1
|
Zaki HA, Shaban E, Elgassim M, Fayed M, Basharat K, Elnabawy W, Abdelrahim MG, Elkandow A, Mahdy A, Azad A. Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs) Revealing the Future of Airway Management: Video Laryngoscopy vs. Macintosh Laryngoscopy for Enhanced Clinical Outcomes. Cureus 2023; 15:e50648. [PMID: 38229823 PMCID: PMC10790117 DOI: 10.7759/cureus.50648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Since the 1940s, Macintosh laryngoscopy (Mac laryngoscopy) has been the gold standard for tracheal intubation, offering visualization of the glottis entrance. However, recent years have witnessed the emergence of various video laryngoscopy (VL) techniques. This systematic review and meta-analysis aims to assess the clinical outcomes of VL versus Mac laryngoscopy in an elective setting. We comprehensively searched five medical databases - PubMed, EMBASE, Medline, Cochrane Library, and Web of Science. All the databases were last searched in January 2023. We only included studies with full texts comparing VL to Mac laryngoscopy clinical outcomes. Studies were excluded if they were non-full text or non-randomized controlled trials (RCTs) and did not compare VL to Mac laryngoscopy. We extracted data comprising author names, publication year, key study outcomes (first-attempt intubation success rate, Cormack and Lehane grade, hypoxia incidence, and glottis view quality), video laryngoscope types, and sample sizes of both VL and Mac laryngoscopy groups. The Cochrane risk of bias tool was used to assess the risk of bias in the included studies. Statistical analysis was performed using Review Manager (RevMan, version 5.4; Cochrane Collaboration, London, UK), presenting results as odds ratio (OR) and risk ratios (RR) at a 95% confidence interval (CI). This facilitated the identification of relevant and appropriate studies of our analysis. The search produced 19 studies that were included in this review. The evaluated sample size ranges from 40 to 802, with 3,238 participants. The rate of success at the first attempt in the use of VL was 1,558/1,890 (82.43%), while the success rate for Mac laryngoscopy was 982/1,348 (72.85%; OR: 1.98 (1.25, 3.12)) at a 95% confidence interval. Pooled analysis indicated no significant difference for hypoxia concerning the type of device used RR (random effects: 1.02; 95% CI: 0.80-1.29). A video laryngoscope had a higher likelihood of visualizing the vocal cords categorized as category 1 in the Cormack-Lehane system of classification (RR: 2.45; 95% CI: 1.43-4.21). Additionally, considerably better glottis views were attained during VL than Mac laryngoscopy (OR: 1.77; 95% CI: 1.19-2.62). In elective tracheal intubation, VL demonstrates superior first-attempt success rates, offers improved glottis visualization, and reduces instances where the glottis cannot be viewed compared to Mac laryngoscopy.
Collapse
Affiliation(s)
- Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Eman Shaban
- Cardiology, Al Jufairi Diagnostic and Treatment, Doha, QAT
| | | | - Mohamed Fayed
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Wael Elnabawy
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | - Ali Elkandow
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Ahmed Mahdy
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Aftab Azad
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| |
Collapse
|
2
|
Sansone P, Giaccari LG, Bonomo A, Gargano F, Aurilio C, Coppolino F, Passavanti MB, Pota V, Pace MC. Comparison of McGrath Videolaryngoscope versus Macintosh Laryngoscope in Tracheal Intubation: An Updated Systematic Review. J Clin Med 2023; 12:6168. [PMID: 37834812 PMCID: PMC10573091 DOI: 10.3390/jcm12196168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: In the last few years, many randomized controlled trials (RCTs) have compared direct Macintosh laryngoscopy with McGrath videolaryngoscopy in order to assess the potential benefits of the latter; the results were sometimes controversial. (2) Methods: We conducted a comprehensive literature search to identify our articles according to inclusion and exclusion criteria: to be included, each study had to be a prospective randomized trial or comparison between the McGrath videolaryngoscope and the Macintosh laryngoscope in an adult population. We did not include manikin trials or studies involving double-lumen tubes. (3) Results: 10 studies met the inclusion criteria necessary. In total, 655 patients were intubated with the McGrath and 629 with the Macintosh. In total, 1268 of 1284 patients were successfully intubated, showing equivalent results for the two devices: 648 of 655 patients with the McGrath videolaryngoscope and 620 of 629 patients with the Macintosh laryngoscope. No differences were noted in terms of hemodynamic changes or the incidence of adverse events. (4) Conclusions: We can assert that the McGrath videolaryngoscope and Macintosh laryngoscope, even if with equivalent tracheal intubation results, supplement each other.
Collapse
Affiliation(s)
- Pasquale Sansone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy; (L.G.G.); (A.B.); (F.G.); (C.A.); (F.C.); (M.B.P.); (V.P.); (M.C.P.)
