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Kumar A, Gupta N, Bhargava T, Gupta A, Kumar V, Bharti SJ, Garg R, Mishra S, Bhatnagar S, Malhotra RK. A comparative evaluation of fibreoptic bronchoscopy versus C-MAC ® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients. Can J Anaesth 2024; 71:503-510. [PMID: 38243098 DOI: 10.1007/s12630-023-02687-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/14/2023] [Accepted: 10/28/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE Nasotracheal intubation (NTI) is required for surgery in oropharyngeal (OP) carcinoma patients, but it may be challenging because of distorted anatomy, mucosal congestion, and increased risk of bleeding. Flexible bronchoscopy (FB)-guided NTI is preferred in these cases but has limitations. In this randomized controlled study, we sought to compare C-MAC® D-BLADE-guided videolaryngoscopy (VL) (Karl Storz SE & Co. KG, Tuttlingen, Germany) with FB for NTI under general anesthesia in patients with OP carcinomas. METHODS We randomized a total of 100 patients with OP carcinoma and El-Ganzouri's risk index (EGRI) < 7 to undergo NTI under general anesthesia with FB (n = 50) or C-MAC D-BLADE-guided VL (n = 50). The primary outcome was the total intubation time. We also recorded the time to glottis view, nasal intubation difficulty scale (NIDS) score, best percentage of glottis opening score, and complications. RESULTS The median [interquartile range (IQR)] total intubation time was shorter with VL than with FB (total intubation time, 38 [26-43] sec vs 60 [52-65] sec; difference, -20 sec [95% confidence interval (CI), -27 to -11]; P < 0.001). Similarly, the median [IQR] time to glottis view was shorter with VL compared to FB (8 [6-9] sec vs 22 [14-25] sec; difference, -13 sec [95% CI, -17 to -10]; P < 0.001). The median NIDS score was higher with VL (difference, 2 [95% CI, 2 to 3]; P < 0.001). The incidences of airway trauma (two cases with FB vs seven with VL; P = 0.30) and postoperative sore throat (ten cases in both groups; P = 0.56) were similar. CONCLUSION Compared to FB, C-MAC D-BLADE-based VL reduced the total time for nasal intubation oropharyngeal carcinoma patients, potentially representing an acceptable alternative in selected cases. TRIAL REGISTRATION CTRI.nic.in (2018/11/0162830); first submitted 8 November 2018.
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Affiliation(s)
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India.
- Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Room No. 139, First Floor, Ansari Nagar, New Delhi, India.
| | - Tanvi Bhargava
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anju Gupta
- Department of Anesthesia, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand Jee Bharti
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anesthesiology & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev K Malhotra
- Delhi Cancer Registry, All India Institute of Medical Sciences, New Delhi, India
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Ardak Z TL, Arslan ZP, Cesur S, Aksu B. Comparison of haemodynamic response to tracheal intubation with two different videolaryngoscopes: A randomized clinical trial. Braz J Anesthesiol 2023; 73:548-555. [PMID: 34384793 PMCID: PMC10533975 DOI: 10.1016/j.bjane.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Endotracheal intubation (ETI), which is the gold standard in coronary artery bypass grafting (CABG), may cause myocardial ischaemia by disturbing the balance between haemodynamic changes and oxygen supply and consumption of the myocardium as a result of sympathetic stimulation. In this study, we aimed to compare two different videolaryngoscopes (C-MAC and Airtraq) in the hemodynamic response to ETI. METHODS Fifty ASA II...III CABG surgery patients were randomly assigned to C-MAC or Airtraq. The hemodynamic data included arterial blood pressure [systolic (SAP), diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at six different points in time: before laryngoscopy-T1, during laryngoscopy-T2, immediately after intubation-T3, and 3 (T4), 5 (T5) and 10 (T6) minutes after intubation. Intraoperative complications were recorded. Patients were questioned about postoperative complications 2 and 24...hours following extubation. RESULTS The hemodynamic response to ETI was significantly greater with C-MAC. The increase in HR started with the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started immediately after ETI (p...=...0.024; p...=...0.012; p...=...0.030; p...=...0.009, respectively). In group analyses, T1...T2, T2...T3 and T1...T3 comparisons did not show any significant differences in HR with Airtraq. However, with C-MAC, HR after intubation increased significantly compared to the pre-laryngoscopy values (T1...T3) (p...=...0.004). The duration of laryngoscopy was significantly reduced with C-MAC (p...<...0.001), but the duration of intubation and total intubation were similar (p...=...0.36; p...=...0.79). CONCLUSIONS Compared to C-MAC, the hemodynamic response to ETI was less with Airtraq. Thus, Airtraq may be preferred in CABG patients for ETI.
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Affiliation(s)
- T Lay Ardak Z
- Kocaeli University of Medical Faculty, Department of Anesthesiology and Reanimation, ..zmit, Turkey.
| | - Z Pek Arslan
- Kocaeli University of Medical Faculty, Department of Anesthesiology and Reanimation, ..zmit, Turkey
| | - Sevim Cesur
- Kocaeli University of Medical Faculty, Department of Anesthesiology and Reanimation, ..zmit, Turkey
| | - Bar Aksu
- Kocaeli University of Kand..ra Vocational School, ..zmit, Turkey
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Abhyankar P, Sabharwal N, Gupta A, Das AK. Comparative evaluation of C-MAC and McGrath MAC videolaryngoscopes with Macintosh direct laryngoscope for endotracheal intubation in adult patients undergoing elective surgeries. J Anaesthesiol Clin Pharmacol 2023; 39:422-428. [PMID: 38025548 PMCID: PMC10661630 DOI: 10.4103/joacp.joacp_451_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Videolaryngoscopes have an undisputed role in difficult airway management, but their role in routine intubation scenarios remains underappreciated. McGrath MAC is a lightweight laryngoscope with a disposable blade. It remains to be proven if it performs as efficiently as the reusable videolaryngoscopes like C-MAC and whether it has an advantage over standard Macintosh laryngoscope in predicted normal airways. Material and Methods We recruited 180 adult patients and randomly divided them into three groups for intubation with either Macintosh laryngoscope (Group-A), C-MAC (Group-B), and McGrath (Group-C). The primary objective was to compare the first attempt success rate. Secondary objectives included Cormack-Lehane (CL) grades, laryngoscopy time, intubation time, ease of intubation, need for optimization manoeuver, and the number of passes to place the endotracheal tube. Results The two videolaryngoscopes provided a superior first attempt success rate as compared to Macintosh laryngoscope (P = 0.027). The CL grade-I was 100% in group B, 41.7% in group-A and 90% in group-C (B vs C; P = 0.037). Laryngoscopy time was 9.9 ± 2.5 s, 12.6 ± 0.8 s, and 13.1 ± 0.8 s for groups A, B, and C, respectively (B vs C; P = 0.001). Intubation time was 24.4 ± 12 s, 28.3 ± 1.9 s, and 37.3 ± 5.8 s for groups A, B, and C, respectively (P < 0.0001). The number of tube passes was highest in group C. Conclusion Videolaryngoscopes provided a superior glottic view and resulted in a superior first attempt success rate as compared to Macintosh laryngoscope. When comparing the two videolaryngoscopes, C-MAC resulted in better intubation characteristics (shorter intubation time, better glottic views, and higher first-attempt success rates) and should be preferred over McGrath for intubation in adult patients with normal airways.
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Affiliation(s)
- Prachi Abhyankar
- Department of Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Nikki Sabharwal
- Department of Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
| | - Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Akshaya K. Das
- Department of Anaesthesiology and Intensive Care, VMMC and Safdarjung Hospital, New Delhi, India
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Kriege M, Noppens RR, Turkstra T, Payne S, Kunitz O, Tzanova I, Schmidtmann I. A multicentre randomised controlled trial of the McGrath Mac videolaryngoscope versus conventional laryngoscopy. Anaesthesia 2023; 78:722-729. [PMID: 36928625 DOI: 10.1111/anae.15985] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/18/2023]
Abstract
Before completion of this study, there was insufficient evidence demonstrating the superiority of videolaryngoscopy compared with direct laryngoscopy for elective tracheal intubation. We hypothesised that using videolaryngoscopy for routine tracheal intubation would result in higher first-pass tracheal intubation success compared with direct laryngoscopy. In this multicentre randomised trial, 2092 adult patients without predicted difficult airway requiring tracheal intubation for elective surgery were allocated randomly to either videolaryngoscopy with a Macintosh blade (McGrath) or direct laryngoscopy. First-pass tracheal intubation success was higher with the McGrath (987/1053, 94%), compared with direct laryngoscopy (848/1039, 82%); absolute risk reduction (95%CI) was 12.1% (10.9-13.6%). This resulted in a relative risk (95%CI) of unsuccessful tracheal intubation at first attempt of 0.34 (0.26-0.45; p < 0.001) for McGrath compared with direct laryngoscopy. Cormack and Lehane grade ≥ 3 was observed more frequently with direct laryngoscopy (84/1039, 8%) compared with McGrath (8/1053, 0.7%; p < 0.001) No significant difference in tracheal intubation-associated adverse events was observed between groups. This study demonstrates that using McGrath videolaryngoscopy compared with direct laryngoscopy improves first-pass tracheal intubation success in patients having elective surgery. Practitioners may consider using this device as first choice for tracheal intubation.
