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With new advances in technology, intubation using video laryngoscopy has been gaining popularity, particularlyin patients with difficult airways or as rescue devices in failed intubation attempts. This study was done tocompare the effectiveness of King Vision video laryngoscope (KVL) and Macintosh laryngoscope whenperforming tracheal intubation under general anesthesia Eighty patients requiring endotracheal intubationduring general anaesthesia were randomly assigned into two groups to undergo tracheal intubation usingeither a King Vision video laryngoscope (n=40) or Macintosh laryngoscope (n=40). The primary outcomeswere the time of intubation and Cormack-Lehane grading and secondary outcomes were number of attemptsand optimisation manoeuvres required and complications related to laryngoscopy and intubation. King Visionvideo laryngoscope was found to be significantly better than the Macintosh laryngoscope in terms of Cormackand Lehane grading, requirement of optimisation manoeuvres and need of second attempt for intubationexcept time of intubation which was comparable between the two groups.
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Background: In anesthetic practice, the introduction of multiple novel laryngoscopes has simplified visualization of the vocal cords and has reduced the complications arising due to difficult or failed tracheal intubation Both Truview scope and C-Mac video laryngoscope have been reported to provide a comparable or superior glottic view on comparison with conventional Macintosh laryngoscope Materials and methods: A randomized controlled study was conducted in 100 subjects scheduled for elective surgery equally divided into 2 groups Conventional Macintosh laryngoscopy was done initially in all subjects enrolled for the study For the Glottic view, One Group (n=50) underwent Truview laryngoscopy while the other (n=50) underwent C-Mac video laryngoscopy Results: The improvement in glottic view from original MCL (Modified Cormack & Lehane) grading obtained from Macintosh laryngoscope was 40% (n=23) in Truview compared to 46% (n=23) in CMac video laryngoscope while downgrading of view was observed in 10% (n=5) in group– T compared to none in C-Mac video laryngoscope There were no statistically significant difference in Intubation Difficulty Scale (IDS) scores between the groups (P = 0072) The mean duration of time R Vimal, A Sivanoli Comparison of Truviewscope and C-Mac Video Laryngoscope with the Conventional Macintosh Laryngoscope in Improving the Glottic View during Endotracheal Intubation IAIM, 2018; 5(12): 125-133 Page 126 for endotracheal intubation with C-Mac video laryngoscope (2310 seconds) was significantly shorter compared with Truview laryngoscope (3126 seconds) Conclusions: There was an improvement in view of the glottis in both Truview and C-Mac video laryngoscope from the initial Macintosh laryngoscope view But C-Mac video laryngoscope offered better view improvement and also required a shorter time for intubation compared to Truview laryngoscope
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Objective To compare the effect of nasotracheal intubation between Airtraq video laryngoscope and Macintosh laryngoscope in patients with obstructive sleep apnea and hyperpnoea syndrome(OSAHS). Methods A total of 60 patients with OSAHS receiving nasotracheal intubation were randomly divided into two groups: the group M was intubated with Macintosh laryngoscope and the group A was intubated with Airtraq video laryngoscope.The blood pressure and heart rate were recorded before induction(T0),before intubation(T1),immediately after intubation(T2),first minute(T3)and fifth minute(T4)after intubation. The intubation time,Cormach-Lehane scale,external laryngeal press,use of magil forceps and the incidence of blood on laryngoscope were recorded. Results The systolic pressure and heart rate at T 2,T3and T4were significantly higher than T1in the group M(P<0.05),but no significant changes were found among T 2,T3and T4in the group A(P>0.05).The systolic pressure was significantly different between the two groups at T 2and T3(P<0.05).The heart rate was significantly different between the two groups at T 2,T3 and T4(P<0.05).The diastolic pressure was not significantly different between the two groups(P >0.05).The laryngoscope exposure scale in the group A was significantly superior to the group M(Z=-4.935,P=0.000).The intubation time in the group A(30.4 ±9.0)s was significantly less than that in the group M[(42.3 ±16.5)s, t =-3.468, P =0.000]. Conclusion Nasotracheal intubation with Airtraq video laryngoscope has less influence on hemodynamics,shorter intubation time and easier performance as compared with Macintosh laryngoscope in patients with OSAHS.