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Comparison of the McGRATH TM Video Laryngoscope and Macintosh Laryngoscope for Orotracheal Intubation in a Simulated Difficult Airway Scenario: An Open-Label, Randomized Clinical Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020282. [PMID: 36837484 PMCID: PMC9966235 DOI: 10.3390/medicina59020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
Background and Objectives: Difficult intubation, which may be encountered unexpectedly during anesthesia, can increase patients' morbidity and mortality. The McGRATH video laryngoscope is known to provide improved laryngeal visibility in patients with difficult or normal airways. The purpose of this study was to evaluate the efficacy of the McGRATH video laryngoscope for orotracheal intubation compared with that of conventional Macintosh laryngoscopes in simulated difficult airway scenarios. Materials and Methods: In this randomized controlled trial, patients who were scheduled for surgery under general anesthesia requiring orotracheal intubation were assigned to the Macintosh laryngoscope (n = 50) or McGRATH video laryngoscope (n = 45) groups. In this study, to create a simulated difficult airway condition, the subjects performed manual in-line stabilization and applied a soft cervical collar. The primary outcome was the rate of successful intubation within 30 s. The time required for an intubation, glottis grade, intubation difficulty scale (IDS score), the subjective ease of intubation, and optimal external laryngeal manipulation (OLEM) were evaluated. In addition, complications caused by each blade were investigated. Results: The intubation success rate within 30 s was not significantly different between the two groups (44 (88.0%) vs. 36 (80.0%), p = 0.286). The glottic grade was better in the McGRATH group than in the Macintosh group (p = 0.029), but neither the intubation time (26.3 ± 8.2 s vs. 24.2 ± 5.0 s, p = 0.134) nor the rates of oral bleeding (2 (4.0%) vs. 0 (0.0%)) and tooth injury (0 (0.0%) vs. 1 (2.2%)) were significantly different between the two groups. Conclusions: The use of the McGRATH video laryngoscope did not improve the intubation success rate or shorten the intubation time. However, the McGRATH video laryngoscope provided a better glottis view than the conventional Macintosh laryngoscope in patients with a simulated difficult airway.
Collapse
|
4
|
Haldar R, Kannaujia AK, Shamim R, Mishra P. A comparison of endotracheal intubation characteristics between Macintosh, CMAC and Smart Trach laryngoscopes; A randomized prospective clinical trial. Expert Rev Med Devices 2022; 19:797-803. [PMID: 36240389 DOI: 10.1080/17434440.2022.2136520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In this study, we compared the performance characteristics of Macintosh laryngoscope, CMAC videolaryngoscope with a recently developed videolaryngoscope called Smart Trach. RESEARCH DESIGN AND METHODS : Three hundred seventy-five patients belonging to mixed population without having anticipated difficult airways undergoing elective surgeries were randomly allocated to be intubated using either of the three laryngoscopes (Macintosh, CMAC or Smart Trach). Time needed for successful intubation, number of attempts, Cormack Lehane's (CL) grading, optimisation maneuverers, intubation difficulty score (IDS), subjective ease of intubation (VAS), subjective lifting force and complications were recorded. RESULTS : Demographic and anthropometric measurements (sex, height, weight and body mass index) among the groups were comparable. CL grades, lifting force, IDS, VAS and intubation times (seconds) were significantly different whereas need for maneuver, attempts and complications were similar. (p>0.05 each). Intubation times (seconds) were significantly different between Macintosh [36(29-43) seconds] CMAC [30(24-37)] and Smart Trach [35(30-42] groups. (p<0.001). Subjective ease of intubation based on VAS score was lowest in Smart trach group [1(1-2)] (p<0.001). CONCLUSION Shortest intubation times were achieved with CMAC with least use of lifting force. First attempt success rates of were similar. Intubation was easiest subjectively using Smart Trach as manifested by lowest VAS and IDS. TRIAL REGISTRATION Clinical Trial registry of India (CTRI/2019/09/021279 dated 17/09/2019).
Collapse
Affiliation(s)
| | | | - Rafat Shamim
- Department of Anaesthesiology, SGPGIMS, Lucknow, India
| | | |
Collapse
|
5
|
Ho CH, Chen LC, Hsu WH, Lin TY, Lee M, Lu CW. A Comparison of McGrath Videolaryngoscope versus Macintosh Laryngoscope for Nasotracheal Intubation: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11092499. [PMID: 35566626 PMCID: PMC9101392 DOI: 10.3390/jcm11092499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background: In this study, it was shown that the routine use of McGrath videolaryngoscopy may improve intubation success rates. The benefits to using a videolaryngoscope in nasotracheal intubation were also demonstrated. However, no solid evidence concerning the effectiveness of the use of McGrath videolaryngoscopes in nasotracheal intubation has previously been reported. As a result, we questioned whether, in adult patients who underwent oral and maxillofacial surgeries with nasotracheal intubation (P), the use of a McGrath videolaryngoscope (I) compared with a Macintosh laryngoscope (C) could reduce the intubation time, improve glottis visualization to a score of classification 1 in the Cormack–Lehane classification system, and improve the first-attempt success rate (O). The secondary outcomes measured were the rate of the use of Magill forceps and the external laryngeal pressure (BURP) maneuver used. Methods: An extensive literature search was conducted using databases. Only randomized controlled trials that compared the McGrath videolaryngoscopy and Macintosh laryngoscopy techniques in nasotracheal intubation in adult patients were included. Results: Five articles met the inclusion criteria and were included in the final analysis (n = 331 patients). The results showed a significant decrease in intubation time and a higher rate of classification 1 scores in the Cormack–Lehane classification system, but no difference in the first-attempt success rates were found between the McGrath group and the Macintosh group. Decreases in the rate of the use of Magill forceps and the use of the external laryngeal pressure maneuver were also found in the pooled analysis. With regard to the overall risk of bias, the selected trials were classified to have at least a moderate risk of bias, because none of the trials could blind the operator to the type of laryngoscope used. Conclusions: Our analysis suggests that the use of a McGrath videolaryngoscope in nasotracheal intubation resulted in shorter intubation times, improved views of the glottis and similar first-success rates in adult patients who received general anesthesia for dental, oral, maxillofacial, or head and neck cancer surgery, and also reduced the use of Magill forceps and the BURP maneuver.