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Affiliation(s)
- M Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - R R Noppens
- Department of Anesthesia and Peri-operative Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, ON, London, Canada
| | - T Turkstra
- Department of Anesthesia and Peri-operative Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, ON, London, Canada
| | - S Payne
- Department of Anaesthesia, Emergency and Intensive Care Medicine, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - O Kunitz
- Department of Anaesthesiology, Christophorus Hospital, Coesfeld, Germany
| | - I Tzanova
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Germany
| | - I Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Germany
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Chun EH, Chung MH, Kim JE, Kim KM, Lee HS, Son JM, Park J, Jun JH. Effects of head-elevated position on tracheal intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway: a prospective randomized crossover study. BMC Anesthesiol 2022; 22:166. [PMID: 35637437 DOI: 10.1186/s12871-022-01706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background The head-elevated laryngoscopy position has been described to be optimal for intubation, particularly in obese patients and those with anticipated difficult airways. Horizontal alignment of the external auditory meatus and sternal notch (AM-S) can be used as endpoints for optimal positioning. Thus, we aligned the head-elevated position with the AM-S in the horizontal plane and evaluated its effect on laryngeal visualization and ease of intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway. Methods Sixty-four patients were included in this prospective, crossover, randomized controlled trial. A cervical collar was used to restrict neck movement and mouth opening. The head-elevated position was achieved by raising the back section of the operation room table and ensuring that the end point was horizontally aligned with the AM-S (table-ramp method). The laryngeal view was randomly assessed in both head-flat and head-elevated positions based on the percentage of glottic opening (POGO) score and modified Cormack–Lehane (MCL) grade. External laryngeal manipulation was not permitted when laryngeal visualization was scored. The trachea was intubated only once (in the second position). The ease of intubation was assessed based on the need for optimization maneuvers, intubation difficulty scale (IDS) scores and time to intubation. Results The mean table-ramp angle required to achieve the horizontal alignment of AM-S was 17.5 ± 4.1°. The mean POGO score improved significantly in the head-elevated position (59.4 ± 23.8%) when compared with the head-flat position (37.5 ± 24%) (P < 0.0001). MCL grade 1 or 2a was achieved in 56 (85.9%) and 28 (43.7%) of patients in the head-elevated and head-flat positions, respectively (P < 0.0001). Optimization maneuvers for intubation were required in 7 (21.9%) and 17 (53.1%) patients in the head-elevated and head-flat positions, respectively (P < 0.0001). The IDS scores and time to intubation did not differ significantly between the two positions. Conclusion In the head-elevated position, aligning the AM-S in the horizontal plane consistently improved laryngeal visualization without worsening the view when the McGrath MAC videolaryngoscope was used in patients with simulated difficult airways. It also improved the ease of intubation, which reduced the need for optimization maneuvers. Trial registration This trial was registered with www.clinicaltrials.gov, NCT04716218, on 20/01/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01706-5.
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Kida K, Sugimoto Y, Sato T. Use of a Bougie vs Endotracheal Tube With Stylet and Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation. JAMA 2022; 327:1503. [PMID: 35438735 DOI: 10.1001/jama.2022.2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Kotaro Kida
- Jikei University School of Medicine, Tokyo, Japan
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Lee J, Cho Y, Kim W, Choi K, Jang B, Shin H, Ahn C, Kim JG, Na MK, Lim TH, Kim DW. Comparisons of Videolaryngoscopes for Intubation Undergoing General Anesthesia: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. J Pers Med 2022; 12:363. [PMID: 35330362 PMCID: PMC8954588 DOI: 10.3390/jpm12030363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/12/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The efficacy and safety of videolaryngoscopes (VLs) for tracheal intubation is still conflicting and changeable according to airway circumstances. This study aimed to compare the efficacy and safety of several VLs in patients undergoing general anesthesia. Methods: Medline, EMBASE, and the Cochrane Library were searched until 13 January 2020. The following VLs were evaluated compared to the Macintosh laryngoscope (MCL) by network meta-analysis for randomized controlled trials (RCTs): Airtraq, Airwayscope, C-MAC, C-MAC D-blade (CMD), GlideScope, King Vision, and McGrath. Outcome measures were the success and time (speed) of intubation, glottic view, and sore throat (safety). Results: A total of 9315 patients in 96 RCTs were included. The highest-ranked VLs for first-pass intubation success were CMD (90.6 % in all airway; 92.7% in difficult airway) and King Vision (92% in normal airway). In the rank analysis for secondary outcomes, the following VLs showed the highest efficacy or safety: Airtraq (safety), Airwayscope (speed and view), C-MAC (speed), CMD (safety), and McGrath (view). These VLs, except McGrath, were more effective or safer than MCL in moderate evidence level, whereas there was low certainty of evidence in the intercomparisons of VLs. Conclusions: CMD and King Vision could be relatively successful than MCL and other VLs for tracheal intubation under general anesthesia. The comparisons of intubation success between VLs and MCL showed moderate certainty of evidence level, whereas the intercomparisons of VLs showed low certainty evidence.
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Dean P, Kerrey B. Video screen visualization patterns when using a video laryngoscope for tracheal intubation: A systematic review. J Am Coll Emerg Physicians Open 2022; 3:e12630. [PMID: 35028640 PMCID: PMC8738719 DOI: 10.1002/emp2.12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Published studies of video laryngoscopes are often limited by the lack of a clear definition of video laryngoscopy (VL). We performed a systematic review to determine how often published studies of VL report on video screen visualization. METHODS We searched PubMed, EMBASE and Scopus for interventional and observational studies in which a video laryngoscope equipped with a standard geometry blade was used for tracheal intubation. We excluded simulation based studies. Our primary outcome was data on video laryngoscope screen visualization. Secondary outcomes were explicit methodology for screen visualization. RESULTS We screened 4838 unique studies and included 207 (120 interventional and 87 observational). Only 21 studies (10% of 207) included any data on video screen visualization by the proceduralist, 19 in a yes/no fashion only (ie, screened viewed or not) and 2 with detail beyond whether the screen was viewed or not. In 11 more studies, visualization patterns could be inferred based on screen availability and in 16 more studies, the methods section stated how screen visualization was expected to be performed without reporting data collection on how the proceduralist interacted with the video screen. Risk of bias was high in the majority of included studies. CONCLUSIONS Published studies of VL, including many clinical trials, rarely include data on video screen visualization. Given the nuances of using a video laryngoscope, this is a critical deficiency, which largely prevents us from knowing the treatment effect of using a video laryngoscope in clinical practice. Future studies of VL must address this deficiency.
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Affiliation(s)
- Preston Dean
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Benjamin Kerrey
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Ozdemirkan A, Onal O, Ozcan IG, Aslanlar E, Saltali A, Sari M, Ciftci C, Bayram HH. Comparison of the intubation success rate between the intubating catheter and videolaryngoscope in difficult airways: a prospective randomized trial. Braz J Anesthesiol 2022; 72:55-62. [PMID: 33991552 PMCID: PMC9373587 DOI: 10.1016/j.bjane.2021.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several devices and algorithms have already been examined and compared for difficult airway management. However, there is no existing study comparing the success of the Intubating Catheter (IC) and the Videolaryngoscope (VL) in patients who are difficult to intubate. We aimed to compare Frova IC and McGrath VL in terms of intubation success rates in patients with difficult intubation. METHODS This prospective, randomized study was performed in an university hospital. Patients who underwent an operation under general anesthesia and whom airway management process was deemed difficult were included in this study. Patients were randomly divided into two groups by envelopes containing a number: the intubating catheter group (Group IC), intubated using the Frova IC, and the videolaryngoscope group (Group VL), intubated using the McGrath VL. Study data were collected by a technician who was blind to the study groups and the type of device used in the intubation procedure. RESULTS A total of 49 patients with difficult airway were included in the study, including 25 patients in the Frova IC Group and 24 patients in the McGrath VL Group. The rate of successful intubation was determined to be 88% in Group IC and 66% in Group VL (p = 0.074). The mean duration of intubation attempt in Group VL was 44.62 seconds, whereas in Group IC, it was 51.12 seconds (p = 0.593). Group VL was found to have a significantly lower Cormack-Lehane grade compared to Group IC (p < 0.001). CONCLUSION Frova IC is a candidate to be an indispensable instrument in terms of cost-effectiveness in clinics such as anesthesia and emergency medicine, where difficult intubation cases are frequently encountered. However, the combination of Frova IC and McGrath VL seems to be more successful in difficult intubation situations, so future studies should focus on using these two devices together.
