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Bacher V, Németh M, Rendeki S, Tornai B, Rozanovic M, Pankaczi A, Oláh J, Farkas J, Chikhi M, Schlégl Á, Maróti P, Nagy B. Comparison of Macintosh Laryngoscope, King Vision ®, VividTrac ®, AirAngel Blade ®, and a Custom-Made 3D-Printed Video Laryngoscope for Difficult and Normal Airways in Mannequins by Novices-A Non-Inferiority Trial. J Clin Med 2024; 13:3213. [PMID: 38892925 PMCID: PMC11173105 DOI: 10.3390/jcm13113213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Endotracheal intubation (ETI) is a cornerstone of airway management. The gold standard device for ETI is still the direct laryngoscope (DL). However, video laryngoscopes (VLs) are now also widely available and have several proven advantages. The VL technique has been included in the major airway management guidelines. During the COVID-19 pandemic, supply chain disruption has raised demand for 3D-printed medical equipment, including 3D-printed VLs. However, studies on performance are only sparsely available; thus, we aimed to compare 3D-printed VLs to the DL and other VLs made with conventional manufacturing technology. Methods: Forty-eight medical students were recruited to serve as novice users. Following brief, standardized training, students executed ETI with the DL, the King Vision® (KV), the VividTrac® (VT), the AirAngel Blade® (AAB), and a custom-made 3D-printed VL (3DVL) on the Laerdal® airway management trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma, and user satisfaction. Results: The KV and VT are proved to be superior (p < 0.05) to the DL in both scenarios. The 3DVL's performance was similar (p > 0.05) or significantly better than that of the DL and mainly non-inferior (p > 0.05) compared to the KV and VT in both scenarios. Regardless of the scenario, the AAB proved to be inferior (p < 0.05) even to the DL in the majority of the variables. The differences between the devices were more pronounced in the difficult airway scenario. The user satisfaction scores were in concordance with the aforementioned performance of the scopes. Conclusions: Based upon our results, we cannot recommend the AAB over the DL, KV, or VT. However, as the 3DVL showed, 3D printing indeed can provide useful or even superior VLs, but prior to clinical use, meticulous evaluation might be recommended.
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Affiliation(s)
- Viktor Bacher
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
| | - Márton Németh
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Szilárd Rendeki
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
| | - Balázs Tornai
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Martin Rozanovic
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Andrea Pankaczi
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - János Oláh
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - József Farkas
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- Department of Anatomy, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Melánia Chikhi
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Ádám Schlégl
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- Department of Orthopedics, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Péter Maróti
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- 3D Printing & Visualization Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Bálint Nagy
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
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Shin KW, Lee SP, Kim T, Choi S, Kim YJ, Park HP, Oh H. Channelled versus nonchannelled Macintosh videolaryngoscope blades in patients with a cervical collar: a randomized controlled noninferiority trial. Can J Anaesth 2024:10.1007/s12630-024-02769-3. [PMID: 38777999 DOI: 10.1007/s12630-024-02769-3] [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: 08/24/2023] [Revised: 02/21/2024] [Accepted: 03/16/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Channelled blades have the advantage of avoiding stylet use and potential airway injury during videolaryngoscopic intubation. Nevertheless, the effectiveness of channelled Macintosh-type blades has not yet been fully established. We sought to assess the utility of channelled Macintosh-type blades for videolaryngoscopic intubation under cervical spine immobilization. METHODS We conducted a randomized controlled noninferiority trial in neurosurgical patients with a difficult airway simulated by a cervical collar. Videolaryngoscopic intubation with a reinforced tracheal tube was performed using a channelled Macintosh-type blade without a stylet (channelled group, n = 130) or a nonchannelled Macintosh-type blade with a stylet (nonchannelled group, n = 131). The primary outcome was intubation success rate. Secondary outcomes included time to intubation and incidence or severity of intubation-related complications (subglottic, lingual, and dental injuries; bleeding; sore throat; and hoarseness). RESULTS The initial intubation success rate was 98% and 99% in the channelled and nonchannelled groups, respectively, showing the noninferiority of the channelled group (difference in proportions -0.8%; 95% confidence interval [CI], -4.8% to 2.9%; predefined noninferiority margin, -5%; P = 0.62). Fewer participants in the channelled group had subglottic injuries than in the nonchannelled group (32% [32/100] vs 57% [54/95]; difference in proportions, -25%; 95% CI, -39% to -11%; P < 0.001). There were no significant differences between the two groups in the overall intubation success rate, time to intubation, and incidence or severity of other intubation-related complications. CONCLUSIONS For videolaryngoscopic intubation in patients with a cervical collar, channelled Macintosh-type blades are an alternative to nonchannelled Macintosh-type blades, with a noninferior initial intubation success rate and a lower incidence of subglottic injury. STUDY REGISTRATION CRIS.nih.go.kr ( KCT0005186 ); first submitted 29 June 2020.