Collapse
Affiliation(s)
- Chia-Hao Ho
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Li-Chung Chen
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Wen-Hao Hsu
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Tzu-Yu Lin
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung University College of Medicine, Chiayi Chang Gung Memorial Hospital, Puzi City, Chiayi 613, Taiwan
- Correspondence: (M.L.); (C.-W.L.); Tel.: +886-2-89667000 (ext. 2383) (M.L. & C.-W.L.); Fax: +886-2-23680782 (M.L. & C.-W.L.)
| | - Cheng-Wei Lu
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
- Correspondence: (M.L.); (C.-W.L.); Tel.: +886-2-89667000 (ext. 2383) (M.L. & C.-W.L.); Fax: +886-2-23680782 (M.L. & C.-W.L.)
| |
Collapse
|
6
|
Kasaudhan S, Gupta M, Singh K, Khan A. A comparison of intubating conditions for nasotracheal intubation with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope employing cuff inflation technique in adult patients. Indian J Anaesth 2021; 65:S104-S109. [PMID: 34703054 PMCID: PMC8500197 DOI: 10.4103/ija.ija_236_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/28/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: While performing laryngoscopy during nasotracheal intubation (NTI), the tip of the advancing endotracheal tube (ETT) generally lies along the posterior pharyngeal wall. The inflation of the ETT cuff brings it anterior towards the glottis. The present study was planned to compare the intubating conditions for NTI with standard direct Macintosh laryngoscope versus C-MAC® video laryngoscope (VL) employing ETT cuff inflation technique. Methods: This prospective randomised study was carried out on 50 patients, American Society of Anesthesiologists physical status I–II, age 18–60 years of either sex with an indication for NTI under general anaesthesia. They were randomly divided into two groups: group VL (n = 25): C-MAC® VL and group ML (n = 25): Macintosh laryngoscope. The primary outcome was to compare the total duration of NTI (T), while the secondary outcomes were to compare the need for cuff inflation or assistance with Magill forceps for successful NTI, the total number of attempts to achieve successful NTI, haemodynamic effects and complications. Results: T was significantly higher in group ML than group VL (P < 0.001). The intubation was successful with cuff inflation in all the patients in group VL, however, six patients of group ML required assistance with Magill forceps (P = 0.022). The haemodynamic parameters were all significantly higher at 3 min in group ML in comparison to group VL. Conclusion: The cuff inflation technique when used along with C-MAC® VL had more success rate, required lesser time and had minimal postoperative complications in comparison to the Macintosh laryngoscope.
Collapse
Affiliation(s)
- Sonia Kasaudhan
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Madhu Gupta
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Kriti Singh
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| | - Anas Khan
- Department of Anaesthesiology, Esi Hospital and PGIMSR, Basaidarapur, New Delhi, India
| |
Collapse
|
7
|
Gupta N, Gupta A, Sarma R, Batra A, Madan K. Video laryngoscopy vs. direct laryngoscopy for nasotracheal intubation in oro-maxillofacial surgery: a systematic review and meta-analysis of randomized controlled trials. Korean J Anesthesiol 2021; 74:439-448. [PMID: 34365774 PMCID: PMC8497912 DOI: 10.4097/kja.21234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nasotracheal intubation (NTI) is commonly performed in oromaxillofacial surgeries. We did this meta-analysis to ascertain whether use of video laryngoscopy (VL) provided better NTI characteristics as compared to direct laryngoscopy (DL) in patients undergoing oromaxillofacial surgeries. Methods We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oromaxillofacial surgery. The primary outcome was time to intubation. Secondary outcomes included the first attempt success, overall success, incidence of nasal bleeding, Cormack and Lehane grade, and maneuvers required. Results Of the 456 studies identified following a systematic search, 10 were included. Meta-analysis showed a significantly lower time to tracheal intubation favoring VL (mean difference: –9.04, 95% CI [–12.71, –5.36], P < 0.001; I2 = 59%). VL was also associated with a greater first attempt success (relative risk [RR]: 1.10, 95% CI [1.04, 1.16], P = 0.001). Maneuvers to facilitate intubation were less with VL (RR: 0.22, 95% CI [0.10, 0.51], P < 0.001). There was no difference in overall intubation success (RR: 1.04, 95% CI [0.98, 1.10], P = 0.17). The incidence of bleeding did not differ between the DL and VL groups (RR: 0.59, 95% CI [0.32, 1.08], P = 0.09). Conclusions Evidence as per this meta-analysis suggests VL leads to a shorter time to NTI, a greater first attempt success rate, and reduced need for maneuvers when compared to DL. The present study supports use of VL as a first line device for NTI in oral-maxillofacial surgeries in experienced hands.
