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Nedunchezhian V, Nedunchezhian I, Van Zundert A. Clinically Preferred Videolaryngoscopes in Airway Management: An Updated Systematic Review. Healthcare (Basel) 2023; 11:2383. [PMID: 37685417 PMCID: PMC10487223 DOI: 10.3390/healthcare11172383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Videolaryngoscopes (VLs) have emerged as a safety net offering several advantages over direct laryngoscopy (DL). The aim of this study is to expand on our previous study conducted in 2016, to deduce which VL is most preferred by clinicians and to highlight any changes that may have occurred over the past 7 years. An extensive systematic literature review was performed on Medline, Embase, Web of Science, and Cochrane Central Database of Controlled Studies for articles published between September 2016 and January 2023. This review highlighted similar results to our study in 2016, with the CMAC being the most preferred for non-channelled laryngoscopes, closely followed by the GlideScope. For channelled videolaryngoscopes, the Pentax AWS was the most clinically preferred. This review also highlighted that there are minimal studies that compare the most-used VLs, and thus we suggest that future studies directly compare the most-used and -preferred VLs as well as the specific nature of blades to attain more useful results.
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Affiliation(s)
- Vikram Nedunchezhian
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD 4029, Australia;
| | - Ishvar Nedunchezhian
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD 4215, Australia;
| | - André Van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Brisbane, QLD 4029, Australia;
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Yao W, Li M, Zhang C, Luo A. Recent Advances in Videolaryngoscopy for One-Lung Ventilation in Thoracic Anesthesia: A Narrative Review. Front Med (Lausanne) 2022; 9:822646. [PMID: 35770016 PMCID: PMC9235869 DOI: 10.3389/fmed.2022.822646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Since their advent, videolaryngoscopes have played an important role in various types of airway management. Lung isolation techniques are often required for thoracic surgery to achieve one-lung ventilation with a double-lumen tube (DLT) or bronchial blocker (BB). In the case of difficult airways, one-lung ventilation is extremely challenging. The purpose of this review is to identify the roles of videolaryngoscopes in thoracic airway management, including normal and difficult airways. Extensive literature related to videolaryngoscopy and one-lung ventilation was analyzed. We summarized videolaryngoscope-guided DLT intubation techniques and discussed the roles of videolaryngoscopy in DLT intubation in normal airways by comparison with direct laryngoscopy. The different types of videolaryngoscopes for DLT intubation are also compared. In addition, we highlighted several strategies to achieve one-lung ventilation in difficult airways using videolaryngoscopes. A non-channeled or channeled videolaryngoscope is suitable for DLT intubation. It can improve glottis exposure and increase the success rate at the first attempt, but it has no advantage in saving intubation time and increases the incidence of DLT mispositioning. Thus, it is not considered as the first choice for patients with anticipated normal airways. Current evidence did not indicate the superiority of any videolaryngoscope to another for DLT intubation. The choice of videolaryngoscope is based on individual experience, preference, and availability. For patients with difficult airways, videolaryngoscope-guided DLT intubation is a primary and effective method. In case of failure, videolaryngoscope-guided single-lumen tube (SLT) intubation can often be achieved or combined with the aid of fibreoptic bronchoscopy. Placement of a DLT over an airway exchange catheter, inserting a BB via an SLT, or capnothorax can be selected for lung isolation.
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Lee J, Cho Y, Kim W, Choi KS, Jang BH, 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] [Abstract] [Key Words] [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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Affiliation(s)
- Juncheol Lee
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (J.L.); (H.S.); (T.H.L.)
| | - Youngsuk Cho
- Department of Emergency Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul 05355, Korea;
- Department of Biomedical Engineering, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Wonhee Kim
- Department of Emergency Medicine, Hallym University, Chuncheon 24253, Korea;
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University College of Medicine, Seoul 04763, Korea; (K.-S.C.); (M.K.N.)
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (J.L.); (H.S.); (T.H.L.)