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Affiliation(s)
- Aysun Ozdemirkan
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Konya, Turkey
| | - Ozkan Onal
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Konya, Turkey; Cleveland Clinic Main Hospital, Anesthesiology Institute, Department of Outcomes Research, Cleveland, Ohio, USA.
| | - Irem Gumus Ozcan
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Konya, Turkey
| | - Emine Aslanlar
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Konya, Turkey
| | - Ali Saltali
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Konya, Turkey
| | - Mehmet Sari
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Konya, Turkey
| | - Cansu Ciftci
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Konya, Turkey
| | - Hasan Huseyin Bayram
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Intensive Care, Konya, Turkey
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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 301] [Impact Index Per Article: 150.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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Ozkan AS, Akbas S, Karaaslan E, Polat N. Comparison of the effects of the McGRATH MAC, C-MAC, and Macintosh laryngoscopes on the intraocular pressures of non-ophthalmic patients: A prospective, randomised, clinical trial. Anaesth Crit Care Pain Med 2021; 40:100974. [PMID: 34740845 DOI: 10.1016/j.accpm.2021.100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/01/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In this prospective, randomised study, we compared the effects of the Macintosh, McGRATH MAC, and C-MAC laryngoscopes on intraocular pressure (IOP) and haemodynamics of non-ophthalmic patients during endotracheal intubation. METHODS One hundred and twenty adult patients undergoing non-ophthalmic surgeries performed in the supine position under general anaesthesia requiring orotracheal intubation were included in this study. The patients were separated randomly and prospectively into 3 groups: Macintosh group (n = 40), McGRATH MAC group (n = 40), and C-MAC group (n = 40). Mean arterial pressure (MAP), heart rate (HR) and IOP of left and right eye were measured at specified times. RESULTS There were no significant differences with regard to patients characteristics. After intubation, the HR increased significantly in the Macintosh group when compared to the other groups (p = 0.001) and the MAP increased significantly in the Macintosh group when compared to the McGRATH MAC group (p = 0.001) and the C-MAC group (p < 0.001). The IOP values increased in the Macintosh group when compared to the McGRATH MAC group (p < 0.001) and the C-MAC group (p < 0.001) after intubation. Additionally, there was a significant difference between the McGRATH MAC group and C-MAC group in the IOP values of the eyes after intubation (p < 0.001). According to the evaluation within the groups, there were significant differences in all of the groups at all times when compared with the baseline values (p < 0.001). CONCLUSIONS In this study, we concluded that the C-MAC VL may be preferable when compared to the Macintosh and McGRATH MAC laryngoscopes for use in ophthalmic patients in whom a rise in the IOP is undesirable.
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Affiliation(s)
- Ahmet Selim Ozkan
- Department of Anaesthesiology and Reanimation, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sedat Akbas
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey.
| | - Erol Karaaslan
- Department of Anaesthesiology and Reanimation, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Nihat Polat
- Department of Opthalmology, Inonu University Faculty of Medicine, Malatya, Turkey
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Serkan Ö, Adem D, Nur AB. Comparison of direct laryngoscopy and video-assisted laryngoscopy in pediatric intensive care unit. Arch Pediatr 2021; 28:658-662. [PMID: 34686426 DOI: 10.1016/j.arcped.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/06/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Our objective was to compare video-assisted laryngoscopy (VAL) with direct laryngoscopy (DL) for glottic visualization in a pediatric intensive care unit in terms of the success rate in first attempts. Our study included patients aged from 1 month to 18 years who were admitted to the pediatric intensive care unit. We excluded patients with limited neck extension (C-spine immobilization, congenital abnormality), congenital anomalies (e.g., Pierre Robin syndrome, micrognathia, macroglossia), and recent airway surgery. Patients were premedicated before intubation. The time to intubation was defined as the time between the start of anesthesia and completion of intubation. The start of anesthetic induction was defined as the time the sedative was first administered. Completion of intubation was defined as the time that the end-tidal carbon dioxide tension was detected. We evaluated 120 of 135 intubations that met our inclusion criteria; 15 were excluded because in eight cases (53%) non-pediatric intensive care physicians made the initial attempts, and in seven cases (47%) the recorded intubation times were erroneous. We detected significantly higher POGO scores in the VAL group (p<0.001). VAL provided a fuller view of the glottis (Cormack and Lehane grade 1) than DL (p<0.001). Although the intubation attempts in the DL group were significantly higher (two or more attempts), no intubation failures occurred in either group.
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Affiliation(s)
- Özsoylu Serkan
- Erciyes University Medical Faculty, Department of Pediatrics, Division of Pediatric Intensive Care Unit, Kayseri, Turkey.
| | - Dursun Adem
- Erciyes University Medical Faculty, Department of Pediatrics, Division of Pediatric Intensive Care Unit, Kayseri, Turkey
| | - Akyıldız Başak Nur
- Erciyes University Medical Faculty, Department of Pediatrics, Division of Pediatric Intensive Care Unit, Kayseri, Turkey
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Zhang J, Tan LZ, Toh H, Foo CW, Wijeratne S, Hu H, Seet E. Comparing the first-attempt tracheal intubation success of the hyperangulated McGrath® X-blade vs the Macintosh-type CMAC videolaryngoscope in patients with cervical immobilization: a two-centre randomized controlled trial. J Clin Monit Comput 2021; 36:1139-1145. [PMID: 34347225 DOI: 10.1007/s10877-021-00746-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Abstract
We compared the hyperangulated McGrath X-blade with the Macintosh-type CMAC videolaryngoscope through the use of manual in-line stabilization on patients. The primary hypothesis was that the McGrath X-blade has a similar first-attempt success rate as the CMAC videolaryngoscope. 210 patients of ASA physical status I to III, aged 21 to 80 years old, undergoing general anesthesia requiring tracheal intubation were prospectively recruited into this two-centre randomized controlled trial, from June 2016 to April 2019. Patients with history of or predicted difficult airway, pre-existing dental risks, BMI > 35 kg/m2, cervical spondylosis or myelopathy, aspiration risks, patients who declined to participate or lacked the mental capacity to give consent were excluded. Participants were intubated using either hyperangulated McGrath X-blade (MGX) or Macintosh-type CMAC (CM) videolaryngoscopy, with manual in-line stabilization. Primary outcome measured was first-attempt tracheal intubation success. Secondary outcomes included overall successful intubation within 2 attempts or 120 s, time to intubation, glottic view obtained and intubation-related complications. First-attempt success rates were 71.4% in the MGX group vs. 79.0% in the CM group (p = 0.26), with an absolute difference of -7.6% (95%CI -20%, 5.0%, p value = 0.26), but this trial was underpowered to detect a difference. Overall success was 91.4% (MGX) vs. 92.4% (CM) (p > 0.99). The Cormack & Lehane laryngeal grade was superior in the MGX group compared to CM group (Grade I: MGX 44%, CM 23%; Grade II: MGX 53%, CM 45%; Grade III: MGX 3%, CM 32%; p < 0.001). The median time to intubation using the MGX was longer than the CM [MGX 55.5 s (42.1-78.3), CM 43.8 s (38-55.3); p < 0.001]. Our study did not demonstrate a significant difference in efficacy between the McGrath X-blade and the CMAC videolaryngoscope. In patients with manual in-line stabilization, no anticipated airway difficulty and in the hands of experienced operators, the McGrath X-blade provided superior glottic views but conferred no advantage over the C-MAC, with a longer median time to intubation compared to the CMAC videolaryngoscope.Trial registration: Australian New Zealand Clinical Trial Registry (ACTRN12616000668404).
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Affiliation(s)
- Jinbin Zhang
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Leng Zoo Tan
- Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Han Toh
- Woodlands Health Campus, 2 Yishun Central 2, Tower E, Level 5, Singapore, 768024, Singapore
| | - Chek Wun Foo
- Woodlands Health Campus, 2 Yishun Central 2, Tower E, Level 5, Singapore, 768024, Singapore
| | - Sujani Wijeratne
- Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Hilda Hu
- Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Edwin Seet
- Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
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Huang P, Zhou R, Lu Z, Hang Y, Wang S, Huang Z. GlideScope® versus C-MAC®(D) videolaryngoscope versus Macintosh laryngoscope for double lumen endotracheal intubation in patients with predicted normal airways: a randomized, controlled, prospective trial. BMC Anesthesiol 2020; 20:119. [PMID: 32434470 PMCID: PMC7238523 DOI: 10.1186/s12871-020-01012-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The double lumen endotracheal tube (DLT) is the most widely-used device for single lung ventilation in current thoracic anesthesia practice. In recent years, the routine application of the videolaryngoscope for single lumen endotracheal intubation has increased; nevertheless there are few studies of the use of the videolaryngoscope for DLT. We wondered whether there were benefits to using the videolaryngoscope for DLT placement in patients with predicted normal airways. Therefore, this study was designed to compare the performances of the GlideScope®, the C-MAC®(D) videolaryngoscope and the Macintosh laryngoscope in DLT intubation. METHODS This was a randomized, controlled, prospective study. We randomly allocated 90 adult patients with predicted normal airways into three groups. All patients underwent routine anesthesia using different laryngoscopes according to group allocation. We compared DLT insertion times, first-pass success rates, numerical rating scales (NRS) of DLT delivery and DLT insertion, Cormack-Lehane degrees (C/L), hemodynamic changes and incidences of intubation complications. All outcomes were analyzed using SPSS13.0. RESULTS Compared with the GlideScope, the Macintosh gave shorter times for DLT insertion (median: 96 (IQR: 51 [min-max: 62-376] s vs 73 (26 [48-419] s, p = 0.003); however, there was no difference between the Macintosh and C-MAC(D) (p = 0.610). The Macintosh had a significantly higher successful first attempt rate than did the GlideScope or C-MAC(D) (p = 0.001, p = 0.028, respectively). NRS of DLT delivery and insertion were significantly lower in the Macintosh than in the others (p < 0.001). However, the C/L degree in the Macintosh was significantly higher than in the others (p < 0.001). The incidences of oral bleeding, hoarseness, sore throat and dental trauma were low in all groups (p > 0.05). There were no significant differences in DLT misplacement, fiberoptic time or hemodynamic changes among the groups. CONCLUSIONS Compared with the Macintosh laryngoscope, the GlideScope® and C-MAC®(D) videolaryngoscopes may not be recommended as the first choice for routine DLT intubation in patients with predicted normal airways. TRIAL REGISTRATION The study was prospectively registered at the Chinese Clinical Trial Registry (no. ChiCTR1900025718); principal investigator: Z.L.H.; date of registration: September 6, 2019.