Collapse
Affiliation(s)
- Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, All India Institute of Medical Sciences, New Delhi
| | - Anju Gupta
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Riniki Sarma
- Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, All India Institute of Medical Sciences, New Delhi
| | - Atul Batra
- Department of Medical Oncology, DR BRAIRCH, All India Institute of Medical Sciences, New Delhi
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi
| |
Collapse
|
8
|
Ambulkar R, Ranganathan P, Savarkar S, Divatia JV. A randomized controlled trial comparing McGRATH series 5 videolaryngoscope with the Macintosh laryngoscope for nasotracheal intubation. J Anaesthesiol Clin Pharmacol 2021; 36:477-482. [PMID: 33840927 PMCID: PMC8022068 DOI: 10.4103/joacp.joacp_1_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/06/2020] [Accepted: 05/03/2020] [Indexed: 11/09/2022] Open
Abstract
Background and Aims: The aim of this study was to compare the efficacy of McGRATH series 5 videolaryngoscope (VL) with Macintosh laryngoscope for nasotracheal intubation (NTI) in patients without anticipated difficult airways undergoing head and neck cancer surgeries. Material and Methods: We randomized 60 adult patients for NTI by experienced anesthetists with either Macintosh laryngoscope or McGRATH series 5 VL (VL group). The primary objective was to compare time taken for intubation (TTI). The secondary objectives included success rates, number of attempts, need for optimization maneuvers, Cormack and Lehane (CL) grade, and percentage of difficult intubations. Results: The mean TTI in the VL group was 43 (±10.6) versus 75 (±38.0) s in the Macintosh group (99% CI: 12.5; –51.6 s; P < 0.001). The overall intubation success rate was 100% in both groups. All 29 (100%) patients in the VL group were intubated in the first attempt versus 26 (86%) patients in the Macintosh group (99% CI –5; 33%; P = 0.11). In the Macintosh group, 20 (66%) patients needed optimization maneuver versus none in the VL group (99% CI 40; 91%; P < 0.001). In the VL group, 28 (96%) patients had a CL grade 1 view versus 9 (31%) in Macintosh group (99% CI 38; 92%; P < 0.001). There were no difficult intubations in the VL group versus 3 (10%) in the Macintosh group (99% CI: 7; 28%; P = 0.237). There was no trauma to oropharyngeal structures in either group. Conclusion: The McGRATH series 5 VL has faster TTI, better glottic visualization, and less need for optimization maneuvers than the Macintosh laryngoscope for NTI in patients with unanticipated difficult airways, when performed by experienced anesthetists.
Collapse
Affiliation(s)
- Reshma Ambulkar
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Priya Ranganathan
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Sukhada Savarkar
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Centre, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| |
Collapse
|
9
|
King BJ, Padnos I, Mancuso K, Christensen BJ. Comparing Video and Direct Laryngoscopy for Nasotracheal Intubation. Anesth Prog 2021; 67:193-199. [PMID: 33393610 DOI: 10.2344/anpr-67-02-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/14/2020] [Indexed: 12/26/2022] Open
Abstract
This parallel group randomized controlled clinical trial compared intubation duration and success using video laryngoscopy (VL) versus direct laryngoscopy (DL) during routine nasotracheal intubation. Fifty patients undergoing oral and maxillofacial surgery under general anesthesia were randomly assigned into 2 groups receiving either VL or DL to facilitate nasotracheal intubation. The primary outcome was the amount of time required to complete nasotracheal intubation. The secondary outcomes included the success of first attempt at intubation and the use of Magill forceps. Results demonstrated a mean time to intubation of 142 seconds in the DL group and 94 seconds in the VL group (p = .011). First attempt intubation success was 92.0% in the VL group and 84.0% in the DL group (p = .34). The use of Magill forceps was significantly increased in the DL group (p = .007). VL for routine nasotracheal intubation in oral and maxillofacial surgery procedures results in significantly faster intubation times and decreased use of Magill forceps compared with traditional DL.
Collapse
Affiliation(s)
- Brett J King
- Assistant Professor, Department of Oral & Maxillofacial Surgery, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Ira Padnos
- Assistant Professor, Department of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Kenneth Mancuso
- Assistant Professor, Department of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Brian J Christensen
- Assistant Professor, Department of Oral & Maxillofacial Surgery, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| |
Collapse
|
10
|
Patel A, Saadi R, Lighthall JG. Securing the Airway in Maxillofacial Trauma Patients: A Systematic Review of Techniques. Craniomaxillofac Trauma Reconstr 2020; 14:100-109. [PMID: 33995830 DOI: 10.1177/1943387520950096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Study Design The present study is a systematic review of the literature. Objective The goal of this study is to review our experience and the current literature on airway management techniques in maxillofacial trauma. Methods Independent searches of the PubMed and MEDLINE databases were performed from January 1, 2019 to February 1, 2019. Articles from the period of 2008 to 2018 were collected. All studies which described both airway management and maxillofacial trauma using the Boolean method and relevant search term combinations, including "maxillofacial," "trauma," and "airway," were considered. Results A total of 452 relevant articles in total were identified. Articles meeting inclusion criteria by abstract review included 68 total articles, of which 16 articles were focused on airway management techniques for maxillofacial trauma in the general population and were deemed appropriate for inclusion in the literature review. Conclusions Establishing an effective and stable airway in patients with maxillofacial trauma is of paramount concern. In both the acute setting and during delayed reconstruction, special considerations must be taken when securing a reliable airway in this patient population. The present article provides techniques for securing the airway and algorithms for utilization of these techniques, including both during the initial evaluation and the definitive operative management.
