Randomized controlled study comparing the hemodynamic response to laryngoscopy and endotracheal intubation with McCoy, Macintosh, and C-MAC laryngoscopes in adult patients

Abstract

Background and Aims:Earlier studies have shown that the type of laryngoscope blade influences the degree of hemodynamic response to endotracheal intubation. The aim of the study was to evaluate the hemodynamic response to oral endotracheal intubation with C-MAC laryngoscopy and McCoy laryngoscopy compared to that of Macintosh laryngoscopy in adult patients under general anesthesia.Material and Methods:This is a prospective randomized parallel group study. Ninety American Society of Anesthesiologists I patients were randomly allotted into three groups. Group A – Macintosh laryngoscopy (control group). Group B – laryngoscopy with McCoy laryngoscope. Group C – laryngoscopy with C-MAC video laryngoscope. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were monitored at baseline (just before induction), just before intubation (T0), 1 min (T1), 3 min (T3), 5 min (T5), and 10 min (T10) after intubation. Intergroup comparison of study parameters was done by unpaired sample t-test for normal data and Mann-Whitney U-test for skewed data. For within-group comparison, the repeated measures of ANOVA for normal data and Friedman followed by Wilcoxon signed rank test for skewed data were performed.Results:In C-MAC group, the HR was significantly higher than the Macintosh group at 3 min after intubation, whereas SBP, DBP, and MAP were significantly higher at 1 min. McCoy group showed a similar response compared to Macintosh group at all time intervals.Conclusion:C-MAC video laryngoscope has a comparatively greater hemodynamic response than Macintosh laryngoscope.

The Effect of Intubation with Video and Conventional Laryngoscopy on Hemodynamic Response

“…In addition, this study also showed that there was sign of myocardial ischemia in the ECG monitor during the surgical procedure [17] . Unlike these results, there are few studies reporting that there was an increased hemodynamic response with VL [13] . On the other hand, there are studies showing that there was a decreased hemodynamic response with the VL method compared to the DL method [10,18] .…”

“…Especially increased HR increases the risk of cardiovascular events by increasing myocardial oxygen consumption [3] . Different results have been reported in studies that explored the effects of VL and DL on hemo-dynamic response in the literature [10,13,14,[16][17][18] . In some studies, the effects of VL and conventional DL methods on hemodynamic response were found to be similar [14,16,17] .…”

“…Hemodynamic responses are observed during intubation due to stress, and it is known that the mentioned risk is especially higher in direct laryngoscopy method [12] . There are few studies comparing the hemodynamic effects of intubation with C-MAC VL and traditional Macintosh DL methods [13,14] .However, to the best of our know-ledge, there is no study to compare the hemodynamic effects of these two intubation methods in hypertensive and normotensive patients in the literature.…”

Ease of intubation and hemodynamic responses to nasotracheal intubation using C-MAC videolaryngoscope with D blade: A comparison with use of traditional Macintosh laryngoscope

“…Use of the C-MAC videolaryngoscope for oral intubation has been shown to result in a greater hemodynamic response than with the Macintosh laryngoscope. [ 8 ] In pediatric patients undergoing tonsillectomy, Storz C-MAC ® videolaryngoscope provided better glottic visualization and less intubation time with less need for Magill's forceps during nasal intubation compared to the conventional Macintosh direct laryngoscope, but with a high need for external manipulations. [ 9 ] In a case series Das et al .…”

Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature

“…Furthermore, there are several randomized controlled trials (RCTs) comparing the performance of V-MAC or C-MAC videolaryngoscope and direct laryngoscope for orotracheal intubation in adult patients with a normal airway 10,20–25. Cavus et al10 found that C-MAC videolaryngoscope provided comparable or better laryngeal views than direct laryngoscopy, and the intubation time was comparable between direct and video laryngoscopy.…”