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Affiliation(s)
- Ping Huang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China
| | - Renlong Zhou
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China
| | - Zhixing Lu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China
| | - Yannan Hang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China
| | - Shanjuan Wang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China.
| | - Zhenling Huang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China.
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Çakir M, Özyurt E. Comparison of direct laryngoscope and McGrath videolaryngoscope in terms of glottic view and hemodynamics in bariatric surgery. Turk J Med Sci 2020; 50:213-218. [PMID: 31931553 PMCID: PMC7080387 DOI: 10.3906/sag-1905-77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 01/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background/aim In the recent years, videolaryngoscopes (VL) have emerged as alternative devices to direct laryngoscopes (DL) in difficult intubation situations. Therefore, we aimed to compare the Macintosh DL and McGrath VL in terms of the glottic image quality, intubation success, intubation time, hemodynamic response after intubation, and complications in bariatric surgery patients. Material and methods After obtaining approval by the ethics committee and receiving informed consent, we recorded the demographic and physical data of patients undergoing bariatric surgery. Patients were divided into 2 groups: Group M was intubated with the Macintosh DL, and Group V was intubated with the McGrath VL. After intubation, we noted the Cormack–Lehane score, the duration of intubation, the number of intubation interventions, and the hemodynamic data of patients. Results A total of 62 patients (ASA II, body mass index of >35 kg/m2) were included in the study. All patients except 1 patient were intubated on the first attempt. Although there was a decrease in heart rate and blood pressure with induction, similar hemodynamic data were obtained between groups during the operation. In group V, we obtained a better glottic image (P = 0.011), but intubation success was similar between the study groups. We also measured the intubation time in group M as 45.9 ± 19.1 s and group V as 57.1 ± 15.8 s (P = 0.015). Discussion Although we measured longer intubation times with the McGrath VL compared with the Macintosh DL, we obtained a better glottic image without causing hemodynamic changes. However, these findings did not make any difference in terms of intubation success.
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Affiliation(s)
- Mehmet Çakir
- Department of Anaesthesiology and Reanimation, Uzunköprü State Hospital, Edirne, Turkey
| | - Erhan Özyurt
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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Sahajanandan R, Dhanyee AS, Gautam AK. A comparison of King vision video laryngoscope with CMAC D-blade in obese patients with anticipated difficult airway in tertiary hospital in India - Randomized control study. J Anaesthesiol Clin Pharmacol 2019; 35:363-367. [PMID: 31543586 PMCID: PMC6747990 DOI: 10.4103/joacp.joacp_245_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background and Aims: This randomized control trial was conducted to compare two video laryngoscopes in obese patients with anticipated difficult airway. Video laryngoscopes have shown to be beneficial in many difficult airway scenarios including obesity. Many studies have shown that even though the glottic view is better, it takes longer to negotiate the endotracheal tube. We proposed to compare CMAC D-blade with King vision-channeled blade for intubating obese patients with anticipated airway difficulty. We hypothesized that channeled scope may be superior as once visualized, tube could be easily negotiated. This would be reflected by time taken for the glottis visualization, time taken for intubation, incidence of complications, and hemodynamic stability. Material and Methods: Sixty-three patients who fulfilled inclusion criteria were enrolled after informed consent. Based on the computer-generated randomization, they were assigned to group 1 (King vision laryngoscope – KVL) and group 2 (CMAC D-blade). All anesthetists who intubated, performed 20 intubations with both video laryngoscopes on manikin before performing the study case. The parameters analyzed were time to visualize the glottis, time to successful intubation, and intubation-related hemodynamic variations and complications. Results: The mean time taken to visualize the glottis with KVL was 12.93 s compared to 10 s with CMAC D-blade (P value 0.12). Time taken to intubate was 50.04 s with KVL compared to CMAC D-blade which took 46.93 s (P value 0.64). KVL had a complication rate of 20.7% compared to 3.1% with CMAC D-blade (P value 0.04). Conclusion: There was no statistically significant difference in time to visualize the glottis and intubation between KVL and CMAC D-blade. But there was a high incidence of complications with KVL.
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Affiliation(s)
- Raj Sahajanandan
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anity Singh Dhanyee
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Arun Kumar Gautam
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Onal O, Gumus I, Ozdemirkan A, Cicekci F, Sarı M, Bayram HH, Ciftci C, Aslanlar E, Celik JB. A comparative randomized trial of intubation success in difficult intubation cases: the use of a Frova intubation catheter versus a Bonfils intubation fiberoscope. Wideochir Inne Tech Maloinwazyjne 2019; 14:486-94. [PMID: 31908693 DOI: 10.5114/wiitm.2019.83610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/04/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction A difficult airway is one of the main causes of morbidity and mortality in patients who undergo surgical interventions. Therefore, many devices and algorithms have been developed for the management of a difficult airway. However no study has been conducted comparing Frova catheter (FC) and a Bonfils fiberoscope (BF) to date. Aim To compare the effectiveness and success of two devices, a FC and BF, in difficult intubation cases. Material and methods Design: Single-centre randomized controlled trial in patients with difficult airways. The assignment order was created by unplanned number charts, and the assignment was hidden in closed covers, which were not unlocked until case permission had been provided. Setting: The trial was undertaken in a university hospital in Turkey. The primary analysis was based on 60 participants (n = 30, n = 30) with difficult intubation. The main outcomes were the success rates of placement of the tracheal tube in the trachea and the duration of the tracheal intubation process. Results In the BF group, successful intubation was carried out in 25 of the 30 (83.3%) patients, whereas intubation was successful in 28 of the 30 patients (93.3%) in the FC group. Patients who could not be intubated with the first device were intubated with the other device. The mean duration of intubation was 109 (85–140) s in the BF group, whereas it was 38.8 (26–60) s in the FC group. Conclusions Both devices were successful in difficult intubation cases. However, given the shorter duration of intubation using the FC and its lower cost as compared with that of the BF, the FC can be considered superior to the BF in difficult intubation cases.
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Ezhar Y, D'Aragon F, Echave P. Hemodynamic responses to tracheal intubation with Bonfils compared to C-MAC videolaryngoscope: a randomized trial. BMC Anesthesiol 2018; 18:124. [PMID: 30193574 PMCID: PMC6129002 DOI: 10.1186/s12871-018-0592-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Direct laryngoscopy (DL) produce tachycardia and hypertension that could be fatal in a patient with a brain injury. Bonfils fiberscope and C-MAC videolaryngoscope are associated with little hemodynamic instability compared to DL. Scientific evidence comparing these two alternatives does not exist. We conducted this study to determine the hemodynamic effects of Bonfils compared to C-MAC in patients undergoing elective surgery. Methods Fifty (50) patients listed for elective surgery were randomly assigned to endotracheal intubation with Bonfils or C-MAC. After a standardized induction, intubation was done via the retromolar approach (Bonfils group) or via videolaryngoscopy (C-MAC group). A research assistant, who was not blinded to the intervention, recorded heart rate (HR) and arterial blood pressure (systolic, diastolic and mean arterial blood pressure [MAP]) at induction and at every minute during the 5 min post intubation. The primary outcome was the hemodynamic response to intubation, as verified every minute for the first 5 min compared to baseline value. Results After randomization, the two groups were comparable except for ASA I/II ratio which was slightly higher in the C-MAC group (p = 0.046). Heart rate (p = 0.40) and MAP (p = 0.30) were comparable between the two groups within 5 min post intubation. Intubation time was shorter with C-MAC than with Bonfils (30 ± 2 s vs 38 ± 2 s; p = 0.02). Conclusion Hemodynamic responses to tracheal intubation using the Bonfils fiberscope is comparable to the C-MAC videolaryngoscope among patients scheduled for an elective surgery. In light of these findings, using either technique appears to be a reasonable course of action. Trial registration ISRCTN #34923, retrospectively registered, 26/03/2018. Electronic supplementary material The online version of this article (10.1186/s12871-018-0592-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Youssef Ezhar
- Department of Anesthesiology, Faculty of Medicine and Health Sciences, Universite de Sherbrooke, 3001 12th Avenue N., Sherbrooke, Quebec, J1H 5N4, Canada
| | - Frederick D'Aragon
- Department of Anesthesiology, Faculty of Medicine and Health Sciences, Universite de Sherbrooke, 3001 12th Avenue N., Sherbrooke, Quebec, J1H 5N4, Canada. .,Research Centre, Centre Hospitalier Universitaire de Sherbrooke and Faculty of Medicine and Health Sciences, Universite de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Pablo Echave
- Department of Anesthesiology, Faculty of Medicine and Health Sciences, Universite de Sherbrooke, 3001 12th Avenue N., Sherbrooke, Quebec, J1H 5N4, Canada