Collapse
Affiliation(s)
- Akshilkumar Patel
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Robert Saadi
- Department of Otolaryngology - Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology - Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
11
|
Neutral Position Facilitates Nasotracheal Intubation with a GlideScope Video Laryngoscope: A Randomized Controlled Trial. J Clin Med 2020; 9:jcm9030671. [PMID: 32131521 PMCID: PMC7141308 DOI: 10.3390/jcm9030671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups according to head position, neutral position (group N), and sniffing position (group S). The primary outcome was the degree of intubation difficulty according to the Intubation Difficulty Scale (IDS): Easy (IDS = 0), mildly difficult (IDS = 1 to 4), and moderately to severely difficult (IDS ≥ 5). Eighty-seven patients completed the study and their data were analyzed. The degree of intubation difficulty was significantly different between the two groups (p = 0.004). The frequency of difficult intubation (IDS > 0) was 12 (27.9%) in group N and 28 (63.6%) in group S (difference in proportion, 35.7%; 95% confidence interval [CI], 14.8 to 52.6%; p = 0.001). The neutral position facilitates nasotracheal intubation with GlideScope by aligning the nasotracheal tube and the glottis inlet more accurately than the sniffing position.
Collapse
|
12
|
Chae YJ, Kim DH, Park EJ, Oh J, Yi IK. A comparison of McGrath MAC, Pentax AWS, and Macintosh direct laryngoscopes for nasotracheal intubation: a randomized controlled trial. Ther Clin Risk Manag 2019; 15:1121-1128. [PMID: 31571890 PMCID: PMC6756366 DOI: 10.2147/tcrm.s220451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/18/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose Videolaryngoscopy in nasotracheal intubation has been reported to be better than direct laryngoscopy. The most suitable type of videolaryngoscope remains unknown. This study aimed to compare two videolaryngoscopes (McGrath MAC and Pentax AWS) with a Macintosh laryngoscope during nasotracheal intubation. Methods Overall, 123 patients older than 18 with normal airways who needed nasotracheal intubation were randomly allocated into three groups: Macintosh (n=41), McGrath (n=41), and Pentax (n=41). Intubation time was the primary outcome and subdivided into three steps: nose to oropharynx, oropharynx to laryngeal inlet, and laryngeal inlet to trachea. Time required, ease of each step, glottic view grade, modified nasal intubation–difficulty score, and subjective difficulty were evaluated. Results Intubation time among the three groups was not significantly different (Macintosh 34.6±8.1 seconds, McGrath 35.2±7.9 seconds, Pentax 36.2±9.7 seconds; p=0.727). While the glottal view was better with videolaryngoscopes (I/IIa/IIb/III 36.6%/36.6%/19.5%/7.3% vs 82.9%/9.8%/7.3%/0%, vs 63.4%/29.3%/4.9%/2.4%, p=0.000), modified nasal intubation–difficulty score and subjective difficulty and ease of each step were not significantly different. However, the Pentax took longest for the second step (11.8±6.3 vs 10.3±3.5 vs 15.1±7.6 seconds, p=0.001) but was shortest for the third step (2.9±2.6 vs 4.4±5.6 vs 1.7±0.7 seconds, p=0.001). Conclusion The McGrath MAC and Pentax AWS showed no benefits in intubation time or difficulty, despite better glottal views, compared to the Macintosh laryngoscope in nasotracheal intubation. Additionally, videolaryngoscopes had variable performance at different steps of nasotracheal intubation.
Collapse
Affiliation(s)
- Yun Jeong Chae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, South Korea
| | - Dae Hee Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, South Korea
| | - Eun Jeong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, South Korea
| | - Juyeon Oh
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, South Korea
| | - In Kyong Yi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, South Korea
| |
Collapse
|
13
|
Zhu H, Liu J, Suo L, Zhou C, Sun Y, Jiang H. A randomized controlled comparison of non-channeled king vision, McGrath MAC video laryngoscope and Macintosh direct laryngoscope for nasotracheal intubation in patients with predicted difficult intubations. BMC Anesthesiol 2019; 19:166. [PMID: 31470814 PMCID: PMC6717380 DOI: 10.1186/s12871-019-0838-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the performance of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators. METHODS Ninety nine ASA I or II adult patients, scheduled for oral maxillofacial surgeries with El-Ganzouri risk index 1-7 were enrolled. Patients were randomly allocated to intubate with one of three laryngoscopes (non-channeled King Vision, McGrath MAC and Macintosh). The intubators were experienced with more than 100 successful nasotracheal intubations using each device. The primary outcome was intubation time. The secondary outcomes included first success rate, time required for viewing the glottis, Cormack-Lehane grade of glottis view, the number of assist maneuvers, hemodynamic responses, the subjective evaluating of sensations of performances and associated complications. RESULTS The intubation time of King Vision and McGrath group was comparable (37.6 ± 7.3 s vs. 35.4 ± 8.8 s) and both were shorter than Macintosh group (46.8 ± 10.4 s, p < 0.001). Both King Vision and McGrath groups had a 100% first attempt success rate, significantly higher than Macintosh group (85%, p < 0.05). The laryngoscopy time was comparable between King Vision and McGrath group (16.7 ± 5.5 s vs. 15.6 ± 6.3 s) and was shorter than Macintosh group (22.8 ± 7.2 s, p < 0.05) also. Compared with Macintosh laryngoscope, Glottis view was obviously improved when exposed with either non-channeled King Vision or McGrath MAC VL (p < 0.001), and assist maneuvers required were reduced (p < 0.001). The maximum fluctuations of MAP were significantly attenuated in VL groups (47.7 ± 12.5 mmHg and 45.1 ± 10.3 mmHg vs. 54.9 ± 10.2 mmHg, p < 0.05 and p < 0.01). Most device insertions were graded as excellent in McGrath group, followed by Macintosh and King Vision group (p = 0.0014). The tube advancements were easier in VLs compared with the Macintosh laryngoscope (p < 0.001). Sore throat was found more frequent in Macintosh group compared with King Vision group (p < 0.05). CONCLUSIONS Non-channeled King Vision and McGrath MAC VLs were comparable and both devices facilitated nasotracheal intubation in managing predicted difficult intubations compared with Macintosh laryngoscope. TRIAL REGISTRATION ClinicalTrials registration number NCT03126344 . Registered on April 24, 2017.