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Objective To explore the application value of videolaryngoscope and Macintosh la ryngoscope in double-lumen endobronchial intubation.Methods Eighty patients (50 males,30 females,aged 18-70 years,ASA grade Ⅰ-Ⅲ) of both sexes,scheduled for thoracic surgery and double lumen endobronchial intubation were randomly divided into two groups using a random number table:videolaryngoscope group and Macintosh laryngoscope group.The intubation time,the success rate of intubation,the views of glottis,the hemodynamics during the first 4 minutes of intubation,the number of positive responses to intubation and the incidence of pharyngalgia at 24 h after the operation were observed and compared between the two groups,the condition of oral hemorrhage and the injury of the tracheal walls were recorded as well.Results Compared with videolaryngoscope group,the C-L grade and the success rate of the first intubation of Macintosh laryngoscope group was significantly higher,the intubation time of Macintosh laryngoscope group was significantly shor ter (P＜0.05).In addition,the positive cases of responses to intubation and the incidence of pharyngalgia at 24 h after the operation of Macintosh laryngoscope group were obviously less than those of videolaryngoscope group (P＜0.05).There was no significant difference between the two groups of oral injury bleeding and the injury of tracheal wall and protuberance.At T2,T3,the two groups of MAP were significantly lower than that of T1,and the MAP of videolaryngoscope group was significantly lower than that of t Macintosh laryngoscope group at T2,T3 (P ＜ 0.05).Conclusion Compared with videolaryngoscope,Macintosh laryngoscope is more suitable for the doublelumen endobronchial intubation in patients predicted without difficulty in intubating.
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Objective To compare the hemodynamic response to orotracheal intubation by Macintosh laryngoscopy (MAC) with Shikani optical stylet (SOS). Methods Forty neurosurgical patients, ASA physical status Ⅰ~Ⅲ, were prospectively randomized to MAC group (n = 20) and SOS group (n = 20) according to the method of orotracheal intubation. Heart rate (HR) and invasive systolic blood pressure (SBP) were recorded at pre- and post-intubation. Results The intubation time was significantly longer in SOS group than in MAC group [(22 ± 8) s vs. (17 ± 8) s, P < 0.05]. SBP in both groups decreased significantly after induction (P < 0.05) and increased greatly at 1 and 2 min post-intubation (P < 0.05), but did not differ at 3, 4 and 5 min. HR in both groups did not differ significantly between the SBP after induction. HR in both groups increased greatly at 1 and 2 min post-intubation (P < 0.05), but did not differ markedly at 3, 4 and 5 min after induction. There were no significant differences in the peak SBP and HR between the two groups. Conclusion MAC and SOS cause similar hemodynamic responses to orotracheal intubation.
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Intubating Laryngeal Mask Airway (ILMA) is a new device to guide blind oro-tracheal intubation thus offering a new approach for endotracheal intubation and is expected to produce less sympathetically driven haemodynamic stress response. The purpose of this study was to assess overall efficacy, haemodynamic advantage and complication rate with use of ILMA compared to conventional method of endotracheal intubation with use of Macintosh Laryngoscope (ML). Methods: This randomized controlled study was conducted on 60 adult patients comparable in age, sex, weight, MPC and ASA status scheduled for elective surgeries. Patients were randomly allocated into two groups of 30 each. Both the groups received similar balanced anaesthesia technique (Inj. fentanyl 2 μg/kg, propofol 2-2.5 mg/kg, rocuronium 1 mg/kg). Tracheal intubation was done using either ILMA or Macintosh laryngoscope. The intubation time, number of attempts required for successful intubation, haemodynamic changes and oro-pharyngo-laryngeal complications encountered during both the methods were recorded. Results: Time to intubation was comparatively longer in the ILMA group than laryngoscopy group (P <0.05). The success rate of intubation was 100% in both the groups. Overall haemodynamic changes in both the groups were statistically comparable (P >0.05) and ILMA appears to be offering no haemodynamic advantage over ML. The incidence of complications was rare and comparable amongst both the groups (P >0.05). Conclusions: Therefore in patients with normal airway blind intubation with ILMA is a successful and equally efficacious method without significant oro-pharyngo-laryngeal morbidity but offers no added haemodynamic advantage compared to conventional direct laryngoscopy with ML. Thus ILMA may act as a suitable alternative to ML for patients with normal airway.
