ABSTRACT
Cervical spine motion restriction is an integral component of protocol for management of trauma victims. The use of rigid cervical collar for the same, presents a hurdle in airway management in patients where intubation is mandated for successful resuscitation. Hence, techniques alternative to conventional laryngoscopy need to be explored through simulation studies, to ease the process of intubation and benefit the actual trauma victims. We wanted to assess the performance of McCoy laryngoscope and LMA CTrach assembly and compare the intubation characteristics in patients with cervical collar.METHODS80 patients of ASA status I or II, scheduled for elective surgery requiring general anaesthesia and endotracheal intubation were randomly allocated to two groups- A and B. Patients in Group A were intubated using McCoy laryngoscope and Group B using LMA CTrach, with cervical collar in situ. Airway assessment included measuring thyromental distance, observing MPC grade and measuring inter-incisor distance, before and after application of semirigid cervical collar. Glottic view was noted using modified Cormack-Lehane grading. Device insertion time, total intubation time, number of attempts, haemodynamic factors and airway complications during the procedure were noted.RESULTSThere was decrease in inter-incisor distance and worsening of MPC grade in both groups post application of cervical collar. The time taken for device insertion in Group A was 16.95 + 3 sec, and in Group B was 33 + 4 sec (P= 0.0001). The total intubation time in Group A was 40.4 + 6 sec and in Group B was 57.4 + 4.37 sec (P= 0.0001). CL grade I was more common in Group B (31) than Group A (17) (P= 0.003). The number of attempts required, mean haemodynamic parameters and airway complication were comparable between the two groups.CONCLUSIONSThe McCoy laryngoscope requires less time to obtain glottic view and subsequent intubation, but LMA CTrach provides better glottic exposure. Thus, LMA CTrach has better performance characteristics in patients with cervical collar in situ.
ABSTRACT
Background: McCoy laryngoscope and video laryngoscopes are being increasingly used and have a definitive advantage over conventional laryngoscopes in management of potentially difficult airways. The aim of our study was to compare relative effectiveness of McCoy laryngoscope and True view PCDTM video laryngoscope in patients undergoing oral tracheal intubation. Methods: Fifty patients of American Society of Anaesthesiologists (ASA) grade I and II, aged 20 – 50 years, posted for elective surgery under general anaesthesia were randomly allocated into Group T (Truview group, n=25) and Group M (McCoy group, n=25). The two groups were compared for demographic data, intubation difficulty score (IDS), Cormack-Lehane (CL) grade, POGO score, time to intubation, number of intubation attempts and haemodynamic parameters. Results: The demographic data and ASA status was comparable in both the groups. Group T had a significantly less IDS score as compared to Group M (p < 0.001). Seventeen patients in Group T and 8 patients in Group M had IDS = 0. The CL grade and POGO scores were better in Group T than in Group M. Intubation was successful in the first attempt in 94% patients in Group T and 88% patients in Group M. There was a transient increase in HR and NIBP after intubation in both the groups which returned back to the baseline within 5 minutes. No incidence of hypoxia and airway trauma was noted in the two groups.Conclusion: Truview PCDTM video laryngoscope resulted in better glottic visualization with lower IDS than McCoy laryngoscope in patients undergoing oral tracheal intubation.
ABSTRACT
Objective To compare the clinical efficacy of double-lumen tube intubation between McGrath-5 video-laryngoscope and McCoy laryngoscope in patients with difficult airway. Methods Sixty patients who were predicted as difficult double-lumen tube intubation were divided into two groups using random number table method:McGrath-5 video-laryngoscope group (group A, n = 30) and McCoy laryngoscope group (group B, n = 30). All patients were intubated by two laryngoscopes correspondingly after conventional induction. The success rate of the first intubation, intubation time, the ratio of right positioning, the number of SpO2 < 90% within intubation time, the number of pressing the cricoid, the incidence of intubation complications and hemodynamic parameters [The changes in systolic pressure and heart rate and BIS were recorded before induction (T0), glottic exposure upon laryngoscope insertion (T1), immediately after intubation (T2), 3 min (T3) after intubation]. Results The number of pressing the cricoid was smaller in group A than in group B (P < 0.05), whereas the intubation time in group A was significantly higher than that in group B (P < 0.05). The systolic pressure and heart rate at T3 were dramatically reduced compared with those measured at T0 in both groups (P < 0.05). The systolic pressure and heart rate at T1 and T2 in group A were considerably lower in group A than those in group B (P < 0.05). Conclusions Compared with the McCoy laryngoscope, double-lumen tube intubation by McGrath-5 video-laryngoscope can less impact on hemodynamics, less intubation complications, intubation time although prolonged but not for influence the patient's oxygen supply, for difficult airway double-lumen tube intubation provides a good choice.