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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.
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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.)
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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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Ketata S, Fourati M, Derbel R, Keskes M, Bouzid K, Zouche I, Sallemi M, Kallel S, Fendri S, Zouari A, Cheikhrouhou H. McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized clinical trial. Pan Afr Med J 2023; 45:108. [PMID: 37719054 PMCID: PMC10504445 DOI: 10.11604/pamj.2023.45.108.36562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/02/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction laryngoscopy and tracheal intubation induce catecholaminergic release. Our study aimed to evaluate the hemodynamic impact of orotracheal intubation by McGrath® compared to the Macintosh laryngoscope in the elderly. Methods we conducted a prospective randomized clinical trial that included elderly patients proposed for a scheduled surgery under general anesthesia with orotracheal intubation and divided into 2 groups: patients who were intubated using the McGrath® (group V) and patients who were intubated using the Macintosh direct laryngoscope (group M). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before induction of anesthesia (baseline), and at 1 min, 3 min, and 5 min after intubation. Our outcomes were the increase of SBP (∆ SBP), MAP (∆ MAP), and HR (∆ HR) between the two groups, during the 5 minutes following the start of the orotracheal intubation, intubation time and the incidence of its related complications. Results sixty patients were included and randomized into 2 groups of 30. The average age of our sample was 70±6 years with a sex ratio of 1.22. Most of the patients were operated on for orthopedic, urologic, or abdominal surgery. There were no statistically significant differences between the two groups in terms of demographic characteristics and the duration of anesthesia (p> 0.05). The intubation time was significantly increased in group M (p≤0.001). There was a significant difference in SBP, MAP, and HR values at 1 min after orotracheal intubation compared with the baseline values in Group V(P<0,05) and Group M (p < 0.05). There was a significant increase in the first minute after tracheal intubation in terms of SBP (151±42 vs 134.5±26 mmHg, p=0.012), MAP (114±4 vs 102±17 mmHg, p=0.015), DBP (89±32 vs 84±16 mmHg, p=0.01), and HR (99.5±10 vs 94.5±2 b/min, p=0.008) when group M was compared to group V. The ∆SBP was significantly different between group M (∆SBP = 36.2±23.5mmHg) and group V (∆SBP= 30.77±21.6mmHg) (p = 0.005). There were 4 ventricular arrhythmias in group M versus zero in group V (p <0.0001). The postoperative sore throat was significantly decreased in group M vs V (p=0.036). Conclusion the McGrath® videolaryngoscope decreased the hemodynamic fluctuations due to endotracheal intubation in elderly patients.
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Affiliation(s)
- Salma Ketata
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mahdi Fourati
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Rahma Derbel
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mariem Keskes
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Karim Bouzid
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Zouche
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Moncef Sallemi
- Department of Oto-rhino-laryngology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Souha Kallel
- Department of Oto-rhino-laryngology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Sami Fendri
- Department of Visceral Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Amine Zouari
- Department of Visceral Surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Hichem Cheikhrouhou
- Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
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4
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Kriege M, Noppens RR, Turkstra T, Payne S, Kunitz O, Tzanova I, Schmidtmann I. A multicentre randomised controlled trial of the McGrath Mac videolaryngoscope versus conventional laryngoscopy. Anaesthesia 2023; 78:722-729. [PMID: 36928625 DOI: 10.1111/anae.15985] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/18/2023]
Abstract
Before completion of this study, there was insufficient evidence demonstrating the superiority of videolaryngoscopy compared with direct laryngoscopy for elective tracheal intubation. We hypothesised that using videolaryngoscopy for routine tracheal intubation would result in higher first-pass tracheal intubation success compared with direct laryngoscopy. In this multicentre randomised trial, 2092 adult patients without predicted difficult airway requiring tracheal intubation for elective surgery were allocated randomly to either videolaryngoscopy with a Macintosh blade (McGrath) or direct laryngoscopy. First-pass tracheal intubation success was higher with the McGrath (987/1053, 94%), compared with direct laryngoscopy (848/1039, 82%); absolute risk reduction (95%CI) was 12.1% (10.9-13.6%). This resulted in a relative risk (95%CI) of unsuccessful tracheal intubation at first attempt of 0.34 (0.26-0.45; p < 0.001) for McGrath compared with direct laryngoscopy. Cormack and Lehane grade ≥ 3 was observed more frequently with direct laryngoscopy (84/1039, 8%) compared with McGrath (8/1053, 0.7%; p < 0.001) No significant difference in tracheal intubation-associated adverse events was observed between groups. This study demonstrates that using McGrath videolaryngoscopy compared with direct laryngoscopy improves first-pass tracheal intubation success in patients having elective surgery. Practitioners may consider using this device as first choice for tracheal intubation.
