Videolaryngoscopy for all intubations: Is direct laryngoscopy obsolete?

Background and Aims: Video laryngoscopy highly improves the success rate for endotracheal intubation. However, commercially available video laryngoscopes such as McGrath MAC ® can be costly. An economical video laryngoscope was assembled by attaching a fibreoptic videoscope into a Macintosh laryngoscope. This randomised study aimed to compare the intubation time of this self-assembled modified Macintosh video laryngoscope (SAM-VL) and McGrath MAC ® (McGrath). Methods: This study enroled 62 adults scheduled for elective surgery under general anaesthesia with endotracheal intubation. The primary outcome was total intubation time. Secondary outcomes were the time for glottic visualisation (time A), time for tube insertion after glottic visualisation (time B), first-attempt intubation success rate, degree of glottic visualisation, and need for backward, upward, rightward pressure (BURP) assistance, complications, and user satisfaction. The tests used were: Kolmogorov-Smirnov and the Mann-Whitney test to analyse the data’s distribution and the primary outcome, respectively. Results: The median total intubation time in the SAM-VL group versus the McGrath was 63 s (27–114s) versus 74 s (40–133s), respectively ( P = 0.032). Intubation time B was significantly faster, while the score of glottic visualisation and BURP assistance was significantly higher in the SAM-VL group. The differences in the rate of successful first attempts and complications were not statistically significant. SAM-VL users rated the ease of blade insertion and manoeuvrability, degree of glottic visualisation, and overall rating as very high. Conclusion: Endotracheal intubation using self-assembled modified video laryngoscope is faster and allows better glottis visualisation than McGrath MAC ® .

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“…This modification is ideal for low and middle-income countries where healthcare budgeting is an issue. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

Comparison of self-assembled video laryngoscope versus McGrath MAC®: A randomised controlled trial

Sukmono¹,

Manggala²,

Auerkari³

et al. 2022

Indian Journal of Anaesthesia

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“…Videolaryngoscopes make it possible to decrease the incidence of unexpectedly unsuccessful intubations, especially in patients who present with an unexpectedly difficult airway ( 21 ). They also allow to improve glottis view and to perform intubation under visual control of the larynx, leading to fewer esophageal intubations ( 22 ). However, some operators are still reluctant to use videolaryngoscopes as a first-attempt device, and remains faithful to the “Old” Macintosh laryngoscopes.…”

Section: A Pathway To Universal Videolaryngoscopymentioning

confidence: 99%

Difficult airway management: is prevent by using routine videolaryngoscopy better than cure?

Jong¹,

Pouzeratte²,

Sfara³

et al. 2022

Ann Transl Med

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“…Video laryngoscopy is one of the latest technologies which uses a camera attached to the tip of the blade and aids in projecting an external view of the airway onto the screen. The video laryngoscopy provides an anterior view of the glottis and a wider field of vision of the larynx more clearly (3). Intubation through direct laryngoscopy needs alignment of the oral, pharyngeal, and laryngeal axis, which may be a problem for the anesthetist in difficult airway scenarios, where a video laryngoscope can be used as it does not require alignment (4).Video laryngoscopy provides a better glottic view, which is of high resolution compared to direct laryngoscopy (5).…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Video Laryngoscopy to Direct Laryngoscopy for Endotracheal Intubation in Pediatric Patients

2023

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Background: Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways. Objectives: We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requiring airway management. The glottic view and the first pass success rate were compared and analyzed. Methods: An observational cross-sectional study was conducted with 120 children between 2 - 8 years with normal airways. They were divided into video laryngoscopy (Group V) and direct laryngoscopy (Group D). The primary outcome measures included time taken for intubation, number of attempts required, Cormack-Lehane glottic view, use of optimization maneuvers, the requirement of tube repositioning, and hemodynamic parameters before and after intubation. Results: The time taken for intubation was longer in the video laryngoscopy group ( group D, 24.28 sec vs. group V, 27.65 seconds (P = 0.01). The Cormack-Lehane glottic view was grade 1 in all the patients in the video laryngoscopy group, while only 35 children showed grade 1 in the direct laryngoscopy group. (P < 0.001). We observed a significant increase in both heart rate and mean arterial pressure in the video laryngoscopy group at 1, 3, 5, and 10 min after intubation ((P < 0.001, P < 0.05). Conclusions: The time taken for intubation was more in group V, but the glottic view was much better, and the requirement for external maneuvers was also less. Pressure response to intubation was more in group V compared to group D.

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Videolaryngoscopy for all intubations: Is direct laryngoscopy obsolete?

Cited by 14 publications

References 34 publications

Comparison of self-assembled video laryngoscope versus McGrath MAC®: A randomised controlled trial

Comparison of self-assembled video laryngoscope versus McGrath MAC®: A randomised controlled trial

Difficult airway management: is prevent by using routine videolaryngoscopy better than cure?

A Comparative Study of Video Laryngoscopy to Direct Laryngoscopy for Endotracheal Intubation in Pediatric Patients

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