Collapse
Affiliation(s)
- Haozhen Zhu
- Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Jinxing Liu
- Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Lulu Suo
- Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chi Zhou
- Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yu Sun
- Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Hong Jiang
- Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| |
Collapse
|
14
|
Roh GU, Kwak HJ, Lee KC, Lee SY, Kim JY. Randomized comparison of McGrath MAC videolaryngoscope, Pentax Airway Scope, and Macintosh direct laryngoscope for nasotracheal intubation in patients with manual in-line stabilization. Can J Anaesth 2019; 66:1213-1220. [PMID: 31144258 DOI: 10.1007/s12630-019-01409-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The objective of this study was to determine the clinical usefulness of videolaryngoscopes (VLs) by comparing the time to intubation (TTI) and the ease of intubation of McGrath MAC VL (MVL), Pentax Airway Scope VL (PVL), and Macintosh direct laryngoscope (DL) during nasotracheal intubation using manual in-line stabilization to simulate difficult airways. METHODS One hundred and twenty patients were randomly assigned to the MVL group (n = 40), the PVL group (n = 40), and the DL group (n = 40). Nasotracheal intubation was performed using MVL, PVL, or DL, according to group assignments. The primary outcome was TTI and secondary outcomes were glottic view, ease of intubation, and bleeding. RESULTS The TTI was significantly shorter in the MVL group than in the DL group (45 sec vs 57 sec; difference in means: - 12; 95% confidence interval [CI], - 21 to - 3; P = 0.01). The percentage of glottic opening and Cormack Lehane grade were significantly superior in the MVL and the PVL groups compared with the DL group (both P < 0.001). The intubation difficulty scale and numeric rating scale regarding ease of intubation were also significantly lower in the MVL and PVL groups than in the DL group (all P < 0.007). The incidence of bleeding was significantly lower in the MVL group than in the DL group (3 vs 15, relative risk 0.2; 95% CI, 0.06 to 0.64; P = 0.001). CONCLUSION This study showed that both MVL and PVL provided better visualization of the glottis and easier intubation, with less additional manipulation than DL during nasotracheal intubation in simulated difficult airways. Additionally, use of the MVL significantly shortened the TTI compared with the DL. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02647606); registered 6 January, 2016.
Collapse
Affiliation(s)
- Go Un Roh
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Bundang CHA General Hospital, Seongnam, Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, Korea
| | - Kyung Cheon Lee
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, Korea
| | - Sun Young Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Bundang CHA General Hospital, Seongnam, Korea
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.
| |
Collapse
|
15
|
Arslan Zİ, Türkyılmaz N. Which nostril should be used for nasotracheal intubation with Airtraq NT®: the right or left? A randomized clinical trial. Turk J Med Sci 2019; 49:116-122. [PMID: 30762320 PMCID: PMC7350855 DOI: 10.3906/sag-1803-177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background/aim Nasotracheal Airtraq is specifically designed to improve the glottis view and ease the nasotracheal intubation process in normal and difficult cases. Materials and methods After Ethics committee approval, we decided to enroll 40 patients with an ASA physical status of I or II, between 18 and 70 years of age undergoing elective maxillofascial, oral, and double chin surgery to determine which nostril is more suitable for nasotracheal intubation with nasotracheal Airtraq. Patients were randomized into the right and left nostril groups. Results Demographic and airway characteristics were similar among the groups. Nasotracheal intubation through the right nostril was shorter than that of the left nostril during nasotracheal intubation with the Airtraq NT (P < 0.001). 90° counterclockwise rotation of the tip of the tube was needed for directing the tube into the vocal cords in both right and left nostril groups (72% vs 88%). External laryngeal pressure and head flexion maneuvers can ease the intubation from the left nostril (P < 0.001 vs P = 0.03). Cuff inflation maneuver also can be helpful in some cases. We did not need any operator change or Magill forceps for any of the patients. Conclusion Nasotracheal intubation via the right nostril can be safely and quickly performed with the Airtraq NT without the need of Magill forceps. We recommend the use of the 90° counterclockwise rotation, external laryngeal pressure, and head flexion maneuvers to direct the tube into the vocal cords first. On the other hand, cuff inflation maneuver must also be kept in mind.
