Randomized comparison of McGrath MAC videolaryngoscope, Pentax Airway Scope, and Macintosh direct laryngoscope for nasotracheal intubation in patients with manual in-line stabilization

Abstract

Background The objective of this study was to determine the clinical usefulness of videolaryngoscopes (VLs) by comparing the time to intubation (TTI) and the ease of intubation of McGrath MAC VL (MVL), Pentax Airway Scope VL (PVL), and Macintosh direct laryngoscope (DL) during nasotracheal intubation using manual in-line stabilization to simulate difficult airways. Methods One hundred and twenty patients were randomly assigned to the MVL group (n = 40), the PVL group (n = 40), and the DL group (n = 40). Nasotracheal intubation was performed using MVL, PVL, or DL, according to group assignments. The primary outcome was TTI and secondary outcomes were glottic view, ease of intubation, and bleeding. ResultsThe TTI was significantly shorter in the MVL group than in the DL group (45 sec vs 57 sec; difference in means: -12; 95% confidence interval [CI], -21 to -3; P = 0.01). The percentage of glottic opening and Cormack Lehane grade were significantly superior in the MVL and the PVL groups compared with the DL group (both P \ 0.001). The intubation difficulty scale and numeric rating scale regarding ease of intubation were also significantly lower in the MVL and PVL groups than in the DL group (all P\0.007). The incidence of bleeding was significantly lower in the MVL group than in the DL group (3 vs 15, relative risk 0.2; 95% CI, 0.06 to 0.64; P = 0.001). Conclusion This study showed that both MVL and PVL provided better visualization of the glottis and easier intubation, with less additional manipulation than DL during nasotracheal intubation in simulated difficult airways. Additionally, use of the MVL significantly shortened the TTI compared with the DL. Trial registration www.clinicaltrials.gov (NCT02647606); registered 6 January, 2016. RésuméContexte L'objectif de cette étude était de déterminer l'utilité clinique des vidéolaryngoscopes (VL) en comparant le temps jusqu'à intubation (TTI) et la facilité d'intubation du VL McGrath MAC (MVL), du VL Pentax Airway Scope (PVL), et du laryngoscope avec lame Macintosh (DL) pour une intubation nasotrachéale avec

Video laryngoscopy vs. direct laryngoscopy for nasotracheal intubation in oromaxillofacial surgery: a systematic review and meta-analysis of randomized controlled trials

“…The definition of time to intubation varied from the mouth opening until the detection of ETCO 2 [ 25 , 27 , 30 ], end of mask ventilation until detection of ETCO 2 [ 26 ], intranasal placement until detection of ETCO 2 [ 28 ], insertion through nostril until detection of ETCO 2 [ 29 ], passing through the nasal cavity until chest rise [ 31 ], placement of the endotracheal tube [ 32 , 33 ], or as not clear [ 34 ]. Pooled analysis showed a significantly shorter time to intubation favoring VL (MD: −9.04, 95% CI [ –12.71, –5.36], n = 597, P < 0.001, I 2 = 59%) ( Fig.…”

“…4 ). A pooled analysis of overall intubation success rates with the two types of laryngoscopes in all studies except two [ 28 , 29 ] showed no significant difference (RR: 1.04, 95% CI [0.98, 1.10], n = 411, P = 0.17, I 2 = 60%; high-quality evidence) ( Supplementary Fig. 1 ).…”

Comparison of C-MAC D-blade videolaryngoscope and McCoy laryngoscope efficacy for nasotracheal intubation in simulated cervical spinal injury: a prospective randomized comparative study

“…However, it can be used on a limited basis because it requires experienced clinicians and takes longer to conduct than other devices. Recognition of these limitation had led to introduction of the variety of endotracheal intubation devices including various videolaryngoscopes to secure the airway for NTI in patients with cervical spine instability [6][7][8].…”

In reply: Comparing videolaryngoscope and direct laryngoscope use for nasotracheal intubation in patients with manual in-line stabilization

“…We thank Dr. Shao et al 1 for their valuable comments on our recent article. 2 They raised important concerns and questions, which we further address below.…”