Body posture during simulated tracheal intubation: GlideScope^® videolaryngoscopy vs Macintosh direct laryngoscopy for novices and experts

Abstract

Summary Tracheal intubation requires the anaesthetist to adopt an awkward body posture. To investigate how posture may be improved, we compared the effects of laryngoscopy technique (GlideScope® vs Macintosh blade) and experience (novices vs experts) on body posture angles and the Rapid Entire Body Assessment postural analysis score. Novices (25 medical students) and experts (26 anaesthetists) were video‐recorded performing intubation in a manikin using both devices. The GlideScope resulted in smaller deflections for all analysed posture angles (all p values < 0.001) except the wrist compared with the Macintosh blade. Novices showed more trunk (p < 0.001) and neck (p = 0.002) flexion than experts. Using the GlideScope resulted in a lower Rapid Entire Body Assessment score compared with using the Macintosh blade (p < 0.001), indicating that the GlideScope resulted in body posture less likely to induce musculoskeletal injuries. From an ergonomic point of view, the GlideScope should be the preferred technique for laryngoscopy.

Muscle activity during endotracheal intubation using 4 laryngoscopes (Macintosh laryngoscope, Intubrite, TruView Evo2 and King Vision) – A comparative study

“…The video laryngoscopes allow to visualize entrance to larynx using less maneuvers and potentially less force. All these factors contribute to reduction of the task workload that is defined as the cost incurred by the operator to achieve a particular level of task [3]. We observed this also in our study, as the video laryngoscope King Vision required the smallest muscle activity during intubation efforts.…”

Upper limb disorders in anaesthetists – a survey of Association of Anaesthetists members

“…The nature of the anaesthetist's job poses a risk from poor posture (especially during airway management) which may be exacerbated if the trolley/bed is too low. It has been shown that less experienced anaesthetists are more likely to stoop and adopt a less ergonomic body posture during laryngoscopy than experienced anaesthetists [6,7], potentially putting them at greater risk. If such movements are repetitive, prolonged or forceful, there is a risk of injury [8].…”

“…Videolaryngoscopy may be associated with less risk of musculoskeletal injury; for example, the GlideScope â , has been shown to promote body positions that are less likely to put the operator at risk of musculoskeletal injury than the traditional Macintosh laryngoscope [9], and requires less physical demand with reduced muscular activation [10].…”

Use of the GlideScope video laryngoscope for intubation during ex utero intrapartum treatment in a fetus with a giant cyst of the 4th branchial cleft

“…Grundgeiger et al [17] demonstrated that the use of the GVL resulted in less trunk and neck flexion and less extended upper arms, namely small deflections of the posture angles, for experts. More ergonomic body posture may be facilitated because the GVL rarely requires the physician to look directly into the patient's mouth for viewing the larynx.…”

“…More ergonomic body posture may be facilitated because the GVL rarely requires the physician to look directly into the patient's mouth for viewing the larynx. [17] Moreover, when using the GVL, the posture of the physician is more consistently erect and the physician is not close to the patient, thereby reducing the risk of contamination of the sterile surgical field.…”