nebraska College of Medicine, Omaha, Nebraska, USA (Lomneth CS)
| | - Lina Lander
- Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, Nebraska(Wadman MC, Branecki CE, Barthold CL, Hoffman LH, Walker RA); Deaconess Medical Center, Spokane, Washington, USA (Dierks TW); Department of Epidemiology, University of Nebraska College of Public Health, Omaha, Nebraska, USA (Lander L); Department of Genetics, Cell Biology, and Anatomy, University of Nebraska College of Medicine, Omaha, Nebraska, USA (Lomneth CS)
| | - Carol S Lomneth
- Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, Nebraska(Wadman MC, Branecki CE, Barthold CL, Hoffman LH, Walker RA); Deaconess Medical Center, Spokane, Washington, USA (Dierks TW); Department of Epidemiology, University of Nebraska College of Public Health, Omaha, Nebraska, USA (Lander L); Department of Genetics, Cell Biology, and Anatomy, University of Nebraska College of Medicine, Omaha, Nebraska, USA (Lomneth CS)
| | - Richard A Walker
- Department of Emergency Medicine, University of Nebraska College of Medicine, Omaha, Nebraska(Wadman MC, Branecki CE, Barthold CL, Hoffman LH, Walker RA); Deaconess Medical Center, Spokane, Washington, USA (Dierks TW); Department of Epidemiology, University of Nebraska College of Public Health, Omaha, Nebraska, USA (Lander L); Department of Genetics, Cell Biology, and Anatomy, University of Nebraska College of Medicine, Omaha, Nebraska, USA (Lomneth CS)
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Durga P, Yendrapati C, Kaniti G, Padhy N, Anne KK, Ramachandran G. Effect of rigid cervical collar on tracheal intubation using Airtraq(®). Indian J Anaesth 2014; 58:416-22. [PMID: 25197109 PMCID: PMC4155286 DOI: 10.4103/0019-5049.138976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Cervical spine immobilisation with rigid cervical collar imposes difficulty in intubation. Removal of the anterior part of the collar may jeopardize the safety of the cervical spine. The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq® was evaluated. Methods: Seventy healthy adults with normal airways included in the study were intubated Using Airtraq® with (group C) and without rigid cervical collar (group NC). The ease of insertion of Airtraq® into the oral cavity, intubation time, intubation difficulty score (IDS) were compared using Wilcoxon sign ranked test and McNemar test, using SPSS version 13. Results: Intubation using Airtraq® was successful in the presence of the cervical collar in 96% which was comparable to group without collar (P = 0.24). The restriction of mouth opening resulted in mild difficulty in insertion of Airtraq®. The median Likert scale for insertion was - 1 in the group C and + 1 in group NC (P < 0.001). The intubation time was longer in group C (30 ± 14.3 s vs. 26.9 ± 14.8 s) compared to group NC. The need for adjusting manoeuvres was 18.5% in group C versus 6.2% in group NC (P = 0.003) and bougie was required in 12 (18.5%) and 4 (6.2%) patients in group C and NC, respectively, to facilitate intubation (P = 0.02). The modified IDS score was higher in group C but there was no difference in the number of patients with IDS < 2. Conclusion: Tracheal intubation using Airtraq® in the presence of rigid cervical collar has equivalent success rate, acceptable difficulty in insertion and mild increase in IDS.