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Background: Direct laryngoscopy for endotracheal intubation with the Macintosh blade is most commonly used for establishing a patent airway. AirtraqTm Optical Laryngoscope, does not require the alignment of the 3 airway axes for glottic visualization. Objective: We aim to compare these two laryngoscopes in view of laryngoscopic grading, ease of tracheal intubation and hemodynamic changes associated with laryngoscopy and intubation. Materials and Methods: 50 ASA I and II patients were randomly divided into Macintosh (M) group and Airtraq (A) group. Cormack Lehane grading, ease of intubation, laryngeal intubation time in secs and incidence of sore throat was noted. HR & BP was recorded at 0, 1, 3, 5 & 10 minutes following intubation. Unpaired ‘t’ test compared inter-group data, while paired ‘t’ test compared within group cardiovascular data. (p<0.05 statistically significant) Results: The demographic data of both groups were comparable. Cormack- Lehane grading was better in group A than in group M [grade I group A(84%) and group M(60%)]. The mean time for laryngeal intubation (Mean ± SD) for group A (8.3 ± 4.6 secs) and group M (20.46 ± 6.6 secs) (t = 7.6, p< 0.01). Ease of intubation was better in group A than group M. The rise in blood pressure and heart rate was significantly less in Group A as compared to Group M. Conclusion: Airtraq laryngoscope was superior to Macintosh laryngoscope as it provided better laryngoscopic views, shorter laryngoscopy and intubation time, easier intubation and the rise in heart rate and systolic blood pressure was significantly less.
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Objective To compare medical students' learning curve between Macintosh laryngoscope and optical laryngoscope in endotracheal intubation and to decide which one is more suitable for novice personnel.Methods Totally 26 interns after being trained by experienced anesthesiologists were enrolled in this study.They performed intubation on 6 patients by using both Macintosh laryngoscope and optical laryngoscope ( each laryngoscope for 3 patients) under the supervision of experienced anesthesiologists.The sequence of laryngoscope was determined by computer-generated random number list.Results Totally 149 patients who were ready to receive surgery under general anesthesia were enrolled in this randomized crossover controlled study.Duration of intubation was significantly shorter in Airtraq group (78 -± 33 ) s than in Macintosh group (114 ± 32) s,P ＜ 0.001.Intubation success rate was significantly higher in Airtraq group than in Macintosh group ( 87.8％ vs.66.7％,P ＜ 0.05 ).Conclusions With the advantages of rapid learning curve,higher intubation success rate and shorter intubation duration,Airtraq laryngoscope is easier to master for novice personnel.
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BACKGROUND: The Pentax AWS and the Glidescope are new intubating devices.They were designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axis. The purpose of this study was to evaluate the effectiveness of the Pentax AWS and the Glidescope in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with mallampati classification I or II. METHODS: Ninety patients presenting for surgery requiring tracheal intubation, and who were deemed easy for tracheal intubation of mallampati classification I or II were randomly assigned to undergo intubation using a Macintosh (Group M, n = 30), Pentax AWS (Group P, n = 30) or Glidescope (Group G, n = 30). Time to complete tracheal intubation and number of attempts until successful intubation were recorded. Noninvasive blood pressure and heart rate recorded before induction (PI), just before intubation (PT), 1 min and 5 min after intubation. Patients were assessed for postoperative sore throat at 6-12 h after surgery. RESULTS: Time to secure the airway with the Macintosh 13.0 (min 7, max 23.0) s was lesser than with the Pentax AWS 20.4 (8, 51.2) s and Glidescope 22.1 (10, 42.0) s. There were no significant differences in the rate of successful intubations and sore throat among the groups. There were significant increases in both mean arterial pressure and heart rate 1 min after intubation in all groups compare with PI. CONCLUSIONS: The Pentax AWS and the Glidescope had no specific advantage over the Macintosh laryngoscope for the patients with normal airway.