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Affiliation(s)
- M Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - R R Noppens
- Department of Anesthesia and Peri-operative Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, ON, London, Canada
| | - T Turkstra
- Department of Anesthesia and Peri-operative Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, ON, London, Canada
| | - S Payne
- Department of Anaesthesia, Emergency and Intensive Care Medicine, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - O Kunitz
- Department of Anaesthesiology, Christophorus Hospital, Coesfeld, Germany
| | - I Tzanova
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Germany
| | - I Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Germany
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Adamu B, Yakubu SY, Muhammad RI. The Use of McGrath MAC Video Laryngoscope Versus McCoy Laryngoscope in Adults with Anticipated Difficult Airway Undergoing Elective Surgery. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:15-26. [PMID: 36923803 PMCID: PMC10010582 DOI: 10.4103/jwas.jwas_265_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/30/2022] [Indexed: 03/18/2023]
Abstract
Background Difficult airway management remains one of the most challenging clinical situations encountered by anaesthetists. Aim The study compared the effectiveness of the McGrath MAC video laryngoscope to the McCoy® laryngoscope in patients with difficult airway. Materials and Methods Following the institution's ethical approval, the randomised controlled trial was conducted involving 74 adults with American Society of anaesthesiologists' physical status (ASA) grading of I-III scheduled for elective surgery. The Patients were randomised into either group MVL (McGrath MAC) or group MCC (McCoy) and intubated after preoxygenation with 100% oxygen and administration of IV propofol and suxamethonium. The Intubation Difficulty Score (IDS), success rate of intubation, time to intubation, number of optimising manoeuvres and complications was assessed. Statistical analysis was performed using the statistical Package for Social Sciences (SPSS) version 24.0 computer software (IBM SPSS Statistics, IBM Corp. NY, United States). Numerical and categorical data were compared using the student's t-test and Chi square (χ2) test respectively. A value of P < 0.05 was considered statistically significant. Results Lower IDS scores were noted in the McGrath group; 54.1% vs. 5.4% of patients had IDS score of 0 in the McGrath and McCoy groups respectively, (P < 0.001). Overall success rate was higher in the McGrath group (100% vs. 89.1%), P = 0.040. Conclusion Lower IDS scores and improved intubation success rate was achieved with the McGrath compared with the McCoy laryngoscope in patients with predicted difficult airway. The McGrath has proved to be useful in managing patients with difficult airway.
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Affiliation(s)
- Bilkisu Adamu
- Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Saidu Yusuf Yakubu
- Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Rabiu Isah Muhammad
- Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
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Uchinami Y, Fujita N, Ando T, Mizunoya K, Hoshino K, Yokota I, Morimoto Y. The relationship between years of anesthesia experience and first-time intubation success rate with direct laryngoscope and video laryngoscope in infants: a retrospective observational study. J Anesth 2022; 36:707-714. [PMID: 36125551 PMCID: PMC9487847 DOI: 10.1007/s00540-022-03106-y] [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: 04/25/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022]
Abstract
Purpose Studies in adults have reported that video laryngoscope is more useful than direct laryngoscope when training less experienced anesthesiologists. However, whether this is true for infants remains unclear. Therefore, this study aimed to evaluate whether the use of video laryngoscope would result in smaller differences in success rate according to anesthesiologists’ expertise than those in direct laryngoscope. Methods Medical records and video recordings from the operating room of patients aged < 1 year who underwent non-cardiac surgery between March 2019 and September 2021 were reviewed. Tracheal intubations between April 8, 2020, and June 20, 2021, were excluded due to the shortage of video laryngoscope blades during the COVID-19 pandemic. Rates of first-time tracheal intubation success were compared by years of anesthesia experience and initial intubation device. Results In total, 125 of 175 tracheal intubations were analyzed (direct laryngoscope group, n = 72; video laryngoscope group, n = 53). The first-time tracheal intubation success rate increased with years of experience as an anesthesiologist in the direct laryngoscope group (odds ratio OR 1.70, 95% confidence interval CI 1.15, 2.49; P = 0.0070), but not the video laryngoscope group (OR 0.99, 95% CI 0.74, 1.35; P = 0.99). Conclusion The differences in success rate according to the anesthesiologists’ years of experience were non-significant when using video laryngoscope in infants, compared to those in direct laryngoscope. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-022-03106-y.