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Affiliation(s)
- Kyung Won Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Phil Lee
- Department of Biomedical Engineering Graduate School, Chungbuk National University, Cheongju, Republic of Korea
| | - Taeyup Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seungeun Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyongmin Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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King D, Blair A. The Evolution of Equipment and Technology for Visualising the Larynx and Airway. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1406:61-78. [PMID: 37016111 DOI: 10.1007/978-3-031-26462-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Laryngoscopy and endotracheal intubation are the core skills of an anaesthetist. The tools and equipment used today are unrecognisable from the methods used in the first recorded attempts at laryngoscopy over 200 years ago. The evolution of the modern-day laryngoscopes has mirrored advancements in technology within general society, and particularly with regard to computer and fibreoptic technology over the last 30 years. The development of these modern visualisation devices would not have been possible without those that went before it, as each new device has been influenced by the previous. Video laryngoscopes have quickly gained popularity as the primary intubating device in many scenarios, driven by ease of use as well as positive patient outcomes. While it is still debated whether videolaryngoscopes can replace direct laryngoscopy for routine intubations, their effectiveness in difficult airways is unquestioned. This chapter will cover the anatomy of the airway and the development of technology from the rudimentary creations in the early 1700s to the modern larynsgocopes created in the twenty-second century which allow the user to view the airway in more detail in order to secure endotracheal intubation even in an airway where intubation would be difficult.
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Affiliation(s)
- Duncan King
- Northern Irish Medical and Dental Agency, Belfast, Northern Ireland
| | - Alison Blair
- Craigavon Hospital, Southern Health and Social Care Trust, Craigavon, UK.
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Gulati S, Samui S, De A. Comparison of Macintosh, McCoy, Truview EVO2, and King Vision Laryngoscopes for Intubation in Patients with Immobilized Cervical Spine: A Randomized, Controlled Trial. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_191_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wu H, Hu D, Chen X, Zhang X, Xia M, Chai X, Wang S, Zhang W. The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract; a prospective observational study. BMC Anesthesiol 2021; 21:28. [PMID: 33494705 PMCID: PMC7829489 DOI: 10.1186/s12871-021-01253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. Methods Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. Results Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient, P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286–0.612) and its OR value was 10.09 (95%CI: 4.19–24.28), sensitivity was 0.469 (95%CI: 0.325–0.617), specificity was 0.929 (95%CI: 0.877–0.964), positive predictive value was 0.676 (95%CI: 0.484–0.745), negative predictive value was 0.847 (95%CI: 0.825–0.865). Conclusion Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract. Trial registration The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).
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Affiliation(s)
- Hao Wu
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Dandan Hu
- Department of Oncology, First Affiliated Hospital of the University of Science and Technology of China, Provincial Cancer Hospital, Hefei, Anhui, China
| | - Xu Chen
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Xuebing Zhang
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Min Xia
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Xiaoqing Chai
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Sheng Wang
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China
| | - Wei Zhang
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China, Anhui Provincial Hospital, 17 Lujiang Road, Hefei, 230000, Anhui, China.
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Lim JZ, Chew SH, Chin BZ, Siew RC. Proficiencies of military medical officers in intubating difficult airways. BMC Emerg Med 2020; 20:78. [PMID: 33028220 PMCID: PMC7542123 DOI: 10.1186/s12873-020-00375-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background This study sheds light on the proficiency of military medical officers who had received between 2 and 3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method One hundred thirty-three doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1 s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4 s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2 s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4 s. Conclusion Military medical officers with 2–3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.