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Normand KC, Vargas LA, Burnett T, Sridhar S, Cai C, Zhang X, Markham TH, Guzman-Reyes S, Hagberg CA. Use of the McGRATH™ MAC: To view or not to view? Trends in Anaesthesia and Critical Care 2018. [DOI: 10.1016/j.tacc.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kriege M, Alflen C, Strauß H, Ott T, Noppens R. Usage of a semi-rigid intubation endoscope is not superior to a video laryngoscope. A prospective, randomised, controlled trial comparing the SensaScope vs. the McGrath Series 5 in surgical patients. Trends in Anaesthesia and Critical Care 2018; 18:23-8. [DOI: 10.1016/j.tacc.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sulser S, Ubmann D, Schlaepfer M, Brueesch M, Goliasch G, Seifert B, Spahn DR, Ruetzler K. C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department: A randomised clinical trial. Eur J Anaesthesiol 2016; 33:943-8. [PMID: 27533711 DOI: 10.1097/EJA.0000000000000525] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Airway management in the emergency room can be challenging when patients suffer from life-threatening conditions. Mental stress, ignorance of the patient's medical history, potential cervical injury or immobilisation and the presence of vomit and/or blood may also contribute to a difficult airway. Videolaryngoscopes have been introduced into clinical practice to visualise the airway and ultimately increase the success rate of airway management. OBJECTIVE The aim of this study was to test the hypothesis that the C-MAC videolaryngoscope improves first-attempt intubation success rate compared with direct laryngoscopy in patients undergoing emergency rapid sequence intubation in the emergency room setting. DESIGN A randomised clinical trial. SETTING Emergency Department of the University Hospital, Zurich, Switzerland. PATIENTS With approval of the local ethics committee, we prospectively enrolled 150 patients between 18 and 99 years of age requiring emergency rapid sequence intubation in the emergency room of the University Hospital Zurich. Patients were randomised (1 : 1) to undergo tracheal intubation using the C-MAC videolaryngoscope or by direct laryngoscopy. INTERVENTIONS Owing to ethical considerations, patients who had sustained maxillo-facial trauma, immobilised cervical spine, known difficult airway or ongoing cardiopulmonary resuscitation were excluded from our study. All intubations were performed by one of three very experienced anaesthesia consultants. MAIN OUTCOME MEASURES First-attempt success rate served as our primary outcome parameter. Secondary outcome parameters were time to intubation; total number of intubation attempts; Cormack and Lehane score; inadvertent oesophageal intubation; ease of intubation; complications including violations of the teeth, injury/bleeding of the larynx/pharynx and aspiration/regurgitation of gastric contents; necessity of using further alternative airway devices for successful intubation; maximum decrease of oxygen saturation and technical problems with the device. RESULTS A total of 150 patients were enrolled, but three patients had to be excluded from the analysis, resulting in 74 patients in the C-MAC videolaryngoscopy group and 73 patients in the direct laryngoscopy group. Tracheal intubation was achieved successfully at the first attempt in 73 of 74 patients in the C-MAC group and all patients in the direct laryngoscopy group (P = 1.0). Time to intubation was similar (32 ± 11 vs. 31 ± 9 s, P = 0.51) in both groups. Visualisation of the vocal cords, represented as the Cormack and Lehane score, was significantly better using the C-MAC videolaryngoscope (P < 0.001). CONCLUSION Our study demonstrates that visualisation of the vocal cords was improved by using the C-MAC videolaryngoscope compared with direct laryngoscopy. Better visualisation did not improve first-attempt success rate, which in turn was probably based on the high level of experience of the participating anaesthesia consultants. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02297113.
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Sato Boku A, Sobue K, Kako E, Tachi N, Okumura Y, Kanazawa M, Hashimoto M, Harada J. The usefulness of the McGrath MAC laryngoscope in comparison with Airwayscope and Macintosh laryngoscope during routine nasotracheal intubation: a randomaized controlled trial. BMC Anesthesiol 2017; 17:160. [PMID: 29191160 PMCID: PMC5710015 DOI: 10.1186/s12871-017-0451-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022] Open
Abstract
Background McGrath MAC video laryngoscope offers excellent laryngosopic views and increases the success rate of orotracheal intubation in some cases. The aim of this study was to determine the usefulness of McGrath MAC for routine nasotracheal intubation by comparing McGrath MAC with Airway scope and Macintosh laryngoscope. Methods A total of 60 adult patients with ASA physical status class 1 or 2, aged 20–70 years were enrolled in this study. Patients were scheduled for elective oral surgery under general anesthesia with nasotracheal intubation. Exclusion criteria included lack of consent and expected difficult airway. Patients were randomly allocated to three groups: McGrath MAC (n = 20), Airway scope (n = 20), and Macintosh laryngoscope (n = 20). After induction, nasotracheal intubation was performed by six expert anesthesiologists with more than 6 years of experience. Results There were no significant differences in preoperative airway assessment among the three groups. Successful tracheal intubation time was 26.8 ± 5.7 (mean ± standard deviation) s for McGrath MAC, 36.4 ± 11.0 s for Airway scope, and 36.5 ± 8.9 s for Macintosh laryngoscope groups. The time for successful tracheal intubation for McGrath MAC group was significantly shorter than that for Airway scope and Macintosh laryngoscope (p < 0.01). McGrath MAC significantly improved the Cormack Lehane grade for nasotracheal intubation compared with Macintosh laryngoscope (p < 0.05). Conclusion McGrath MAC significantly facilitates routine nasotracheal intubation compared with Airwayscope and Macintosh laryngoscope by shortening the tracheal intubation time and improving the Cormack Lehane grade. Trial registration UMINCTR Registration number UMIN000023506. Registered 5 Aug 2016.
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Affiliation(s)
- Aiji Sato Boku
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusaku, Nagoya, 464-8651, Japan.
| | - Kazuya Sobue
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Eisuke Kako
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Naoko Tachi
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusaku, Nagoya, 464-8651, Japan
| | - Yoko Okumura
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusaku, Nagoya, 464-8651, Japan
| | - Mayuko Kanazawa
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusaku, Nagoya, 464-8651, Japan
| | - Mayumi Hashimoto
- Department of Anesthesiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusaku, Nagoya, 464-8651, Japan
| | - Jun Harada
- Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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Xue FS, Li HX, Liu YY, Yang GZ. Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature. Ther Clin Risk Manag 2017; 13:831-841. [PMID: 28740393 PMCID: PMC5505682 DOI: 10.2147/tcrm.s136221] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The C-MAC videolaryngoscope is the first Macintosh-typed videolaryngoscope. Since the advent of its original version video Macintosh system in 1999, this device has been modified several times. A unique feature of C-MAC device is its ability to provide the 2 options of direct and video laryngoscopy with the same device. The available evidence shows that in patients with normal airways, C-MAC videolaryngoscope compared with direct laryngoscopy can provide comparable or better laryngeal views and exerts less force on maxillary incisors, but does not offer conclusive benefits with regard to intubation time, intubation success, number of intubation attempts, the use of adjuncts, and hemodynamic responses to intubation. In patients with predicted or known difficult airways, C-MAC videolaryngoscope can achieve a better laryngeal view, a higher intubation success rate and a shorter intubation time than direct laryngoscopy. Furthermore, the option to perform direct and video laryngoscopy with the same device makes C-MAC videolaryngoscope exceptionally useful for emergency intubation. In addition, the C-MAC videolaryngoscope is a very good tool for tracheal intubation teaching. However, tracheal intubation with C-MAC videolaryngoscope may occasionally fail and introduction of C-MAC videolaryngoscope in clinical practice must be accompanied by formal training programs in normal and difficult airway managements.
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Affiliation(s)
- Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hui-Xian Li
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Gui-Zhen Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Hossfeld B, Jongebloed A, Lampl L, Helm M. [Out-of-hospital airway management in trauma patients : Experiences with the C-MAC® video laryngoscope]. Unfallchirurg 2017; 119:501-7. [PMID: 25135707 DOI: 10.1007/s00113-014-2642-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Securing the airway is the top priority in trauma resuscitation. The most important factor for successful endotracheal intubation (ETI) is good visualization of the vocal cords. The aim of this study was to summarize the practical experiences with the C-MAC® video laryngoscope as initial device in out-of-hospital airway management of trauma patients. METHODS The C-MAC® video laryngoscope uses standard Macintosh shaped laryngoscope blades. At the Helicopter Emergency Medical Service (HEMS) Christoph 22 it is used as the initial device for every out-of-hospital ETI. All prehospital data on ETI involving trauma patients were documented for a period of 17 months. RESULTS A total of 116 out-of-hospital ETIs were enrolled in this study (overall success rate 100 %). In 88.8 % the first attempt was successful, whereas in 10.3 % a second and in 0.9 % a third ETI attempt was necessary. No patient required alternative airway devices or surgical airway interventions. The results of a subgroup with an immobilized cervical spine (n = 17) did not show any increased difficulties. CONCLUSION The use of the C-MAC® video laryngoscope by experienced anesthesiologists in an out-of-hospital setting seems to be a safe method even in patients with an immobilized cervical spine. Adverse laryngoscopy results (C/L III and IV) were reduced compared to other studies.