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Korea;
| | - Jae Guk Kim
- Department of Emergency Medicine, Hallym University, Chuncheon 24253, Korea;
| | - Min Kyun Na
- Department of Neurosurgery, Hanyang University College of Medicine, Seoul 04763, Korea; (K.-S.C.); (M.K.N.)
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (J.L.); (H.S.); (T.H.L.)
| | - Dong Won Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul 04763, Korea;
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Kar P, Mounika K, Padhy S, Pathy A, Durga P. Comparison of Airtraq DL ™ and Macintosh laryngoscope for double-lumen tube placement in simulated difficult airway: A randomised study. Indian J Anaesth 2022; 66:442-448. [PMID: 35903592 PMCID: PMC9316664 DOI: 10.4103/ija.ija_119_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/15/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: The Airtraq DL ™ is a prototype channeled video laryngoscope, designed specifically for endobronchial intubation with a double-lumen tube (DLT). Evidence on its superiority over Macintosh laryngoscope for DLT placement in the difficult airway is limited. This study compared the efficacy of both these laryngoscopes in the simulated difficult airway. Methods: A prospective randomised controlled study was conducted on 52 patients undergoing elective thoracic surgery with lung isolation using a left-sided DLT. The patients were randomised into Airtraq DL ™ group (group A) and Macintosh group (group M). The primary objective was to compare the time required for intubation, and the secondary objectives were to evaluate time to best glottic view, Cormack–Lehane (CL) grading, intubation difficulty score (IDS), manoeuvres, attempts at intubation, haemodynamic response and complications. Operating anaesthesiologists were also asked to grade the ease of laryngoscopy and intubation for both devices on a 4-point Likert scale. Results: The mean time to intubation was found to be lesser in group A than in group M (18 ± 6.91 s vs 25.48 ± 9.47 s, P = 0.003). Group A showed better CL grading (P ≤ 0.001), lesser requirement of manoeuvres (P = 0.02) and lower IDS (P = 0.003). Also, group A had significantly better Likert scale results as compared to group M. Conclusion: The Airtraq DL ™ is superior to Macintosh laryngoscope as it requires lesser time for intubation and provides favourable intubating conditions (better CL grading, lesser manoeuvres, lower IDS and improved Likert scales) for double-lumen placement in the simulated difficult airway.
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Varshney P, Ahmed SM, Siddiqui OA, Nadeem A, Ajmal PM. A comparative evaluation of Airtraq and Hansraj Video laryngoscopes in patients undergoing tracheal intubation with cervical spine immobilization - A randomized prospective study. J Anaesthesiol Clin Pharmacol 2021; 37:336-341. [PMID: 34759540 PMCID: PMC8562461 DOI: 10.4103/joacp.joacp_327_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: Airway management is a key concern in trauma patients with cervical spine fracture. Application of manual inline axial stabilization (MIAS) has become the standard of care in these patients. Indirect laryngoscopy only requires alignment of the pharyngeal and laryngeal axis. Hence the primary objective of the study was to compare two indirect laryngoscopes, Airtraq (with adaptor) and Hansraj Video laryngoscopes based on its Intubation Difficulty Score. Material and Methods: Sixty anesthetized patients were divided into two groups using computer-based randomization, and tracheal intubation was performed using either Airtraq or Hansraj Videolaryngoscope with cervical spine immobilization. Results: Both Airtraq and Hansraj groups were comparable in terms of percentage of glottic opening (POGO) scoring (92 ± 9.88% vs. 89.3 ± 10.4%.) and duration of intubation attempt (14.9 ± 4.36 sec vs. 16.97 ± 3.64 sec). Intubation difficulty scale (IDS) score was significantly shorter with Airtraq (1 ± 0.58 vs. 1.8 ± 0.805; P < 0.0001). The mean duration of time taken for laryngoscopy in Airtraq (12.9 ± 2.07 s vs. 19.06 ± 3.83 s; P < 0.0001)) was significantly shorter and also the duration of time taken to secure airway in Airtraq VL was significantly shorter (29.47 ± 4.75 s vs. 36.03 ± 5.80 sec; P < 0.0001). The heart rate and MABP changes were modest in both groups, but was significantly more in Hansraj VL as compared to Airtraq VL, post-intubation. Conclusion: Both Airtraq and Hansraj videolaryngoscope can be used as first-hand device in the scenario of cervical spine stabilization. Airtraq videolaryngoscope is better than Hansraj videolaryngoscope due to shorter IDS and lessor hemodynamic changes.