Collapse
|
16
|
Tracheal Tube Blockage by Fractured Middle Turbinate During Nasal Intubation: A Rare Airway Complication. J Maxillofac Oral Surg 2018; 17:439-440. [DOI: 10.1007/s12663-017-1049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
|
17
|
A comparison of the Macintosh laryngoscope, McGrath video laryngoscope, and Pentax Airway Scope in paediatric nasotracheal intubation. Sci Rep 2018; 8:17365. [PMID: 30478457 PMCID: PMC6255773 DOI: 10.1038/s41598-018-35857-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/11/2018] [Indexed: 12/22/2022] Open
Abstract
We evaluated the performance of the McGrath video laryngoscope and Pentax Airway Scope in comparison with the Macintosh laryngoscope for nasotracheal intubation in paediatric patients. For this, 108 patients were enrolled in an open-label, randomized controlled trial. Patients were randomly allocated to one of three groups based on use of the Macintosh laryngoscope, McGrath video laryngoscope, or Pentax Airway Scope. Time to intubation, the intubation difficulty, and the quality of navigation were compared among groups. The median nasotracheal intubation time [interquartile range] in the Macintosh group (33.5 [28.3–39.8] s) was significantly shorter than those of the McGrath (39.0 [32.0–43.0] s) and Pentax groups (43.0 [35.0–52.0] s). The difficulty of nasotracheal intubation was similar among all groups. When navigating and aligning the tube from the oropharynx into the glottic inlet, the cuff inflation method was required in significantly fewer patients for the Macintosh group (11.1%) than for the McGrath (48.6%) and Pentax (51.4%) groups. Thus, compared to the McGrath video laryngoscope and Pentax Airway Scope, the Macintosh laryngoscope allowed shorter nasotracheal intubation times and better facilitated tracheal navigation, requiring less use of the cuff inflation method to navigate the tracheal tube into the glottic inlet.
Collapse
|
18
|
Saxen MA. A Review of Current Literature of Interest to the Office-Based Anesthesiologist. Anesth Prog 2018; 65:214-216. [PMID: 30235435 DOI: 10.2344/anpr-65-03-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Mark A Saxen
- Indiana Office-Based Anesthesia Indiana University School of Dentistry Indianapolis, IN
| |
Collapse
|
19
|
Videolaryngoscopy versus direct laryngoscopy for nasotracheal intubation: A systematic review and meta-analysis of randomised controlled trials. J Clin Anesth 2018; 52:6-16. [PMID: 30153543 DOI: 10.1016/j.jclinane.2018.08.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/05/2018] [Accepted: 08/16/2018] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE Nasotracheal intubation (NTI) is a common practice in the oral and maxillofacial surgeries. A systematic review and meta-analysis was performed to determine whether videolaryngoscopy (VL) compared with direct laryngoscopy (DL) can lead to better outcomes for NTI in adult surgical patients. MEASUREMENTS Only randomised controlled trials comparing VL and DL for NTI were included. The primary outcome was overall success rate and the second outcomes were first-attempt success rate, intubation time, rate of Cormack and Lehane classification 1, rate of Magill Forceps used, rate of postoperative sore throat, and ease of intubation. MAIN RESULTS Fourteen studies with 20 comparisons (n = 1052) were included in quantitative synthesis. The overall success rate was similar between two groups (RR, 1.03; p = 0.14; moderate-quality evidence). VL was associated with a higher first-attempt success rate (RR 1.09; p = 0.04; low-quality evidence), a shorten intubation time (MD-6.72 s; p = 0.0001; low-quality evidence), a higher rate of Cormack and Lehane classification 1 (RR, 2.11; p < 0.01; high-quality evidence), a less use of the Magill forceps (RR, 0.11; p < 0.01; high-quality evidence) and a lower incidence of postoperative sore throat (RR, 0.50; p = 0.03; high-quality evidence). Subgroup analysis based on whether with a difficult airway showed higher overall success (p < 0.01) and first-attempt success rates with VL (p = 0.04) in patients with difficult airways; however, these benefits was not shown in patients with a normal airway (p > 0.05); Subgroup analysis based on operators' experience showed that success rate did not differ between groups (p > 0.05), but intubation time was shortened by more than 50s by non-experienced operators (p < 0.05). Subgroup analysis based on different devices used showed that only non-integrated VL led to a shorter intubation time (p < 0.05). CONCLUSIONS The use of VL does not increase the overall success rate of NTI in adult patients with general anesthesia, but it improves the first-attempt success rate and laryngeal visualization, and shortens the intubation time. VL is particularly beneficial for patients with difficult airways.