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Affiliation(s)
- Jonathan Zm Lim
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
| | - Shi Hao Chew
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Benjamin Zb Chin
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Raymond Ch Siew
- RS Anaesthesia & Intensive Care, 71 Ubi Road 1, #05-41, Singapore, 408732, Singapore
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Yi IK, Kwak HJ, Lee KC, Lee JH, Min SK, Kim JY. Comparison of McGrath, Pentax, and Macintosh laryngoscope in normal and cervical immobilized manikin by novices: a randomized crossover trial. Eur J Med Res 2020; 25:35. [PMID: 32819444 PMCID: PMC7441605 DOI: 10.1186/s40001-020-00435-0] [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: 02/26/2019] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to compare tracheal intubation performance regarding the time to intubation, glottic view, difficulty, and dental click, by novices using McGrath videolaryngoscope (VL), Pentax Airway Scope (AWS) and Macintosh laryngoscope in normal and cervical immobilized manikin models. METHODS Thirty-five anesthesia nurses without previous intubation experience were recruited. Participants performed endotracheal intubation in a manikin model at two simulated neck positions (normal and fixed neck via cervical immobilization), using three different devices three times each. Performance parameters included intubation time, success rate of intubation, Cormack Lehane laryngoscope grading, dental click, and subjective difficulty score. RESULTS Intubation time and success rate during first attempt were not significantly different between the 3 groups in normal airway manikin. In the cervical immobilized manikin, the intubation time was shorter (p = 0.012), and the success rate with the first attempt was significantly higher (p < 0.001) when using McGrath VL and Pentax AWS compared with Macintosh laryngoscope. Both VLs showed less difficulty score (p < 0.001) and more Cormack Lehane grade I (p < 0.001) in both scenarios. The incidence of dental clicks was higher with Macintosh laryngoscope compared with McGrath VL in cervical immobilized airway (p < 0.001). CONCLUSIONS McGrath VL and Pentax AWS did not show clinically significant decrease in intubation time, however, they achieved higher first attempt success rate, easier intubation and better glottis view compared with Macintosh laryngoscope by novices in a cervical immobilized manikin model. McGrath VL may reduce the risk of dental injury compared with Macintosh laryngoscope in cervical immobilized scenario. TRIAL REGISTRATION ClinicalTrials.gov (NCT03161730), May 22, 2017 https://clinicaltrials.gov/ct2/hom.
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Affiliation(s)
- In Kyong Yi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 24, Namdong-Daero 774beon-gil, Namdong-gu, Incheon, 21565, Korea
| | - Kyung Cheon Lee
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 24, Namdong-Daero 774beon-gil, Namdong-gu, Incheon, 21565, Korea
| | - Ji Hyea Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Sang Kee Min
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea
| | - Jong Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Korea.
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Mallick T, Verma A, Jaiswal S, Haldar M, Sheikh WR, Vishen A, Snehy A, Ahuja R. Comparison of the time to successful endotracheal intubation using the Macintosh laryngoscope or KingVision video laryngoscope in the emergency department: A prospective observational study. Turk J Emerg Med 2020; 20:22-27. [PMID: 32355898 PMCID: PMC7189822 DOI: 10.4103/2452-2473.276381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE: Intubation is a skill that must be mastered by the emergency physician (EP). Today, we have a host of video laryngoscopes which have been developed to make intubations easier and faster. It may seem that in a busy emergency department (ED), a video laryngoscope (VL) in the hands of an EP would help him intubate patients faster compared to the traditional direct laryngoscope (DL). Our goal was to compare the time taken to successfully intubate patients coming in ED using King Vision VL (KVVL) and DL. MATERIALS AND METHODS: This was a prospective observational study on patients coming to the ED requiring emergent intubation. They were allocated one to one alternatively into two groups – KVVL and DL. Accordingly, KVVL or DL intubations were carried out by the EPs. Time taken to intubate, first-pass success, and crossover between laryngoscopes were recorded. RESULTS: A total of 350 patients were enrolled in the study. Overall, mean time to intubate patients using the DL was 15.85 s (95% confidence interval [CI] 14.05–17.65), while the meantime with KVVL was 13.75 s (95% CI 12.32–15.18) (P = 0.084). The overall first-pass success rates with DL and KVVL were 89.94% and 85.16%, respectively (P = 0.076). A total of 7.43% (95% CI 5.12–10.66) patients had crossover between laryngoscopes. CONCLUSION: We found the KVVL to have a similar performance to the DL in terms of time for intubations and ease in difficult airways. We consider the KVVL a useful device for EDs to equip themselves with.