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Affiliation(s)
- Yuka Uchinami
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan.
| | - Noriaki Fujita
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan
| | - Takashi Ando
- Department of Anesthesiology, Hakodate Central Hospital, 3-2 Honcho, 040-8585, Hakodate, Japan
| | - Kazuyuki Mizunoya
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan
| | - Koji Hoshino
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, N15 W7, Sapporo, 060-8638, Japan
| | - Yuji Morimoto
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan
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Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation. Cochrane Database Syst Rev 2022; 4:CD011136. [PMID: 35373840 PMCID: PMC8978307 DOI: 10.1002/14651858.cd011136.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tracheal intubation is a common procedure performed to secure the airway in adults undergoing surgery or those who are critically ill. Intubation is sometimes associated with difficulties and complications that may result in patient harm. While it is traditionally achieved by performing direct laryngoscopy, the past three decades have seen the advent of rigid indirect videolaryngoscopes (VLs). A mounting body of evidence comparing the two approaches to tracheal intubation has been acquired over this period of time. This is an update of a Cochrane Review first published in 2016. OBJECTIVES To assess whether use of different designs of VLs in adults requiring tracheal intubation reduces the failure rate compared with direct laryngoscopy, and assess the benefits and risks of these devices in selected population groups, users and settings. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL and Web of Science on 27 February 2021. We also searched clinical trials databases, conference proceedings and conducted forward and backward citation searches. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs with adults undergoing laryngoscopy performed with either a VL or a Macintosh direct laryngoscope (DL) in any clinical setting. We included parallel and cross-over study designs. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We collected data for the following outcomes: failed intubation, hypoxaemia, successful first attempt at tracheal intubation, oesophageal intubation, dental trauma, Cormack-Lehane grade, and time for tracheal intubation. MAIN RESULTS We included 222 studies (219 RCTs, three quasi-RCTs) with 26,149 participants undergoing tracheal intubation. Most studies recruited adults undergoing elective surgery requiring tracheal intubation. Twenty-one studies recruited participants with a known or predicted difficult airway, and an additional 25 studies simulated a difficult airway. Twenty-one studies were conducted outside the operating theatre environment; of these, six were in the prehospital setting, seven in the emergency department and eight in the intensive care unit. We report here the findings of the three main comparisons according to videolaryngoscopy device type. We downgraded the certainty of the outcomes for imprecision, study limitations (e.g. high or unclear risks of bias), inconsistency when we noted substantial levels of statistical heterogeneity and publication bias. Macintosh-style videolaryngoscopy versus direct laryngoscopy (61 studies, 9883 participants) We found moderate-certainty evidence that a Macintosh-style VL probably reduces rates of failed intubation (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.26 to 0.65; 41 studies, 4615 participants) and hypoxaemia (RR 0.72, 95% CI 0.52 to 0.99; 16 studies, 2127 participants). These devices may also increase rates of success on the first intubation attempt (RR 1.05, 95% CI 1.02 to 1.09; 42 studies, 7311 participants; low-certainty evidence) and probably improve glottic view when assessed as Cormack-Lehane grade 3 and 4 (RR 0.38, 95% CI 0.29 to 0.48; 38 studies, 4368 participants; moderate-certainty evidence). We found little or no clear difference in rates of oesophageal intubation (RR 0.51, 95% CI 0.22 to 1.21; 14 studies, 2404 participants) but this finding was supported by low-certainty evidence. We were unsure of the findings for dental trauma because the certainty of this evidence was very low (RR 0.68, 95% CI 0.16 to 2.89; 18 studies, 2297 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I2 = 96%). Hyperangulated videolaryngoscopy versus direct laryngoscopy (96 studies, 11,438 participants) We found moderate-certainty evidence that hyperangulated VLs probably reduce rates of failed intubation (RR 0.51, 95% CI 0.34 to 0.76; 63 studies, 7146 participants) and oesophageal intubation (RR 0.39, 95% CI 0.18 to 0.81; 14 studies, 1968 participants). In subgroup analysis, we noted that hyperangulated VLs were more likely to reduce failed intubation when used on known or predicted