Collapse
|
20
|
Tabrizi R. In Reply. J Oral Maxillofac Surg 2018; 76:1831-1832. [PMID: 29859159 DOI: 10.1016/j.joms.2018.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 11/16/2022]
|
21
|
Tabrizi R, Dahi M, Moshari MR, Pourdanesh F, Zolfigol S. Video Laryngoscopy or Macintosh Laryngoscopy: Which One Is More Successful in Patients With Bilateral Mandibular Fractures? J Oral Maxillofac Surg 2018; 76:1864-1868. [PMID: 29679586 DOI: 10.1016/j.joms.2018.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/03/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Successful intubation is challenging in patients with bilateral mandibular fractures. The aim of this study was to compare the video laryngoscope (VL) with the Macintosh laryngoscope (ML) for intubation of patients with bilateral mandibular fractures. MATERIALS AND METHODS In this randomized controlled trial study, patients who had bilateral mandibular fractures (angle or subcondylar) were studied. Patients were randomly assigned to 1 of 2 groups using computerized randomization. Laryngoscopy was performed by the ML in group 1 and the VL in group 2. Intubation device (ML or VL) was the predictive factor of the study and age, maximum mouth opening (MMO), incisor fracture, and gender were the variables. Intubation time and successful intubation at the first attempt were the study outcomes. Independent t test was applied to compare intubation time, MMO, and age between the 2 groups. RESULTS Seventy-eight patients were studied (40 in group 1 and 38 in group 2). Mean intubation time was 33.02 ± 9.68 seconds in group 1 and 39.16 ± 7.40 seconds in group 2. Comparison of the data showed a significant difference between the 2 groups (P = .002). Twenty-four patients in group 1 and 31 in group 2 were successfully intubated at the first attempt. There was a significant difference in the number of successful or failed intubation attempts between the 2 groups (P = .03). CONCLUSION According to the present findings, use of the VL increased the first-attempt success rate of intubation in patients with bilateral mandibular fractures. Time of intubation could be longer when using the VL than when using the ML.
Collapse
Affiliation(s)
- Reza Tabrizi
- Associate Professor of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mastaneh Dahi
- Associate Professor of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Moshari
- Assistant Professor of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereydoon Pourdanesh
- Associate Professor of Oral and Maxillofacial Surgery, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Zolfigol
- Dental Student, Shahid Beheshti Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
22
|
Hoshijima H, Mihara T, Maruyama K, Denawa Y, Takahashi M, Shiga T, Nagasaka H. McGrath videolaryngoscope versus Macintosh laryngoscope for tracheal intubation: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth 2018; 46:25-32. [PMID: 29414609 DOI: 10.1016/j.jclinane.2017.12.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/21/2017] [Accepted: 12/27/2017] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE The McGrath laryngoscope is a novel self-contained videolaryngoscope with a single-use blade. There are several anecdotal reports that the McGrath is superior to the Macintosh laryngoscope for tracheal intubation. However this remains controversial. DESIGN Meta-analysis and systematic review. SETTING Operating room or intensive care unit. MEASUREMENTS A comprehensive literature search was conducted to identify clinical trials that met our inclusion criteria. To qualify, studies had to be prospective randomized trials comparing tracheal intubation between the McGrath and the Macintosh in an adult population. We extracted data on success rate, glottic visualization during intubation, and intubation time from the studies identified. In subgroup analysis, we assessed the influence on each of these parameters which included airway condition (normal or difficult) and operator (novice or experienced). We then conducted a trial sequential analysis (TSA). MAIN RESULTS Fourteen articles met our inclusion criteria. The McGrath offered better glottic visualization than the Macintosh (risk ratio, 1.34; 95% confidence interval (CI), 1.25-1.45). However, the McGrath required longer intubation time (mean difference, 10.1s; CI, 2.74-17.5) and demonstrated similar success rate of tracheal intubation (risk ratio, 1.00; CI, 0.95-1.05) compared to the Macintosh. TSA showed that total sample size reached the required information size (RIS) in glottic visualization and success rate. However, only 15.1% of the RIS was achieved in intubation time. In the subgroup analysis for airway condition and operator experience level, there were no subgroup differences in both glottic visualization and intubation time. CONCLUSIONS Our meta-analysis suggests that the McGrath is superior to the Macintosh in terms of glottic visualization (GRADE: moderate). However, it significantly extends intubation time (GRADE: very low) and its success rate (GRADE: very low) for tracheal intubation is not excellent. TSA suggests that further studies are necessary to confirm the results of intubation time.
Collapse
Affiliation(s)
- Hiroshi Hoshijima
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan.
| | - Takahiro Mihara
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan
| | - Koichi Maruyama
- Department of Anesthesiology, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kawasaki, Kanagawa 213-8507, Japan
| | - Yohei Denawa
- Department of Anesthesiology, Allegheny Health Network, PA, USA
| | - Masato Takahashi
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
| | - Toshiya Shiga
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare, School of Medicine, Ichikawa, Chiba 286-8686, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan
| |
Collapse
|
23
|
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: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
24
|
Sanuki T, Kurata S, Watanabe T, Ayuse T. A liquid crystal display monitor failure of a McGRATH video laryngoscope. J Clin Anesth 2016; 31:122-3. [PMID: 27185693 DOI: 10.1016/j.jclinane.2016.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Takuro Sanuki
- Division of Clinical Physiology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan.
| | - Shinji Kurata
- Department of Dental Anesthesiology, Nagasaki University Hospital, Nagasaki, 852-8523, Japan.
| | - Toshihiro Watanabe
- Department of Special Care Dentistry, Nagasaki University Hospital, Nagasaki, 852-8523, Japan.
| | - Takao Ayuse
- Division of Clinical Physiology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8523, Japan.
| |
Collapse
|