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Affiliation(s)
- Padmaja Durga
- Department of Anesthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Chiranjeevi Yendrapati
- Department of Anesthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Geeta Kaniti
- Department of Anesthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Narmada Padhy
- Department of Anesthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kiran Kumar Anne
- Department of Anesthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gopinath Ramachandran
- Department of Anesthesiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Kim W, Choi HJ, Lim T, Kang BS. Can the new McGrath laryngoscope rival the GlideScope Ranger portable video laryngoscope? A randomized manikin study. Am J Emerg Med 2014; 32:1225-9. [PMID: 25171799 DOI: 10.1016/j.ajem.2014.07.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/20/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE We hypothesized that novices would be able to use the McGrath MAC (Aircraft Medical Ltd, Edinburgh, UK) equally as well as the GlideScope Ranger (Verathon, Inc, Bothell, WA) for intubation in regular simulated airways. METHODS We performed a prospective, randomized crossover study of 39 medical students using the McGrath MAC, GlideScope Ranger, and Macintosh in a manikin with 2 normal airways. The primary outcome was the intubation time. Secondary outcomes included the success rates and the overall glottic view of the 3 laryngoscopes. RESULTS The mean intubation times for each attempt with the McGrath MAC were 30.8 ± 16.9 seconds or less and did not differ significantly from those obtained with the GlideScope Ranger or the Macintosh in both airway scenarios (P = .18; P = .49). The mean success rates at each attempt with the McGrath MAC were 82.0% ± 38.8% or more, equal to the Macintosh and the GlideScope Ranger in both scenarios (P = .026; P = .72) except during the first intubation attempt in a normal airway (P = .008). The median grades of the glottic view visible at each intubation attempt with the McGrath Mac were Cormack-Lehane grade 1 (scenario 1: interquartile range, 1-1; scenario 2: interquartile range, 1-2), which was significantly better than the Macintosh laryngoscope in both scenarios. However, the McGrath Mac did not produce a better glottic view than the GlideScope Ranger with either scenario. CONCLUSIONS The intubation performance of novices using the McGrath MAC was equal to their performance using the GlideScope Ranger in regular simulated airways.
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Affiliation(s)
- Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Taeho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Kılıçaslan A, Topal A, Erol A, Uzun ST. Comparison of the C-MAC D-Blade, Conventional C-MAC, and Macintosh Laryngoscopes in Simulated Easy and Difficult Airways. Turk J Anaesthesiol Reanim 2014; 42:182-9. [PMID: 27366418 DOI: 10.5152/tjar.2014.59672] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 03/14/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Recently, to further enhance the potential in the management of difficult airways, the highly angulated D-Blade was added to the C-MAC system. The purpose of this study was to investigate the laryngoscopic view and intubation parameters using the new C-MAC D-Blade in comparison to the conventional C-MAC video laryngoscope and Macintosh direct laryngoscope in simulated easy and difficult airways. METHODS We recruited 26 experienced anaesthesia providers into a randomized trial. Each performed tracheal intubation of a Laerdal SimMan(®) manikin with each laryngoscope in the following laryngoscopy scenarios: (1) normal airway, (2) cervical spine immobilization, and (3) tongue edema. The intubation times, success rates, number of intubation attempts, laryngoscopic views, and severity of dental compression were recorded. RESULTS In all scenarios, video laryngoscopes provided better laryngeal exposure than the ML and appeared to produce less dental pressure. In the cervical spine immobilization scenario, D-Blade caused less dental pressure and showed better Cormack-Lehane (CL) classes than the other devices (p<0.001). There were no differences between video laryngoscopes in success of tracheal intubation (p>0.05). The CMAC provided the most rapid intubation. The rate of failure was 19% with ML. In the tongue edema scenario, the CMAC provided the most rapid and successful intubation (p<0.001). There were no differences between video laryngoscopes in laryngoscopic views according to CL classification and dental pressure (p>0.05). The rate of failure was 46% with the ML and 7% with the D-Blade. CONCLUSION The CMAC D-Blade caused less dental pressure than the conventional C-MAC and ML in the cervical immobilization scenario. The conventional CMAC performed better than the D-Blade and ML in the tongue edema scenario. These two video laryngoscopes may complement each other in various difficult airway situations.