difficult airways (RR 0.29, 95% CI 0.17 to 0.48; P = 0.03 for subgroup differences; 15 studies, 1520 participants). We also found that these devices may increase rates of success on the first intubation attempt (RR 1.03, 95% CI 1.00 to 1.05; 66 studies, 8086 participants; low-certainty evidence) and the glottic view is probably also improved (RR 0.15, 95% CI 0.10 to 0.24; 54 studies, 6058 participants; data for Cormack-Lehane grade 3/4 views; moderate-certainty evidence). However, we found low-certainty evidence of little or no clear difference in rates of hypoxaemia (RR 0.49, 95% CI 0.22 to 1.11; 15 studies, 1691 participants), and the findings for dental trauma were unclear because the certainty of this evidence was very low (RR 0.51, 95% CI 0.16 to 1.59; 30 studies, 3497 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I2 = 99%). Channelled videolaryngoscopy versus direct laryngoscopy (73 studies, 7165 participants) We found moderate-certainty evidence that channelled VLs probably reduce rates of failed intubation (RR 0.43, 95% CI 0.30 to 0.61; 53 studies, 5367 participants) and hypoxaemia (RR 0.25, 95% CI 0.12 to 0.50; 15 studies, 1966 participants). They may also increase rates of success on the first intubation attempt (RR 1.10, 95% CI 1.05 to 1.15; 47 studies, 5210 participants; very low-certainty evidence) and probably improve glottic view (RR 0.14, 95% CI 0.09 to 0.21; 40 studies, 3955 participants; data for Cormack-Lehane grade 3/4 views; moderate-certainty evidence). We found little or no clear difference in rates of oesophageal intubation (RR 0.54, 95% CI 0.17 to 1.75; 16 studies, 1756 participants) but this was supported by low-certainty evidence. We were unsure of the findings for dental trauma because the certainty of the evidence was very low (RR 0.52, 95% CI 0.13 to 2.12; 29 studies, 2375 participants). We were not able to pool data for time required for tracheal intubation owing to considerable heterogeneity (I2 = 98%). AUTHORS' CONCLUSIONS VLs of all designs likely reduce rates of failed intubation and result in higher rates of successful intubation on the first attempt with improved glottic views. Macintosh-style and channelled VLs likely reduce rates of hypoxaemic events, while hyperangulated VLs probably reduce rates of oesophageal intubation. We conclude that videolaryngoscopy likely provides a safer risk profile compared to direct laryngoscopy for all adults undergoing tracheal intubation.
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Affiliation(s)
| | - Andrew M Rogers
- Department of Anaesthesia, Royal United Hospitals Bath NHS Trust, Bath, UK
| | - Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Tim M Cook
- Department of Anaesthesia, Royal United Hospitals Bath NHS Trust, Bath, UK
- University of Bristol, Bristol, UK
| | - Andrew F Smith
- Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK
- Lancaster University, Lancaster, UK
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Dean P, Kerrey B. Video screen visualization patterns when using a video laryngoscope for tracheal intubation: A systematic review. J Am Coll Emerg Physicians Open 2022; 3:e12630. [PMID: 35028640 PMCID: PMC8738719 DOI: 10.1002/emp2.12630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Published studies of video laryngoscopes are often limited by the lack of a clear definition of video laryngoscopy (VL). We performed a systematic review to determine how often published studies of VL report on video screen visualization. METHODS We searched PubMed, EMBASE and Scopus for interventional and observational studies in which a video laryngoscope equipped with a standard geometry blade was used for tracheal intubation. We excluded simulation based studies. Our primary outcome was data on video laryngoscope screen visualization. Secondary outcomes were explicit methodology for screen visualization. RESULTS We screened 4838 unique studies and included 207 (120 interventional and 87 observational). Only 21 studies (10% of 207) included any data on video screen visualization by the proceduralist, 19 in a yes/no fashion only (ie, screened viewed or not) and 2 with detail beyond whether the screen was viewed or not. In 11 more studies, visualization patterns could be inferred based on screen availability and in 16 more studies, the methods section stated how screen visualization was expected to be performed without reporting data collection on how the proceduralist interacted with the video screen. Risk of bias was high in the majority of included studies. CONCLUSIONS Published studies of VL, including many clinical trials, rarely include data on video screen visualization. Given the nuances of using a video laryngoscope, this is a critical deficiency, which largely prevents us from knowing the treatment effect of using a video laryngoscope in clinical practice. Future studies of VL must address this deficiency.