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Affiliation(s)
- Tanvi Mallick
- Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India
| | - Ankur Verma
- Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India
| | - Sanjay Jaiswal
- Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India
| | - Meghna Haldar
- Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India
| | - Wasil Rasool Sheikh
- Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India
| | - Amit Vishen
- Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India
| | - Abhishek Snehy
- Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India
| | - Rinkey Ahuja
- Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India
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Votruba J, Brozek T, Blaha J, Henlin T, Vymazal T, Donaldson W, Michalek P. Video Laryngoscopic Intubation Using the King Vision TM Laryngoscope in a Simulated Cervical Spine Trauma: A Comparison Between Non-Channeled and Channeled Disposable Blades. Diagnostics (Basel) 2020; 10:E139. [PMID: 32138162 PMCID: PMC7151076 DOI: 10.3390/diagnostics10030139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
Videolaryngoscopes may reduce cervical spine movement during tracheal intubation in patients with neck trauma. This manikin study aimed to compare the performance of disposable non-channeled and channeled blades of the King Vision™ videolaryngoscope in simulated cervical spine injury. Fifty-eight anesthesiologists in training intubated the TruMan manikin with the neck immobilized using each blade in a randomized order. The primary outcome was the time needed for tracheal intubation, secondary aims included total success rate, the time required for visualization of the larynx, number of attempts, view of the vocal cords, and subjective assessment of both methods. Intubation time with the channeled blade was shorter, with a median time of 13 s (IQR 9-19) vs. 23 s (14.5-37.5), p < 0.001, while times to visualization of the larynx were similar in both groups (p = 0.54). Success rates were similar in both groups, but intubation with the non-channeled blade required more attempts (1.52 vs. 1.05; p < 0.001). The participants scored the intubation features of the channeled blade significantly higher, while visualization features were scored similarly in both groups. Both blades of the King Vision™ videolaryngoscope are reliable intubation devices in a simulated cervical spine injury in a manikin model when inserted by non-experienced operators. The channeled blade allowed faster intubation of the trachea.
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Affiliation(s)
- Jiri Votruba
- First Department of Tuberculosis and Respiratory Care, 1st Medical Faculty of the Charles University and General University Hospital, 128 00 Prague, Czech Republic;
| | - Tomas Brozek
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty of the Charles University and General University Hospital, 128 00 Prague, Czech Republic; (T.B.); (J.B.)
- Medical Faculty, Masaryk University, 625 00 Brno, Czech Republic
| | - Jan Blaha
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty of the Charles University and General University Hospital, 128 00 Prague, Czech Republic; (T.B.); (J.B.)
| | - Tomas Henlin
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty of the Charles University and University Military Hospital, 128 00 Prague, Czech Republic;
| | - Tomas Vymazal
- 2 nd Medical Faculty of the Charles University and University Hospital Motol, 150 06 Prague, Czech Republic;
| | - Will Donaldson
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK;
| | - Pavel Michalek
- Department of Anaesthesia and Intensive Medicine, 1st Medical Faculty of the Charles University and General University Hospital, 128 00 Prague, Czech Republic; (T.B.); (J.B.)
- Department of Anaesthesia, Antrim Area Hospital, Antrim BT41 2RL, UK;
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A comparison of the king vision® and glidescope® video intubation systems in patients at risk for difficult intubation. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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: 7] [Impact Index Per Article: 1.4] [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.
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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.
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Biro P, Schlaepfer M. Tracheal intubation with channeled vs. non-channeled videolaryngoscope blades. Rom J Anaesth Intensive Care 2018; 25:97-101. [PMID: 30393765 DOI: 10.21454/rjaic.7518.252.sch] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Study objective Videolaryngoscopes can be fitted either with channeled or non-channeled blades, which may result in a different performance and success of tracheal intubation. We investigated the characteristics of the two different blade types of the commercially available KingVision™ videolaryngoscope. Design A prospective, randomized, single center investigation study in a urological operation unit of a tertiary hospital. Subjects and Methods Forty adult patients undergoing elective urological surgery in general anaesthesia with tracheal intubation were randomly allocated into group 1 (channeled videolaryngoscopy, n = 20) and group 2 (non-channeled videolaryngoscopy, n = 20). We measured the times from laryngoscope insertion to recognize the glottis and to conclude tracheal intubation. The number of laryngoscopy/intubation attempts and the degree of visual glottis exposure on a visual analog scale from 0 (glottis not visible) to 10 (glottis fully visible) was assessed. The lowest SpO2 value during airway management was recorded. Results There was no statistically significant difference in biometric data between the 2 groups. The time from the laryngoscope insertion to glottis recognition with the non-channeled blades was 5 (4-8) s as compared to the channeled ones with 11 (7-14) s (median and range; p = 0.01). Intubation duration was shorter with the channeled blades 17 (12-27) s vs. 29 (25-51) s (median and range; p < 0.001). Number of laryngoscopy/intubation attempts, grades for glottis visibility, intubation difficulty were not different. The lowest SpO2 was 98% in both groups. Conclusions Videolaryngoscopic glottis recognition time was longer and the total time to secure the airway was shorter with the channeled blades.
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Affiliation(s)
- Peter Biro
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Martin Schlaepfer
- Institute of Anaesthesiology, Institute of Physiology, University and University Hospital Zurich, Switzerland
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