Evaluation of the McGrath^® Series 5 videolaryngoscope after failed direct laryngoscopy*

Abstract

SummaryUnanticipated difficulties during tracheal intubation and failure to intubate are among the leading causes of anaesthesia-related morbidity and mortality. Using the technique of video laryngoscopy, the alignment of the oral and pharyngeal axes to facilitate tracheal intubation is unnecessary. In this study we evaluated the McGrath Ò Series 5 videolaryngoscope for tracheal intubation in 61 patients who exhibited Cormack and Lehane grade 3 or 4 laryngoscopies with a Macintosh laryngoscope. Using the McGrath resulted in an improved glottic view, compared to Macintosh laryngoscope. Laryngoscopy was improved by one grade in 10%, by two grades in 80% and by three grades in 10% of cases (p < 0.0001). The success rate for intubation was 95% with the McGrath. These results suggest that the McGrath videolaryngoscope can be used with a high success rate to facilitate tracheal intubation in difficult intubation situations.

A randomised controlled trial comparing the McGrath® videolaryngoscope with the straight blade laryngoscope when used in adult patients with potential difficult airways*

“…According to El-Ganzouri et al's study [20], the positive predictive value of Mallampati class ‡ 3 was 21% for laryngoscopy grades 3 and 4 combined. In Noppens et al's study [21], it was shown that 80% of patients with a direct laryngoscopy view of 3 or 4 improved by two grades with the use of the McGrath videolaryngoscope. On the other hand, there were significantly more patients with a laryngoscopy view of grade 2 and 3 in the Henderson group (27.5%) than in the McGrath group (2.5%).…”

Comparison of the C-MAC D-Blade, Conventional C-MAC, and Macintosh Laryngoscopes in Simulated Easy and Difficult Airways

“…Ng et al (23), in a study of adult patients with potentially difficult airways, demonstrated that the C-MAC allowed more rapid intubation times with fewer intubation attempts, although more grade 1 laryngoscopic views are obtained by McGrath video laryngoscopes. In another study evaluating McGrath video laryngoscopes in unexpected difficult intubations, failure was reported in 5% of the patients (29). Although good views are obtained using the GlideScope, failure of intubation was reported in 6% of the patients (30).…”

S1 guidelines on airway management

“…Regardless of the shape of the laryngoscope blade used, this technological development alone provides an improved view of the glottis. The view of the glottic area can often be improved with video laryngoscopy if direct laryngoscopy is difficult or even impossible [37][38][39]; however, despite good visibility, intubation can be delayed and can even fail [40].…”