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Affiliation(s)
- Preston Dean
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Benjamin Kerrey
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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9
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Samal RL, Swain S, Samal S. A Comparative Study between Truview PCD Video Laryngoscope and Macintosh Laryngoscope with Respect to Intubation Quality and Hemodynamic Changes. Anesth Essays Res 2021; 15:73-80. [PMID: 34667352 PMCID: PMC8462422 DOI: 10.4103/aer.aer_62_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Video laryngoscopes resemble traditional laryngoscopes, but they have a video chip embedded in the tip of laryngoscope blade. This enables the operator to "look around the corners" which is not possible with conventional direct laryngoscopes. The present study was undertaken to compare Truview video laryngoscope and Macintosh laryngoscope for glottis visualization, ease of tracheal intubation, and associated hemodynamic response. Setting The study was conducted in operation theater in a medical college. Study Design It was a randomized prospective observational study. Materials and Methods Sixty patients of American Society of Anesthesiologists Grade 1 and 2 of either sex aged 18-60 years who were scheduled to undergo elective surgery requiring general anesthesia with orotracheal intubation were selected. In patients of Group T (n = 30), intubation was done using Truview video laryngoscope, while in Group M (n = 30), intubation was done using Macintosh laryngoscope. Various airway and hemodynamic parameters were assessed and compared. Statistical Analysis Statistical analysis was done using Chi-square test, paired and unpaired Student's t-test, and ANOVA test. P < 0.05 is considered statistically significant. Results Distribution of modified Mallampati Class (MMPC), ease of laryngoscopic blade insertion, and size of cuffed endotracheal tube used were statistically comparable in both the groups. The time to intubation was more in Group T (37.16 ± 8.23 s) as compared to Group M (29.80 ± 6.75 s). There was a statistically significant better modified Cormack and Lehane (CL) grading view obtained in Group T as compared to Group M (P = 0.025). CL Grades 2 and 3 were not seen in any of either of the group. The mean intubation difficulty score (IDS) was significantly lower in Group T (0.3 ± 0.60) as compared to Group M (0.73 ± 0.86). In both the Groups T and M, the mean heart rate, systolic blood pressure (BP), and diastolic BP were significantly increased from baseline for up to 3 min after laryngoscopy, but they were comparable between the two groups all the time. Conclusion Truview propaganda cum distribution laryngoscope provides a better glottis view than the Macintosh laryngoscope. Although it requires a longer time to intubate using Truview, the overall IDS score was lower as compared to Macintosh laryngoscope. Hemodynamic changes remained similar in both the groups.
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Affiliation(s)
- Rajiba Lochan Samal
- Department of Anaesthesiology, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India
| | - Sumita Swain
- Department of Anaesthesiology, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India
| | - Soumya Samal
- Department of Anaesthesiology, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India
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Chen T, Yasen Y, Wu J, Cheng H. Factors influencing lower respiratory tract infection in older patients after general anesthesia. J Int Med Res 2021; 49:3000605211043245. [PMID: 34521241 PMCID: PMC8447098 DOI: 10.1177/03000605211043245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective Pulmonary complication is common in older patients after surgery. We analyzed
risk factors of lower respiratory tract infection after general anesthesia
among older patients. Methods In this retrospective investigation, we included older patients who underwent
surgery with general anesthesia. Logistic regression analyses were performed
to determine risk factors of lower respiratory tract infection. Results A total 418 postoperative patients with general anesthesia were included; the
incidence of lower respiratory tract infection was 9.33%. Ten cases were
caused by gram-positive bacteria, 26 cases by gram-negative bacteria, and 2
cases by fungus. We found significant differences in age, smoking, diabetes,
oral/nasal tracheal intubation, and surgery duration. Logistic regression
analysis indicated that age ≥70 years (odds ratio [OR] 2.028, 95% confidence
interval [CI] 1.115–3.646), smoking (OR 2.314, 95% CI 1.073–4.229), diabetes
(OR 2.185, 95% CI 1.166–4.435), nasotracheal intubation (OR 3.528, 95% CI
1.104–5.074), and duration of surgery ≥180 minutes (OR 1.334, 95% CI
1.015–1.923) were independent risk factors of lower respiratory tract
infections. Conclusions Older patients undergoing general anesthesia after tracheal intubation have a
high risk of lower respiratory tract infections. Clinical interventions
should be provided to prevent pulmonary infections in patients with relevant
risk factors.
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Affiliation(s)
- Tingting Chen
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yali Yasen
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jianjiang Wu
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hu Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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