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Affiliation(s)
- Poojangi Varshney
- Dr Poojangi Varshney: Senior Resident, GTB, New Delhi Syed M. Ahmed: Professor in the Department of Anesthesiology JNMCH, AMU. Abu Nadeem: Associate Prof in the Department of Anesthesiology JNMCH, AMU. Obaid A. Siddiqui: Associate Prof in the Department of Anesthesiology JNMCH, AMU Ajmal PM: Assistant Professor GMC, Palakkad, Kerala
| | - Syed M Ahmed
- Dr Poojangi Varshney: Senior Resident, GTB, New Delhi Syed M. Ahmed: Professor in the Department of Anesthesiology JNMCH, AMU. Abu Nadeem: Associate Prof in the Department of Anesthesiology JNMCH, AMU. Obaid A. Siddiqui: Associate Prof in the Department of Anesthesiology JNMCH, AMU Ajmal PM: Assistant Professor GMC, Palakkad, Kerala
| | - Obaid A Siddiqui
- Dr Poojangi Varshney: Senior Resident, GTB, New Delhi Syed M. Ahmed: Professor in the Department of Anesthesiology JNMCH, AMU. Abu Nadeem: Associate Prof in the Department of Anesthesiology JNMCH, AMU. Obaid A. Siddiqui: Associate Prof in the Department of Anesthesiology JNMCH, AMU Ajmal PM: Assistant Professor GMC, Palakkad, Kerala
| | - Abu Nadeem
- Dr Poojangi Varshney: Senior Resident, GTB, New Delhi Syed M. Ahmed: Professor in the Department of Anesthesiology JNMCH, AMU. Abu Nadeem: Associate Prof in the Department of Anesthesiology JNMCH, AMU. Obaid A. Siddiqui: Associate Prof in the Department of Anesthesiology JNMCH, AMU Ajmal PM: Assistant Professor GMC, Palakkad, Kerala
| | - P M Ajmal
- Dr Poojangi Varshney: Senior Resident, GTB, New Delhi Syed M. Ahmed: Professor in the Department of Anesthesiology JNMCH, AMU. Abu Nadeem: Associate Prof in the Department of Anesthesiology JNMCH, AMU. Obaid A. Siddiqui: Associate Prof in the Department of Anesthesiology JNMCH, AMU Ajmal PM: Assistant Professor GMC, Palakkad, Kerala
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Ynineb Y, Boglietto E, Bonnet F, Quesnel C, Garnier M. Face-To-Face Double-Lumen Tube Intubation With the Airtraq Video Laryngoscope for Emergency Thoracic Surgery: A Case Report. Semin Cardiothorac Vasc Anesth 2021; 26:90-94. [PMID: 33840292 DOI: 10.1177/10892532211007664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Double-lumen intubation is commonly used for thoracic surgery as it allows rapid and effective one-lung ventilation. However, it is more difficult than single-lumen tube intubation, notably in the context of emergency surgery and/or in hypoxemic patients. We report the case of a 57-year-old patient requiring emergency revision surgery after an upper right lobectomy due to postoperative pneumothorax and pleuropneumonia. As rapid lung isolation was required due to a bronchopleural fistula, rapid sequence induction and double-lumen tube intubation were performed. In addition, as the patient was hypoxemic with incomplete pre-oxygenation and too uncomfortable to tolerate the recumbent position despite high-flow oxygen, intubation was performed in face-to-face position. The patient was successfully intubated in 22 seconds and the right lung immediately isolated, allowing the surgeon to clean the pleural cavity. This is the first report of a double-lumen tube intubation in face-to-face position. The expected difficulties related to this type of intubation were successfully prevented using an Airtraq laryngoscope. Although such a strategy cannot be recommended from this one case, this report is encouraging for future studies evaluating the potential advantages of Airtraq use for double-lumen face-to-face intubation for emergency thoracic surgery.