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Affiliation(s)
- B Hossfeld
- Klinik für Anästhesiologie und Intensivmedizin - Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89070, Ulm, Deutschland.
| | - A Jongebloed
- Klinik für Anästhesiologie und Intensivmedizin - Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89070, Ulm, Deutschland
| | - L Lampl
- Klinik für Anästhesiologie und Intensivmedizin - Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89070, Ulm, Deutschland
| | - M Helm
- Klinik für Anästhesiologie und Intensivmedizin - Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89070, Ulm, Deutschland
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Shravanalakshmi D, Bidkar PU, Narmadalakshmi K, Lata S, Mishra SK, Adinarayanan S. Comparison of intubation success and glottic visualization using King Vision and C-MAC videolaryngoscopes in patients with cervical spine injuries with cervical immobilization: A randomized clinical trial. Surg Neurol Int 2017; 8:19. [PMID: 28217398 PMCID: PMC5309444 DOI: 10.4103/2152-7806.199560] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/14/2016] [Indexed: 02/03/2023] Open
Abstract
Background: Glottic visualization can be difficult with cervical immobilization in patients with cervical spine injury. Indirect laryngoscopes may provide better glottic visualization in these groups of patients. Hence, we compared King Vision videolaryngoscope, C-MAC videolaryngoscope for endotracheal intubation in patients with proven/suspected cervical spine injury. Methods: After standard induction of anesthesia, 135 patients were randomized into three groups: group C (conventional C-MAC videolaryngoscope), group K (King Vision videolaryngoscope), and group D (D blade C-MAC videolaryngoscope). Cervical immobilization was maintained with Manual in line stabilization with anterior part of cervical collar removed. First pass intubation success, time for intubation, and glottic visualization (Cormack – Lehane grade and percentage of glottic opening) were noted. Intubation difficulty score (IDS) was used for grading difficulty of intubation. Five-point Likert scale was used for ease of insertion of laryngoscope. Results: First attempt success rate were 100% (45/45), 93.3% (42/45), and 95.6% (43/45) in patients using conventional C-MAC, King Vision, and D blade C-MAC videolaryngoscopes, respectively. Time for intubation in seconds was significantly faster with conventional C-MAC videolaryngoscope (23.3 ± 4.7) compared to D blade C-MAC videolaryngoscope (26.7 ± 7.1), whereas conventional C-MAC and King Vision were comparable (24.9 ± 7.2). Good grade glottic visualization was obtained with all the three videolaryngoscopes. Conclusion: All the videolaryngoscopes provided good glottic visualization and first attempt success rate. Conventional C-MAC insertion was significantly easier. We conclude that all the three videolaryngoscopes can be used effectively in patients with cervical spine injury.
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Affiliation(s)
- Dhanyasi Shravanalakshmi
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Prasanna U Bidkar
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - K Narmadalakshmi
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Suman Lata
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sandeep K Mishra
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - S Adinarayanan
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Jain D. Retention of laryngoscopy skills in novices. Anaesthesia 2016; 72:124. [PMID: 27988957 DOI: 10.1111/anae.13756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Jain
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Background: Videolaryngoscopes have become increasingly popular in recent years for use in both normal and difficult airways. Despite this trend, their benefit remains controversial. The McGrath® MAC videolaryngoscope (Aircraft Medical Ltd, Edinburgh, UK) is used for first line or rescue intubation, and for training in videolaryngoscopy intubation. We conducted a prospective observational study to assess the performance of the McGrath® MAC. Methods: We evaluated the use of the McGrath® MAC videolaryngoscope from January 2016 to April 2016. We recruited 500 adult patients undergoing elective surgery requiring endotracheal intubation. Data was collected via an online survey. The primary outcome was the success of intubation with the McGrath® MAC. Secondary outcomes included the ease of the McGrath® MAC insertion, best glottic view, ease of tracheal tube insertion, number of intubation attempts, evidence of airway trauma, quality of view, adjunct used, airway manoeuvres used, quality of image on monitor screen and overall impression of the device. Results: A total of 428 responses were analysed. The overall success rate was 97.9% (95% confidence interval 96.0–99.0%). The success rate for those with predictors of difficult airway was 95.5% (95% confidence interval 87.6–99.5%). Easy scope insertion was reported by 97.2% of anaesthetists and 89.7% reported easy tube insertion. Some of our cases (1.9%) were complicated by airway trauma involving superficial oropharyngeal or lip injury. Conclusion: The McGrath® MAC videolaryngoscope is a good choice for a videolaryngoscope, conferring advantages of a high intubation success rate, ease of laryngoscope insertion and ease of intubation. It is suitable for use in predicted difficult airways.
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Affiliation(s)
- Jolin Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Zihui Tan
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Kleine-Brueggeney M, Buttenberg M, Greif R, Nabecker S, Theiler L. Evaluation of three unchannelled videolaryngoscopes and the Macintosh laryngoscope in patients with a simulated difficult airway: a randomised, controlled trial. Anaesthesia 2016; 72:370-378. [DOI: 10.1111/anae.13714] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M. Kleine-Brueggeney
- Department of Peri-operative Medicine; Barts Heart Centre; Barts Health NHS Trust; London UK
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - M. Buttenberg
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - R. Greif
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - S. Nabecker
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - L. Theiler
- Department of Anaesthesiology and Pain Medicine; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
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Abstract
BACKGROUND Successful tracheal intubation during general anaesthesia traditionally requires a line of sight to the larynx attained by positioning the head and neck and using a laryngoscope to retract the tongue and soft tissues of the floor of the mouth. Difficulties with intubation commonly arise, and alternative laryngoscopes that use digital and/or fibreoptic technology have been designed to improve visibility when airway difficulty is predicted or encountered. Among these devices, a rigid videolaryngoscope (VLS) uses a blade to retract the soft tissues and transmits a lighted video image to a screen. OBJECTIVES Our primary objective was to assess whether use of videolaryngoscopy for tracheal intubation in adults requiring general anaesthesia reduces risks of complications and failure compared with direct laryngoscopy. Our secondary aim was to assess the benefits and risks of these devices in selected population groups, such as adults with obesity and those with a known or predicted difficult airway. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase on 10 February 2015. Our search terms were relevant to the review question and were not limited by outcomes. We carried out clinical trials register searches and forward and backward citation tracking. We reran the search on 12 January 2016; we added potential new studies of interest from the 2016 search to a list of 'Studies awaiting classification', and we will incorporate these studies into the formal review during the review update. SELECTION CRITERIA We considered all randomized controlled trials and quasi-randomized studies with adult patients undergoing laryngoscopy performed with a VLS or a Macintosh laryngoscope in a clinical, emergency or out-of-hospital setting. We included parallel and cross-over study designs. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data, consulting a third review author to resolve disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias. MAIN RESULTS We included 64 studies identified during the 2015 search that enrolled 7044 adult participants and compared a VLS of one or more designs with a Macintosh laryngoscope. We identified 38 studies awaiting classification and seven ongoing studies. Of the 64 included studies, 61 included elective surgical patients, and three were conducted in an emergency setting. Among 48 studies that included participants without a predicted difficult airway, 15 used techniques to simulate a difficult airway. Seven recruited participants with a known or predicted difficult airway, and the remaining studies did not specify or included both predicted and not predicted difficult airways. Only two studies specifically recruited obese participants. It was not possible to blind the intubator to the device, and we noted a high level of inevitable heterogeneity, given the large number of studies.Statistically significantly fewer failed intubations were reported when a VLS was used (Mantel-Haenszel (M-H) odds ratio (OR), random-effects 0.35, 95% confidence Interval (CI) 0.19 to 0.65; 38 studies; 4127 participants), and fewer failed intubations occurred when a VLS was used in participants with an anticipated difficult airway (M-H OR, random-effects 0.28, 95% CI 0.15 to 0.55; six studies; 830 participants). We graded the quality of this evidence as moderate on the basis of the GRADE system. Failed intubations were fewer when a VLS was used in participants with a simulated difficult airway (M-H OR, random-effects 0.18, 95% CI 0.04 to 0.77; nine studies; 810 participants), but groups with no predicted difficult airway provided no significant results (M-H OR, random-effects 0.61, 95% CI 0.22 to 1.67; 19 studies; 1743 participants).Eight studies reported on hypoxia, and only three of these described any events; results showed no differences between devices for this outcome (M-H OR, random-effects 0.39, 95% CI 0.10 to 1.44; 1319 participants). Similarly, few studies reported on mortality, noting no differences between devices (M-H OR, fixed-effect 1.09, 95% CI 0.65 to 1.82; two studies; 663 participants), and only one study reporting on the occurrence of respiratory complications (78 participants); we graded these three outcomes as very low quality owing to lack of data. We found no statistically significant differences between devices in the proportion of successful first attempts (M-H OR, random-effects 1.27, 95% CI 0.77 to 2.09; 36 studies; 4731 participants) nor in those needing more than one attempt. We graded the quality of this evidence as moderate. Studies reported no statistically significant differences in the incidence of sore throat in the postanaesthesia care unit (PACU) (M-H OR, random-effects 1.00 (95% CI 0.73 to 1.38); 10 studies; 1548 participants) nor at 24 hours postoperatively (M-H OR random-effects 0.54, 95% CI 0.27 to 1.07; eight studies; 844 participants); we graded the quality of this evidence as moderate. Data combined to include studies of cross-over design revealed statistically significantly fewer laryngeal or airway traumas (M-H OR, random-effects 0.68, 95% CI 0.48 to 0.96; 29 studies; 3110 participants) and fewer incidences of postoperative hoarseness (M-H OR, fixed-effect 0.57, 95% CI 0.36 to 0.88; six studies; 527 participants) when a VLS was used. A greater number of laryngoscopies performed with a VLS achieved a view of most of the glottis (M-H OR, random-effects 6.77, 95% CI 4.17 to 10.98; 22 studies; 2240 participants), fewer laryngoscopies performed with a VLS achieved no view of the glottis (M-H OR, random-effects 0.18, 95% CI 0.13 to 0.27; 22 studies; 2240 participants) and the VLS was easier to use (M-H OR, random-effects 7.13, 95% CI 3.12 to 16.31; seven studies; 568 participants).Although a large number of studies reported time required for tracheal intubation (55 studies; 6249 participants), we did not present an effects estimate for this outcome owing to the extremely high level of statistical heterogeneity (I2 = 96%). AUTHORS' CONCLUSIONS Videolaryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway. They improve the glottic view and may reduce laryngeal/airway trauma. Currently, no evidence indicates that use of a VLS reduces the number of intubation attempts or the incidence of hypoxia or respiratory complications, and no evidence indicates that use of a VLS affects time required for intubation.