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Humans , Arterial Pressure , Axis, Cervical Vertebra , Blood Pressure , Glottis , Heart Rate , Imidazoles , Intubation , Laryngoscopes , Nitro Compounds , PharyngitisABSTRACT
BACKGROUND: The Glidescope Videolaryngoscope (GVL) is a newly developed video laryngoscope. It offers a significantly improved laryngeal view and facilitates endotracheal intubation in difficult airways, but it is controversial in that it offers an improved laryngeal view in normal airways as well. And the price of GVL is expensive. We hypothesized that intubation carried out by fully experienced anesthesiologists using the GVL with appropriate pre-anesthetic preparations offers an improved laryngeal view and shortened intubation time in normal airways. Therefore, the aim of this study was to compare the GVL with the Macintosh laryngoscope in normal airways and to determine whether GVL can substitute the Macintosh laryngoscope. METHODS: This study included 60 patients with an ASA physical status of class 1 or 2 requiring tracheal intubation for elective surgery. All patients were randomly allocated into two groups, GVL (group G) or Macintosh (group M). ADS (airway difficulty score) was recorded before induction of anesthesia. The anesthesiologist scored vocal cord visualization using the percentage of glottic opening (POGO) visible and the subjective ease of intubation on a visual analogue scale (VAS). The time required to intubate was recorded by an assistant. RESULTS: There was a significant increase in POGO when using the GVL (P < 0.05). However, there was no difference in the time required for a successful tracheal intubation using the GVL compared with the Macintosh laryngoscope. The VAS score on the ease of intubation was significantly lower for the GVL than for the Macintosh laryngoscope (P < 0.05). CONCLUSIONS: GVL could be a first-line tool in normal airways.
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Humans , Anesthesia , Intubation , Intubation, Intratracheal , Laryngoscopes , Vocal CordsABSTRACT
Objective: To evaluate the clinical value of Truview™ EVO2 optic laryngoscope by comparing it with the Macintosh laryngoscope in patients receiving cervical vertebral surgery. Methods: One hundred patients scheduled for elective cervical vertebral surgery were enrolled in this randomized crossover study. After induction, the patients' glottis in group A (n=50) was displayed by Macintosh laryngoscope and the Cormack-Lehane (C/L) grade was recorded, and then optic laryngoscope was employed to display the laryngeal structure. The order of laryngoscopy attempts was reversed in group B (n=50). Parameters recorded included demographics,airway assessment features (BMI, thyromental distance, mandibular size, mouth opening, mallampati oropharyngeal scale,and neck movement), C/L grade, laryngoscopic force applied, duration of intubation, difficulties of laryngeal view and injury of upper airway. Results: There were no significant difference in demographics, airway assessment features,C/L grade and duration of intubation between the 2 groups,whereas the laryngoscopic force in group A was significantly lower than that in group B (P < 0.05). The C/L grade obtained with optic laryngoscope was 69:26:5 (I:II:III),which was significantly better than that with Macintosh laryngoscope (26:46:28,P<0.001). A poor laryngeal view of 5% was obtained with optic laryngoscope,which was significantly better than that with Macintosh laryngoscope (28%, P<0.001). There was significant association between airway assessment features and C/L grade or laryngoscopic force (P<0.05). Conclusion: The Truview™ EVO2 optic laryngoscope has better glottic view and lighter laryngoscopic force than those of Macintosh laryngoscope,and may have potential advantages for managing the difficult airways for cervical vertebral surgery.
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Objective: To compare the clinical outcomes of intubation between HPHJ-A video laryngoscope and Macintosh laryngoscope, and to analyze the advantages and disadvantages of each approach. Methods: Totally 100 patients who were to undergo general anesthesia with endotracheal intubation were randomly allocated for airway management with one of the two devices: HPHJ-A video laryngoscope and Macintosh laryngoscope. The following data were observed and recorded for the two groups: the Cormack-Lehane grade of exposing the glottis, hemodynamic alteration before and after endotracheal intubation, intubation time, and intubation attempts. Results: HPHJ-A video laryngoscope resulted in a better glottis exposure than the Macintosh laryngoscope, and the results of hemodynamic alteration, intubation time, and intubation attempts were similar between the two groups. For patients with a difficult airway (Cormack-Lehane III-IV), HPHJ-A video laryngoscope resulted in a slighter hemodynamic alteration(P < 0.05), a higher successful intubation rate, and a shorter intubation time(P < 0.05) compared with Macintosh laryngoscope. Conclusion: The HPHJ-A video laryngoscope can greatly improve the glottic exposure compared with the Macintosh laryngoscope, especially for patients with difficult airway.
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BACKGROUND: Macintosh laryngoscopic intubation is a lifesaving procedure, but a difficult skill to learn. The Airtraq optical laryngoscope (AOL) is a novel intubation device with advantages over the direct laryngoscope for untrained personnel in a manikin study. We compared the effectiveness of AOL with Macintosh laryngoscope for tracheal intubation by novice personnel. METHODS: We selected 37 medical students with no prior tracheal intubation experience and educated them on using both laryngoscopes. Seventy-four patients were randomly divided into two groups (group A: AOL, group M: Macintosh laryngoscope). We recorded the tracheal intubation success rate, intubation time, number of attempts, intubation difficulty scale, and adverse effects. RESULTS: The total success rate was similar in the two groups, but the success rate at first attempt was higher in group A (P < 0.01). Group A also showed reduced duration and attempts at intubation, as well as adverse effects such as oral cavity injury. Additionally, participant reports indicated that using the AOL was easier than the Macintosh laryngoscope (P < 0.01). CONCLUSIONS: The AOL is a more effective instrument for tracheal intubation than Macintosh laryngoscope when used by novice personnel.
