A Comparison of McGrath Videolaryngoscope versus Macintosh Laryngoscope for Nasotracheal Intubation: A Systematic Review and Meta-Analysis

Abstract

Background: In this study, it was shown that the routine use of McGrath videolaryngoscopy may improve intubation success rates. The benefits to using a videolaryngoscope in nasotracheal intubation were also demonstrated. However, no solid evidence concerning the effectiveness of the use of McGrath videolaryngoscopes in nasotracheal intubation has previously been reported. As a result, we questioned whether, in adult patients who underwent oral and maxillofacial surgeries with nasotracheal intubation (P), the use of a McGrath videolaryngoscope (I) compared with a Macintosh laryngoscope (C) could reduce the intubation time, improve glottis visualization to a score of classification 1 in the Cormack–Lehane classification system, and improve the first-attempt success rate (O). The secondary outcomes measured were the rate of the use of Magill forceps and the external laryngeal pressure (BURP) maneuver used. Methods: An extensive literature search was conducted using databases. Only randomized controlled trials that compared the McGrath videolaryngoscopy and Macintosh laryngoscopy techniques in nasotracheal intubation in adult patients were included. Results: Five articles met the inclusion criteria and were included in the final analysis (n = 331 patients). The results showed a significant decrease in intubation time and a higher rate of classification 1 scores in the Cormack–Lehane classification system, but no difference in the first-attempt success rates were found between the McGrath group and the Macintosh group. Decreases in the rate of the use of Magill forceps and the use of the external laryngeal pressure maneuver were also found in the pooled analysis. With regard to the overall risk of bias, the selected trials were classified to have at least a moderate risk of bias, because none of the trials could blind the operator to the type of laryngoscope used. Conclusions: Our analysis suggests that the use of a McGrath videolaryngoscope in nasotracheal intubation resulted in shorter intubation times, improved views of the glottis and similar first-success rates in adult patients who received general anesthesia for dental, oral, maxillofacial, or head and neck cancer surgery, and also reduced the use of Magill forceps and the BURP maneuver.

Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs) Revealing the Future of Airway Management: Video Laryngoscopy vs. Macintosh Laryngoscopy for Enhanced Clinical Outcomes

“…The available variety will be limited due to prices; nevertheless, departments of anesthesiology might be harshly judged when a dangerous airway event occurs and is investigated in light of new guidelines [ 36 ]. Our results show consensus with previous systematic reviews and meta-analyses [ 37 , 38 ] showing that this improvement is more noticeable in patients that have a complex airway [ 39 ] and that endorse the usage of video laryngoscopes to accomplish successful intubation in patients that have a greater complex laryngoscopy risk [ 40 ].…”

“…The results of this review also indicated an increase in the degree of classification from the Cormack-Lehane classification system after using VL as compared to Mac laryngoscopy, which recommends the visualization of the glottis using the VL technique. This finding is also supported by another systematic review and meta-analysis [ 37 ].…”

Articulating Video Stylet Compared to Other Techniques for Endotracheal Intubation in Normal Airways: A Simulation Study in Consultants with No Prior Experience

“…The direct laryngoscopy (DL) is the most widely used method to perform ETI; notably, it might a challenging learning curve [7,8], and the proficiency with DL deteriorates over time if not routinely practiced [9]. Alternatively, video laryngoscopes (VLSs) have improved the visualization of the vocal cords [10], with improved results suggested both in any setting [11] as well as in challenging scenarios such as cardiac arrest [12] or nasotracheal intubation [13]. Moreover, the VLS technique has recently shown better performance than DL in a large multicentric randomized controlled trial conducted mostly in the emergency department setting [14].…”