Optimal external laryngeal manipulation versus McCoy blade in active position in patients with poor view of glottis on direct laryngoscopy

Abstract

Successful endotracheal intubation requires a clear view of glottis. Optimal external laryngeal manipulation may improve the view of glottis on direct laryngoscopy with Macintosh blade, but it requires another trained hand. Alternatively, McCoy laryngoscope with elevated tip may be useful. This study has been designed to compare the two techniques in patients with poor view of glottis. Two hundred patients with ‘Grade 2 or more’ view of glottis on direct laryngoscopy with Macintosh blade are included in the study. Optimal external laryngeal manipulation was applied, followed by laryngoscopy with McCoy blade in activated position; and the view was noted in both situations. The two interventions were compared using Chi-square test. The overall changes, in the views, were analyzed with Wilcoxon signed rank test. Both the techniques improved the view of glottis significantly (P<0.05). Optimal external laryngeal manipulation was significantly better than McCoy laryngoscope in active position, especially in patients with Grade 3 or 4 baseline view, poor oropharyngeal class, decreased head extension and decreased submandibular space (odds ratio = 2.36, 3.17, 3.22 and 26.48 respectively). To conclude, optimal external laryngeal manipulation is a better technique than McCoy laryngoscope in patients with poor view of glottis on direct laryngoscopy with Macintosh blade.

Comparison Between McCoy Laryngoscope and C-MAC Video Laryngoscope in Anticipated Difficult Airway: A Prospective Randomised Study

“…It was found that the median time to intubation was significantly less in C-MAC compared to McCoy laryngoscope. A thorough search of all the studies was made but very few studies were found comparing ease of intubation and glottis visualisation during laryngoscopy and intubation with C-MAC VL and McCoy laryngoscope [ 20 ]. A previous study showed a significantly lesser time for intubation in the McCoy laryngoscopy group as compared to the C-MAC group.…”

Failed fibre optic intubation in a difficult airway- an anaesthetic nightmare

“…Challenges of large neck mass 2 are distorted airway, difficulties in visualizing the airway and risk of sudden complete airway occlusion. Although awake fibreoptic intubation is the gold standard for an anticipated difficult intubation 3,4 the distorted airway anatomy or deviation of the larynx due to masses, oedema or soft tissue contraction can contribute to difficult fibreoptic exposures. BURP manoeuvre 4 and assistant jaw thrust are recommended in facilitating fibreoptic bronchoscopy; however, in our patient the giant neck mass limited their use.…”