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Affiliation(s)
- Yacine Ynineb
- Sorbonne University, Paris, France.,Tenon Hospital, Paris, France
| | - Emilie Boglietto
- Sorbonne University, Paris, France.,Tenon Hospital, Paris, France
| | - Francis Bonnet
- Sorbonne University, Paris, France.,Tenon Hospital, Paris, France
| | | | - Marc Garnier
- Sorbonne University, Paris, France.,Tenon Hospital, Paris, France
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Samuels JD, Tangel VE, Lui B, Turnbull ZA, Pryor KO, White RS, Jiang SY. Adoption of video laryngoscopy by a major academic anesthesia department. J Comp Eff Res 2021; 10:101-108. [PMID: 33470849 DOI: 10.2217/cer-2020-0185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim: To describe the adoption patterns of intubating devices used at a major teaching and research facility. Materials & methods: Retrospective analysis of 2012-2019 data on frequency and trends in airway management devices collected from our anesthesia information management system. Results: Use of direct laryngoscopy was more frequent, but there was a downward trend in use over time (p < 0.008) in favor of video laryngoscopy (VL), which increased significantly (p < 0.008). The largest growth among devices was the McGrath VL, which increased from 0.2% in 2012 to 36.2% of cases in 2019. Conclusion: Our study shows a clear increase in VL usage which has implications in quality of care and medical education.
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Affiliation(s)
- Jon D Samuels
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Virginia E Tangel
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Briana Lui
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Zachary A Turnbull
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Kane O Pryor
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Silis Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA
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Kim YS, Song J, Lim BG, Lee IO, Won YJ. Different classes of videoscopes and direct laryngoscopes for double-lumen tube intubation in thoracic surgery: A systematic review and network meta-analysis. PLoS One 2020; 15:e0238060. [PMID: 32857788 PMCID: PMC7455027 DOI: 10.1371/journal.pone.0238060] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/08/2020] [Indexed: 12/20/2022] Open
Abstract
Background Double-lumen tube is commonly used in thoracic surgeries that need one-lung ventilation, but its big size and stiff structure make it harder to perform intubation than a conventional tracheal intubation tube. Objectives To investigate the effectiveness and safety of videoscopes for double-lumen tube insertion. The primary outcome was the success rate of first attempt intubation. Secondary outcomes were intubation time, malposition, oral mucosal damage, sore throat, and external manipulation. Design Systematic review and network meta-analysis Data sources Databases (Pubmed, Embase, Cochrane, Kmbase, Web of science, Scopus) up to June 23, 2020 were searched. Eligibility Randomized controlled trials comparing different videoscopes for double-lumen tube intubation were included in this study. Methods We classified and lumped the videoscope devices into the following groups: standard (non-channeled) videolaryngoscope, channeled videolaryngoscope, videostylet, and direct laryngoscope. After assessing the quality of evidence, we statistically analyzed and chose the best device based on the surface under the cumulative ranking curve (SUCRA) by using STATA software (version 16). Results We included 23 studies (2012 patients). Based on the success rate of the first attempt, a rankogram suggested that the standard videolaryngoscope (76.4 of SUCRA) was the best choice, followed by videostylet (65.5), channeled videolaryngoscope (36.1), and direct laryngoscope (22.1), respectively. However, with regard to reducing the intubation time, the best choice was videostylet, followed by a direct laryngoscope, channeled videolaryngoscope, and standard videolaryngoscope, respectively. Direct laryngoscope showed the lowest incidence of malposition but required external manipulation the most. Channeled videolaryngoscope showed the highest incidence of oral mucosal damage, but showed the lower incidence of sore throat than standard videolaryngoscope or direct laryngoscope. Conclusion Most videoscopes improved the success rate of double-lumen tube intubation; however, they were time-consuming (except videostylet) and had a higher malposition rate than the direct laryngoscope.
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Affiliation(s)
- Young Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jihyun Song
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Il Ok Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Young Ju Won
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
- * E-mail:
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