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Affiliation(s)
- Alper Kılıçaslan
- Department of Anaesthesiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Ahmet Topal
- Department of Anaesthesiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Atilla Erol
- Department of Anaesthesiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Sema Tuncer Uzun
- Department of Anaesthesiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Murphy LD, Kovacs GJ, Reardon PM, Law JA. Comparison of the King Vision Video Laryngoscope with the Macintosh Laryngoscope. J Emerg Med 2014; 47:239-46. [DOI: 10.1016/j.jemermed.2014.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/30/2013] [Accepted: 02/09/2014] [Indexed: 02/07/2023]
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Bhola R, Bhalla S, Gupta R, Singh I, Kumar S. Tracheal intubation in patients with cervical spine immobilization: A comparison of McGrath(®) video laryngoscope and Truview EVO2(®) laryngoscope. Indian J Anaesth 2014; 58:269-74. [PMID: 25024468 PMCID: PMC4090991 DOI: 10.4103/0019-5049.135035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Literature suggests that glottic view is better when using McGrath(®) Video laryngoscope and Truview(®) in comparison with McIntosh blade. The purpose of this study was to evaluate the effectiveness of McGrath Video laryngoscope in comparison with Truview laryngoscope for tracheal intubation in patients with simulated cervical spine injury using manual in-line stabilisation. METHODS This prospective randomised study was undertaken in operation theatre of a tertiary referral centre after approval from the Institutional Review Board. A total of 100 consenting patients presenting for elective surgery requiring tracheal intubation were randomly assigned to undergo intubation using McGrath(®) Video laryngoscope (n = 50) or Truview(®) (n = 50) laryngoscope. In all patients, we applied manual-in-line stabilisation of the cervical spine throughout the airway management. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. Demographic data, airway assessment and haemodynamics were compared using the Chi-square test. A P < 0.05 was considered significant. RESULTS The time to successful intubation was less with McGrath video laryngoscope when compared to Truview (30.02 s vs. 38.72 s). However, there was no significant difference between laryngoscopic views obtained in both groups. The number of second intubation attempts required and incidence of complications were negligible with both devices. Success rate of intubation with both devices was 100%. Intubation with McGrath Video laryngoscope caused lesser alterations in haemodynamics. CONCLUSIONS Both laryngoscopes are reliable in case of simulated cervical spine injury using manual-in-line stabilisation with 100% success rate and good glottic view.
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Affiliation(s)
- Ruchi Bhola
- Department of Anaesthesiology, Jaipur Golden Hospital, Rohini, New Delhi, India
| | - Swaran Bhalla
- Department of Anaesthesiology, Jaipur Golden Hospital, Rohini, New Delhi, India
| | - Radha Gupta
- Department of Anaesthesiology, Jaipur Golden Hospital, Rohini, New Delhi, India
| | - Ishwar Singh
- Department of Anaesthesiology, Jaipur Golden Hospital, Rohini, New Delhi, India
| | - Sunil Kumar
- Department of Anaesthesiology, Max Hospital, Pitampura Branch, New Delhi, India
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Khandelwal N, Galgon RE, Ali M, Joffe AM. Cardiac arrest is a predictor of difficult tracheal intubation independent of operator experience in hospitalized patients. BMC Anesthesiol 2014; 14:38. [PMID: 24904233 PMCID: PMC4046074 DOI: 10.1186/1471-2253-14-38] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background Placement of advanced airways has been associated with worsened neurologic outcome in survivors of out-of-hospital cardiac arrest. These findings have been attributed to factors such as inexperienced operators, prolonged intubation times and other airway related complications. As an initial step to examine outcomes of advanced airway placement during in-hospital cardiac arrest (IHCA), where immediate assistance and experienced operators are continuously available, we examined whether cardiopulmonary resuscitation efforts affect intubation difficulty. Additionally, we examined whether or not the use of videolaryngoscopy increases the odds of first attempt intubation success compared with traditional direct laryngoscopy. Methods The study setting is a large urban university-affiliated teaching hospital where experienced airway managers are available to perform emergent intubation for any indication in any out-of-the-operating room location 24 hours a day, 7 days-a-week, 365 days-a-year. Intubations occurring in all adults >18 years-of-age who required emergent tracheal intubation outside of the operating room between January 1, 2008 and December 31, 2012 were examined retrospectively. Multivariate logistic regression was used to estimate the odds of difficult intubation during IHCA compared to other emergent non-IHCA indications with adjustment for a priori defined potential confounders (body mass index, operator experience, use of videolaryngoscopy versus direct laryngoscopy, and age). Results In adjusted analyses, the odds of difficult intubation were higher when taking place during IHCA (OR=2.63; 95% CI 1.1-6.3, p=0.03) compared to other emergent indications. Use of video versus direct laryngoscopy for initial intubation attempts during IHCA, however, did not improve the odds of success (adjusted OR = 0.71; 95% CI 0.35-1.43, p = 0.33). Conclusions Difficult intubation is more likely when intubation takes place during IHCA compared to other emergent indications, even when experienced operators are available. Under these conditions, direct laryngoscopy (versus videolaryngoscopy) remains a reasonable first choice intubation technique.