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Affiliation(s)
- Sharon R Lewis
- Patient Safety Research Department, Royal Lancaster Infirmary, Pointer Court 1, Ashton Road, Lancaster, UK, LA1 1RP
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Altun D, Ozkan-seyhan T, Orhan-sungur M, Sivrikoz N, Camci E. Comparison of 4 Laryngoscopes in 2 Difficult Airway Scenarios: A Randomized Crossover Simulation-Based Study. ACTA ACUST UNITED AC 2016; 11:304-8. [DOI: 10.1097/sih.0000000000000161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sargin M, Uluer MS. Comparison of McGrath(®) Series 5 video laryngoscope with Macintosh laryngoscope: A prospective, randomised trial in patients with normal airways. Pak J Med Sci 2016; 32:869-74. [PMID: 27648030 PMCID: PMC5017093 DOI: 10.12669/pjms.324.10037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: The McGrath Video laryngoscope is a newly developed video laryngoscope that significantly improves laryngeal view and facilitates endotracheal intubation in difficult airways. However in patients with normal airway that is not mentioned before. The aim of this study was to compare the McGrath video laryngoscope with the Macintosh laryngoscope in patients with normal airways. Methods: A total of 100 patients requiring orotracheal intubation, were randomized to either having intubation with the McGrath video laryngoscope or the Macintosh laryngoscope. The primary outcome was the laryngoscopy view using percentage of glottic opening (POGO) score. Secondary outcomes included Cormack and Lehane grading system, time to intubation, number of failed intubations, number of attempts before successful intubation and hemodynamic parameters during intubation. Results: POGO scores were significantly higher in the McGrath group compared with the Macintosh group (p<0.001) despite time to successful intubation was similar in both groups. The McGrath video laryngoscope provided more Grade-I laryngoscopic views than the Macintosh laryngoscope (p<0.001). Number of more than one attempts in order to achieve success was significantly higher in the Macintosh group (p=0.001). The number of minor complications were significantly higher in the Macintosh group (p=0.004). There were no significant changes in hemodynamic responses between the two groups (p>0.05). Conclusion: McGrath video laryngoscope allows patients with normal airways to achieve higher POGO scores and significantly more Grade-I laryngoscopic views when compared with the Macintosh laryngoscope.
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Affiliation(s)
- Mehmet Sargin
- Mehmet Sargin, MD. Anesthesiology and Reanimation Department, Konya Training and Research Hospital, Konya, Turkey
| | - Mehmet Selcuk Uluer
- Mehmet Selcuk Uluer, MD. Anesthesiology and Reanimation Department, Konya Training and Research Hospital, Konya, Turkey
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Shin M, Bai SJ, Lee KY, Oh E, Kim HJ. Comparing McGRATH® MAC, C-MAC®, and Macintosh Laryngoscopes Operated by Medical Students: A Randomized, Crossover, Manikin Study. Biomed Res Int 2016; 2016:8943931. [PMID: 27703983 DOI: 10.1155/2016/8943931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [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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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 12/22/2022] Open
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Jain D, Bala I, Gandhi K. Comparative effectiveness of McCoy laryngoscope and CMAC(®) videolaryngoscope in simulated cervical spine injuries. J Anaesthesiol Clin Pharmacol 2016; 32:59-64. [PMID: 27006543 PMCID: PMC4784216 DOI: 10.4103/0970-9185.173349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Videolaryngoscopes are increasingly being used in potentially difficult airway. McCoy laryngoscope provides definitive advantage over conventional laryngoscopes in cervical spine patients. The aim of this study was to compare the performance of the CMAC® videolaryngoscope with the McCoy Laryngoscope in patients with a cervical collar. Material and Methods: Sample size of at least 22 patients in each group was calculated using Intubation Difficulty Scale (IDS) score as the primary outcome. 60 American Society of Anesthesiologists I and II patients requiring tracheal intubation for elective surgery were randomly allocated into the McCoy group (n = 30) and the CMAC® videolaryngoscope group (n = 30). Anesthesia was induced with fentanyl 2 mcg/kg, propofol 2-3 mg/kg and rocuronium 0.6 mg/kg. A rigid collar was applied to immobilize the cervical spine. Comparative data on the IDS scale, Cormack-Lehane (CL) laryngoscopic view, time taken for glottis visualization, time taken to pass endotracheal tube, total time to intubate, number of optimizing maneuvers and hemodynamic variables were recorded in the two groups. Results: IDS score was significantly less in the CMAC® group compared to the McCoy group (median [interquartile range (IQR)], 1 [0-1] vs. 4 [3-6], P < 0.05). CMAC® videolaryngoscope required significantly less time for glottic visualization with median (IQR), 5 (5-7) versus 14 (8-15), P = 0.000 in McCoy laryngoscope, 29 (96.7%) patients in the CMAC® group had Modified CL Grade I compared with 16 (53.3%) patients in McCoy group. The hemodynamic variables, number of optimizing maneuvers and incidence of side effects were comparable in the two groups. Conclusion: CMAC® videolaryngoscope forms an effective tool for the airway management of cervical spine patients with a cervical collar.
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Affiliation(s)
- Divya Jain
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Bala
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Komal Gandhi
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Foulds LT, McGuire BE, Shippey BJ. A randomised cross-over trial comparing the McGrath®Series 5 videolaryngoscope with the Macintosh laryngoscope in patients with cervical spine immobilisation. Anaesthesia 2016; 71:437-42. [DOI: 10.1111/anae.13384] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- L. T. Foulds
- Department of Anaesthetics; Ninewells Hospital; Dundee UK
| | - B. E. McGuire
- Department of Anaesthetics; Ninewells Hospital; Dundee UK
| | - B. J. Shippey
- Department of Anaesthetics; Ninewells Hospital; Dundee UK
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Liu ZJ, Yi J, Guo WJ, Ma C, Huang YG. Comparison of McGrath Series 3 and Macintosh Laryngoscopes for Tracheal Intubation in Patients With Normal Airway by Inexperienced Anesthetists: A Randomized Study. Medicine (Baltimore) 2016; 95:e2514. [PMID: 26765472 PMCID: PMC4718298 DOI: 10.1097/md.0000000000002514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Difficult and failed intubations account for the major causes of morbidity and mortality in current anesthetic practice. Several devices including McGrath Series 3 videolaryngoscope are available which may facilitate tracheal intubation by improving view of the larynx compared with Macintosh blade laryngoscopy. But no studies demonstrate whether McGrath Series 3 performs better than Macintosh laryngoscope in normal airway intubations by inexperienced anesthetists so far. We therefore designed this randomized controlled study to compare McGrath with Macintosh in routine tracheal intubation performed by inexperienced anesthetists.In total, 180 adult patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to be intubated by 9 inexperienced anesthetists with McGrath or Macintosh. The primary outcome was time to intubation. Ease of intubation was assessed by a 5-point ordinal scale. Intubation attempts/failures, best laryngoscopy view using the Cormack-Lehane grade, associated complications and hemodynamic changes during intubation were recorded.We found that there was no significant difference between McGrath and Macintosh in the median time to intubation (P = 0.46); the Cormack-Lehane views attained using McGrath were superior (P < 0.001); the difference of ease of intubation was statistically significant (P = 0.01). No serious trauma occurred in both groups. And there was statistically significant difference in the systolic blood pressure changes between 2 groups (P < 0.05).We demonstrated that in orotracheal intubation in patients with normal airway by inexperienced anesthetists, McGrath compared with the Macintosh allows superior glottis views, greater ease of intubation, less complications, and hemodynamic changes with noninferior intubation time. And it remained a potential selection for inexperienced anesthetists in uncomplicated intubation.
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Affiliation(s)
- Zi-Jia Liu
- From the Department of Anesthesia, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medicine Science, Dongcheng District, Beijing, China (Z-JL, JY, W-JG, Y-GH) and Department of Anatomy, Histology and Embryology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China (CM)
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Abstract
Recent technological advances have made airway management safer. Because difficult intubation remains challenging to predict, having tools readily available that can be used to manage a difficult airway in any setting is critical. Fortunately, video technology has resulted in improvements for intubation performance while using laryngoscopy by various means. These technologies have been applied to rigid optical stylets, flexible intubation scopes, and, most notably, rigid laryngoscopes. These tools have proven effective for the anticipated difficult airway as well as the unanticipated difficult airway.
