Intubation of non-difficult airways using video laryngoscope versus direct laryngoscope: a randomized, parallel-group study

Abstract

Background The video laryngoscope is recommended for intubating difficult airways. The present study aimed to determine whether the video laryngoscope can further improve intubation success rates compared with the direct laryngoscope in patients with non-difficult airways. Methods In total, 360 patients scheduled for elective abdominal surgeries were randomly assigned to undergo intubation using either a video laryngoscope ( n = 179) or a direct laryngoscope ( n = 181). The following parameters were measured: mouth opening; thyromental distance; sternomental distance; shape angle of the tracheal catheter; and glottic exposure grade. Results The percentage of patients with level I-II of total glottic exposure in the video laryngoscope group was 100% versus 63.5% in the direct laryngoscope group ( P < 0.001). The one-attempt success rate of intubation was 96.1% using a video laryngoscope versus 90.1% using a direct laryngoscope ( P = 0.024). The intubation success rate using a video laryngoscope was 100% versus 94.5% using a direct laryngoscope ( P = 0.004). Immediate oropharyngeal injury occurred in 5.1% of patients intubated using a direct laryngoscope versus 1.1% using a video laryngoscope ( P = 0.033). On postoperative day 1, obvious hoarseness was exhibited by 7.9% of patients intubated using a direct laryngoscope versus 2.8% using a video laryngoscope ( P = 0.035). The grade of glottic exposure and catheter shape angle were independent risk factors for tracheal intubation failure. Thyromental distance, shape angle, glottic exposure time, and surgical position were independent risk factors for postoperative complications. Thyromental distance and glottic exposure time were independent risk factors for complications lasting > 2 days. Conclusions Intubation using a video laryngoscope yielded significantly higher intubation success rates and significantly fewer postoperative complications than direct laryngoscopy in patients with non-difficult airways. Trial registration Chinese Clinical Trial Registry. No: ChiCTR-IOR-16009023 . Prospective registration.

A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods

“…Most of the VL studies compared glottis visualization, intubation success rate at overall and/or the first attempt, time to intubation, and complication, with those observed using the Macintosh laryngoscope. In many studies, VL has been reported to improve glottis visualization, increase intubation success rate, reduce intubation attempts, reduce pressure on laryngeal structures, and reduce complications compared to those observed on using the Macintosh laryngoscope [3][4][5][6][7][8][9]16]. Since the VL is evolving rapidly and has various advantages over Macintosh laryngoscope, it is considered that VL will become a routine practice in airway management during anesthesia in place of the Macintosh laryngoscope in the near future.…”

“…Recently, the method of intubation has changed from that involving a direct glottic view to an indirect glottic view because video laryngoscopes (VL) have several advantages such as improvement of glottis visualization, a higher intubation success rate, reduction in intubation attempts and complications compared to direct laryngoscopes [2][3][4][5][6][7][8][9][10].…”

Barrier Enclosure for Endotracheal Intubation in a Simulated COVID-19 Scenario: A Crossover Study

“…14 Video laryngoscopy has been shown to have higher first-pass success rates and fewer complications. 29 , 30 In addition, direct laryngoscopy generally requires that the proceduralist’s face is closer to the patient’s mouth than is required for video laryngoscopy. For these reasons, we chose to test the barrier shield using the video laryngoscopy technique.…”

Anesthesia of a child with open Botalli’s duct – a case report

“…Mogućnost uporabe naprednih pomagala za intubaciju poput videolaringoskopa ili Bonfilsova rigidnog endoskopa iskusnim korisnicima omogućava sigurniju i bržu intubaciju. 7 Pri odabiru lijekova za indukciju anestezije u pacijenata s PDA-om bitno je održati sustavni vaskularni otpor, očuvati funkciju lijevog srca te izbjegavati smanjenje plućnoga vaskularnog otpora. 8 U bolesnika s teškom disfunkcijom lijeve klijetke i smanjenom srčanom rezervom, kod kojih se zbog prevencije neželjenih događaja mora očuvati preostala funkcija miokarda, lijek izbora jest etomidat zbog njegova protektivnog učinka na srčanu frekvenciju, srednji arterijski tlak te sustavni vaskularni otpor.…”