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Humans , Intubation , Laryngoscopes , Manikins , Mouth , Students, Medical , VolunteersABSTRACT
Objective To evaluate the clinical application of GlideScope~ video laryngoscope in anesthetic endotracheal intubation.Methods Two hundred patients who received surgery under general anesthesia with ASA I or II were involved in this study.One hundred patients were assigned to be intubated with GlideScope~(GS group) and the other 100 with size 3 Macintosh laryngoscope(ML group).The following data were recorded and analyzed: noninvasive blood pressure(NBP),heart rate(HR) at the different time points of intubation process,glottic exposure time,CormarkLehane grade,tracheal intubation time and total intubation attempts. Results The rise of NBP and HR in ML group were significantly higher than those in GS group(P
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0.05).The Cormack and Lehane laryngeal exposure grades obtained by the Macintosh laryngoscope with and without ELM were significantly different(Z=3.55 P0.05).Of all 33 pediatric patients,successful orotracheal intubation using the GSLV was completed by one attempt in 31 patients and by 2 attempts in 2 cases.The time required to achieve successful tracheal intubation was 20-51(30.0? 7.9) s.Conclusions GSLV is as useful as Macintosh laryngoscope for laryngeal exposure and orotracheal intubation in children.When the orotracheal intubation is done using the GSLV in children,the distal end of a styletted endotracheal tube should be bent anteriorly to an angle of 70-80 degrees and ELM is routinely used.
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BACKGROUND: Endotracheal intubation with direct laryngoscope requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomical reasons or because of cervical spine injury. The lightwand requires less neck flexion and head extension than the conventional laryngoscope. The purpose of this study was to compare the extension of cervical spine obtained with lightwand and Macintosh laryngoscope. METHODS: Twenty patients requiring general anesthesia with endotracheal intubation were studied. Patients were placed on the operating table and anesthesia was induced. Intubation were performed on two occasions: with lightwands and Macintosh #3 laryngoscopes. Cricoid pressure was not applied. To determine cervical spine extension, five radiographs were taken in each patient (before induction, during mask ventilation, during intubation with lightwand, during laryngoscopy with the Macintosh blade: in the best glottic view or during intubation). RESULTS: Of 20 cases, we excluded 2 cases due to the technical error. Significant reduction of radiographic cervical spine extension were found in the lightwand compared to Macintosh blade at all cervical level. Mean atlantooccipital extension angles were 6.2o and 11.7o for the lightwand and Macintosh, respectively. There were no significant differences between mask ventilation and intubation with lightwand. CONCLUSIONS: Lightwand may be better than the conventional intubation in patients whose cervical spine movement is limited or undesirable, especially in the patients in whom awake intubation is not available.
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Humans , Anesthesia , Anesthesia, General , Head , Intubation , Intubation, Intratracheal , Laryngoscopes , Laryngoscopy , Masks , Neck , Operating Tables , Spine , VentilationABSTRACT
Objective:To evaluate the clinical value of Truview~(TM)EVO_2 optic laryngoscope by comparing it with the Macintosh laryngoscope in patients receiving cervical vertebral surgery.Methods:One hundred patients scheduled for elective cervical vertebral surgery were enrolled in this randomized crossover study.After induction,the patients'glottis in group A (n=50)was displayed by Macintosh laryngoscope and the Cormack-Lehane(C/L)grade was recorded,and then optic laryngoscope was employed to display the laryngeal structure.The order of laryngoscopy attempts was reversed in group B(n= 50).Parameters recorded included demographics,airway assessment feat ures(BMI,thyromental distance,mandibular size,mouth opening,mallampati oropharyngeal scale,and neck movement),C/L grade,laryngoscopic force applied,duration of intubation, difficulties of laryngeal view and injury of upper airway.Results:There were no significant difference in demographics,airway assessment features,C/L grade and duration of intubation between the 2 groups,whereas the laryngoscopic force in group A was significantly lower than that in group B(P