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Affiliation(s)
- Michael Aziz
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Porltand, Oregon, 97239, USA
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Mihara R, Komasawa N, Matsunami S, Minami T. Comparison of Direct and Indirect Laryngoscopes in Vomitus and Hematemesis Settings: A Randomized Simulation Trial. Biomed Res Int 2015; 2015:806243. [PMID: 26618177 DOI: 10.1155/2015/806243] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/06/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings. METHODS Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations. RESULTS In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P = 0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P = 0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P < 0.001, compared to McL or McGRATH in both settings). CONCLUSION The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Szarpak L, Karczewska K, Evrin T, Kurowski A, Czyzewski L. Comparison of intubation through the McGrath MAC, GlideScope, AirTraq, and Miller Laryngoscope by paramedics during child CPR: a randomized crossover manikin trial. Am J Emerg Med 2015; 33:946-50. [DOI: 10.1016/j.ajem.2015.04.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 03/26/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022] Open
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Cierniak M, Timler D, Wieczorek A, Sekalski P, Borkowska N, Gaszynski T. The comparison of the technical parameters in endotracheal intubation devices: the Cmac, the Vividtrac, the McGrath Mac and the Kingvision. J Clin Monit Comput 2015; 30:379-87. [PMID: 26120020 PMCID: PMC4960280 DOI: 10.1007/s10877-015-9727-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/13/2015] [Indexed: 11/03/2022]
Abstract
Currently, there are plenty of videolaryngoscopes that appear on the market. They have different specifications. Some of these features favor the fact that they are more suited for educational purposes of future operators and others can be characterized with an excellent clinical use. In this study we compared four types of videolaryngoscopes. The aim of the study was to compare the technical specifications of the above-mentioned devices for usefulness in clinical practice and correlate these parameters with the subjective evaluation of these videolaryngoscopes usage performed in practice by an experienced medical staff. All devices considered in this study participated in another multicenter clinical study on the basis of which we completed the subjective evaluation of the operators. In order to examine the technical parameters of the equipment we established the cooperation with the Department of Microelectronics at Technical University of Lodz. Mechanical and optical parameters and the endoscopic tube current were taken into consideration. The C-MAC has a camera with the widest viewing angle (the OX axis-63.1, the axis OY-47.8), which in combination with the largest diagonal size of the display enables the operator to see the details relevant to clinical practice. It has also the strongest lamp intensity of the devices mentioned in this comparison (7800 Lx). In comparison of the clinical use in almost all compared parameters the Cmac D-blade is a winner, although for clinical education purpose we consider the Vividtrac a better device.
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Affiliation(s)
- Marcin Cierniak
- Department of Emergency Medicine and Disaster Medicine, Barlicki University Hospital, Medical University of Lodz, Ul. Kopcinskiego 22, 90-153, Lodz, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Barlicki University Hospital, Medical University of Lodz, Ul. Kopcinskiego 22, 90-153, Lodz, Poland
| | - Andrzej Wieczorek
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Przemyslaw Sekalski
- Department of Microelectronics and Computer Science, IT Centre, Lodz University of Technology, Lodz, Poland
| | - Natalia Borkowska
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland
| | - Tomasz Gaszynski
- Department of Emergency Medicine and Disaster Medicine, Barlicki University Hospital, Medical University of Lodz, Ul. Kopcinskiego 22, 90-153, Lodz, Poland.
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Hossfeld B, Frey K, Doerges V, Lampl L, Helm M. Improvement in glottic visualisation by using the C-MAC PM video laryngoscope as a first-line device for out-of-hospital emergency tracheal intubation: An observational study. Eur J Anaesthesiol 2015; 32:425-31. [DOI: 10.1097/eja.0000000000000249] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Background and Aims: MacGrath videolaryngoscope is one of the recent videolaryngoscopes, which can be used to facilitate nasotracheal intubations using Scroeder directional stylet. Material and Methods: 15 patients, American Society of Anesthesiologists Grades I-II, undergoing tonsillectomy, requiring nasotracheal intubation were included. All patients were intubated with MacGrath videolaryngoscope and Schroeder stylet. Primary outcome measures were duration and ease of intubation. Overall success rate, number of attempts, modified Cormack-Lehane (C-L) grading, and complications were also recorded. Results: All 15 intubations were successful during first laryngoscopy attempt. C-L Grade I views were obtained in 14 patients (93%) and Grade II view in one patient (7%). The time required to obtain the best C-L view was 9.4 ± 1.5 s. The time taken to complete tracheal intubation was 34.27 ± 3.38 s. Average numerical rating scale for tracheal intubation was 8.7 ± 0.9. Minor complications occurred in four patients (26.7%). Conclusions: MacGrath videolaryngoscope produces excellent laryngoscopic views in patients with normal airways. Impaction of tracheal tube on posterior nasopharyngeal wall can be overcome by Schroeder stylet.
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Affiliation(s)
- Bikramjit Das
- Department of Anaesthesiology, Government Medical College, Haldwani, Uttarakhand, India
| | - Syed Moied Ahmed
- Department of Anaesthesiology, J.N. Medical College, A.M.U., Aligarh, Uttar Pradesh, India
| | - Nadeem Raza
- Department of Anaesthesiology, J.N. Medical College, A.M.U., Aligarh, Uttar Pradesh, India
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Sulser S, Ubmann D, Brueesch M, Goliasch G, Seifert B, Spahn DR, Ruetzler K. The C-MAC videolaryngoscope compared with conventional laryngoscopy for rapid sequence intubation at the emergency department: study protocol. Scand J Trauma Resusc Emerg Med 2015; 23:38. [PMID: 25903358 PMCID: PMC4407430 DOI: 10.1186/s13049-015-0119-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
Background Especially in the emergency setting, rapid and successful airway management is of major importance. Conventional endotracheal intubation is challenging and requires high level of individual skills and experience. Videolaryngoscopes like the C-MAC are likely to offer better glottis visualization and serve as alternatives to conventional endotracheal intubation. The aim of this study is to compare clinical performance and feasibility of the C-MAC videolaryngoscope compared to conventional endotracheal intubation in the emergency setting. Methods/Design This study is designed as a prospective, patient-blinded, mono-center, randomized cohort study. This study will be performed at the Emergency Department of the University Hospital Zurich, Zurich, Switzerland. All patients transferred to the Emergency Department and requiring emergent endotracheal intubation will be screened. Successful intubation with first intubation attempt will serve as the primary outcome. Time to intubation, intubation attempts, Cormack & Lehane Score, ease of intubation, complications, necessity of using alternate intubation device, maximum drop of saturation, and potential technical problems serve as secondary outcomes. Discussion In the clinical setting, the ultimate success rate of endotracheal intubation ranges between 97% and 99%. Unexpected difficulties during laryngoscopy and poor glottis visualization occur in up to 9% of all cases. In these cases, videolaryngoscopes may increase success rate of initial intubation attempt and thereby patient safety. Trial registration www.clinicaltrials.gov (identifier NCT02297113).
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Affiliation(s)
- Simon Sulser
- Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
| | - Dirk Ubmann
- Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
| | - Martin Brueesch
- Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
| | - Georg Goliasch
- Department of Cardiology, Medical University Vienna, Vienna, Austria.
| | - Burkhardt Seifert
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Zurich, Switzerland.
| | - Donat R Spahn
- Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
| | - Kurt Ruetzler
- Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland. .,Outcomes Research Consortium, Cleveland, Ohio, USA.
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Okada D, Komasawa N, Fujiwara S, Minami T. Comparison of tube-guided and guideless videolaryngoscope for tracheal intubation during chest compression in a manikin: a randomized crossover trial. J Anesth 2014; 29:331-337. [DOI: 10.1007/s00540-014-1936-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022]
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50
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Ilyas S, Symons J, Bradley WPL, Segal R, Taylor H, Lee K, Balkin M, Bain C, Ng I. A prospective randomised controlled trial comparing tracheal intubation plus manual in-line stabilisation of the cervical spine using the Macintosh laryngoscope vs the McGrath®Series 5 videolaryngoscope. Anaesthesia 2014; 69:1345-50. [DOI: 10.1111/anae.12804] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 12/23/2022]
Affiliation(s)
- S. Ilyas
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
| | - J. Symons
- Department of Anaesthesia and Perioperative Medicine; The Alfred and Monash University; Melbourne Victoria Australia
| | - W. P. L. Bradley
- Department of Anaesthesia and Perioperative Medicine; The Alfred and Monash University; Melbourne Victoria Australia
| | - R. Segal
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
| | - H. Taylor
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
| | - K. Lee
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
| | - M. Balkin
- Department of Anaesthesia and Perioperative Medicine; The Alfred and Monash University; Melbourne Victoria Australia
| | - C. Bain
- Department of Anaesthesia and Perioperative Medicine; The Alfred and Monash University; Melbourne Victoria Australia
| | - I. Ng
- Department of Anaesthesia and Pain Management; Royal Melbourne Hospital and University of Melbourne; Melbourne Victoria Australia
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