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Affiliation(s)
- Nita Khandelwal
- University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359724, Seattle, WA 98104, USA
| | - Richard E Galgon
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Marwan Ali
- Northeast Ohio Medical University, School of Medicine, Rootstown, OH, USA
| | - Aaron M Joffe
- University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359724, Seattle, WA 98104, USA
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Marshall EM, O'Loughlin E, Swann AD. First comparison of the Venner(TM) A.P. Advance(TM) versus the Macintosh laryngoscope for intubations by non-anaesthetists: a manikin study. Emerg Med Australas 2014; 26:262-7. [PMID: 24720848 DOI: 10.1111/1742-6723.12213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The present study aims to study whether using a videolaryngoscope (A.P. Advance™) facilitates or hinders intubation by non-anaesthetists inexperienced in its use. METHODS Thirty doctors from Emergency and Intensive Care Medicine backgrounds performed laryngoscopy and tracheal intubation using the Macintosh laryngoscope (MAC), A.P. Advance™ Normal Blade (AP N) and A.P. Advance™ Difficult Airway Blade (AP DAB) in simulated normal and difficult airway manikins. The primary outcomes measured were time to successful tracheal intubation and failure to intubate within 3 min or three attempts. Secondary outcomes were number of intubation attempts, adjuncts used, glottic view and ease of intubation. RESULTS There was a higher rate of failed intubation in the simulated difficult airway in participants using the AP N blade than either the MAC or AP DAB (23% vs 3% and 7%, P = 0.031). This was associated with a longer median time to intubate with the AP N and the AP DAB versus MAC (56.6, 50.2 vs 39.9 s, P = 0.007 and P = 0.041). In the normal airway median time to intubate was longest with the AP N (27.8 s), and this was significantly slower than the MAC (18.1 s, P = 0.003) and the AP DAB (17.3 s, P < 0.001). No one failed to intubate the normal manikin. CONCLUSIONS The use of the A.P. Advance™ videolaryngoscope should not be considered, without adequate prior training and experience, in the management of a difficult airway. The level of adequate training has yet to be established.
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Affiliation(s)
- Elizabeth M Marshall
- Department of Anaesthesia, Glasgow Royal Infirmary and Stobhill ACH, Glasgow, UK
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Najafi A, Imani F, Makarem J, Khajavi MR, Etezadi F, Habibi S, Shariat Moharari R. Postoperative sore throat after laryngoscopy with macintosh or glide scope video laryngoscope blade in normal airway patients. Anesth Pain Med 2014; 4:e15136. [PMID: 24660157 PMCID: PMC3961026 DOI: 10.5812/aapm.15136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/17/2013] [Accepted: 11/27/2013] [Indexed: 12/01/2022] Open
Abstract
Background: The Glide Scope videolaryngoscope provides a suitable view for intubation, with less force required. Objectives: The present study was conducted, to compare postoperative sore throat and hoarseness after laryngoscopy and intubation, by Macintosh blade or Glide Scope video laryngoscope in normal airway patients. Patients and Methods: Three hundred patients were randomly allocated into two groups of 150: Macintosh blade laryngoscope or Glide Scope video laryngoscope. The patients were evaluated for 48 hours for sore throat and hoarseness by an interview. Results: The incidence and severity of sore throat in the Glide Scope group, at 6, 24 and 48 hours after the operation, were significantly lower than in the Macintosh laryngoscope group. In addition, the incidence of hoarseness in the Glide Scope group, at 6 and 24 hours after the operation, were significantly lower than in the Macintosh laryngoscope group. The incidence and severity of sore throat in men, at 6 and 24 hours after the operation, were significantly lower than in the women. Conclusions: The incidence and severity of sore throat and hoarseness after tracheal intubation by Glide Scope were lower than in the Macintosh laryngoscope. The incidence and severity of sore throat were increased by intubation and longer operation times.
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Affiliation(s)
- Atabak Najafi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farsad Imani
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Jalil Makarem
- Department of Anesthesiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Khajavi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Etezadi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Habibi
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shariat Moharari
- Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Reza Shariat Moharari, Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9123088460, Fax: +98-2144696415, E-mail:
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