Comparison between stylet and bougie with the C-MAC D-blade in cervical simulated immobility. A prospective randomized controlled trial

Introduction The C-MAC D-blade was designed for difficult airway intubation scenarios. To facilítate easier and faster endotracheal intubation in the laryngoscopy paradox, an introducer is preferred. Hence, we decided to conduct a study to compare the 60° angled C-MAC stylet and the gum elastic bougie as aids to intubation while using the C-MAC D-blade laryngoscope in a simulated difficult airway setting. Objective To compare the ease of oral intubation with the use of the C-MAC stylet (60° angled stylet) versus intubation performed over a bougie inserted using the C-MAC D-blade guidance in patients with simulated restricted cervical mobility. Method Prospective, randomized controlled single-center study. Intubation using the C-MAC D-blade laryngoscope was performed in 48 surgical patients randomly assigned to 2 groups of 24 each: Stylet group, Group S (using 60° angled stylet) and Bougie group, Group B (using bougie) after providing manual in-line stabilization to restrict cervical mobility. The Mann-Whitney U test and the Chi square test were used as applicable. Results The use of stylet resulted in easier (Group S 75% vs. Group B 16.7%) and faster (Group S 26.83 ± 8.61s vs. Group B 47.18 ± 16.46s) intubation with fewer attempts compared to group B. Both groups experienced a similar hemodynamic stress response to intubation. Conclusions The 60° angled C-MAC Stylet is a more effective and time-saving intubation aid with C-MAC D-blade compared to bougie.

Introducción: El videolaringoscopio C-MAC D-blade se diseñó para los casos de intubación de la vía aérea difícil. Para facilitar una intubación más rápida y sencilla en la paradoja de la laringoscopía se prefiere un introductor. Por tanto, decidimos realizar un estudio para comparar el estilete de 60° C-MAC y el bougie elástico de goma como ayudas para la intubación utilizando el laringoscopio C-MAC D-blade en una situación simulada de vía aérea difícil. Objetivo: Comparar la facilidad de intubación oral mediante el uso del estilete del C-MAC (estilete angulado de 60°) con la intubación realizada sobre un bougie insertado con la guía del C-MAC D0-blade en pacientes con restricción simulada de la movilidad cervical. Métodos: Estudio prospectivo, aleatorizado y controlado realizado en un solo centro. Se realizó intubación utilizando el laringoscopio C-MAC D-blade D en 48 pacientes quirúrgicos asignados aleatoriamente a 2 grupos de 24 cada uno: grupo de estilete, grupo S (con el estilete angulado de 60°) y el grupo de bougie o grupo B (con bougie) después de establecer una estabilización manual del eje para restringir la movilidad cervical. Se aplicaron las pruebas U de Mann-Whitney U y de Chi cuadrado según correspondiera. Resultados: Con el estilete fue más fácil (Grupo S 75% vs. Grupo B 16.7%) y más rápida (Grupo S 26.83 ± 8.61s vs. Grupo B 47.18 ± 16.46s) la intubación, requiriéndose un menor número de intentos en comparación con el Grupo B. Los dos grupos experimentaron un estrés hemodinámico similar en respuesta a la intubación. Conclusiones: El estilete angulado de 60° C-MAC es una ayuda más efectiva y ahorra más tiempo con el C-MAC D-blade en comparación con el bougie.

Anesthetic induction and endotracheal intubation in the sitting position due to the fixed forearm caught by a meat grinder

Abstract A male patient was scheduled for urgent amputation of his right forearm. His right forearm was stuck inside the insertion slot of a meat grinder, resulting in severe pain to his injured arm. His upper body could not move to sit in a semi-upright position. An endotracheal tube was successfully placed after rapid sequence intubation using a video laryngoscope from behind the patient on the first attempt. This case report is the first documentation of successful anesthetic induction with subsequent endotracheal intubation using a video laryngoscope from behind an injured patient whose upper body was upright with limited positioning.

Laringoscopio híbrido: Una opción de costo razonable para el abordaje de la vía aérea difícil. Reporte de un caso / Hybrid laryngoscope: A reasonable option cost for approaching the airway difficulty. A case report

The laryngoscope is a primary tool that every medical professional who performs in airway care should know how to use. Although it's an irreplaceable tool, in the last decade have been considered transformations and modifications in them that have allowed the medical professional, especially the anesthesiologist to perform successfully for critical management especially in the context of unanticipated difficult airway, because most of the time the only available resource at hand is the laryngoscope and a malleable stylet that guides the orotracheal. The new technological age of visual instruments such as video cameras and photographs many of these with small sizes, has been used in the manufacture of video laryngoscopes that today are used, which have managed to approach the aerea in a minimally traumatic way and also safeguard lives. Our hydrid video laryngoscope is a handcrafted tool made of high-quality elements, strength, durability and low cost.

El laringoscopio es una herramienta primordial que todo profesional médico que se desempeña en la atención de la vía aérea debería saber utilizar. Pese a ser un dispositivo insustituible, en la última década se han considerado transformaciones y modificaciones en los mismos que le han permitido al profesional de la medicina, fundamentalmente al anestesiólogo, desempeñarse exitosamente durante el manejo crítico especialmente en el contexto de vía aérea difícil no anticipada, en el que la mayoría de las veces el único recurso disponible a la mano es el laringoscopio y un estilete maleable que sirve de guía para dirigir la sonda orotraqueal. La nueva era tecnológica de los instrumentos visuales como cámaras de video y fotografía, (muchos de estos con tamaños reducidos) han sido empleados en la fabricación de videolaringoscopios que hoy en día se utilizan y que han logrado abordar la vía aérea de manera mínimamente traumática, así mismo, salvaguardar vidas. Nuestro videolaringoscopio híbrido es una herramienta artesanal fabricada con elementos de alta calidad, resistencia, durabilidad y bajo costo.

Anestesia en paciente pediátrico con Síndrome de Treacher Collins / Anesthesia in a pediatric patient withTreacher Collins Syndrome / Anestesia em paciente pediátrico com Síndrome de Treacher Collins

El Síndrome de Treacher Collins (STC) constituye un reto para el anestesiólogo por malformaciones craneofaciales que complican el manejo de su vía aérea e intubación. Presentamos el caso de una paciente (8 años) con diagnóstico de STC que debía someterse a una cirugía de colocación de implante de conducción ósea bajo anestesia general. Presentaba un antecedente de intubación difícil, marcada micrognatia y distancia tiromentoniana de 2 cm. Se planteó un esquema de intubación en dos etapas secuenciales. En la primera etapa se realizó una evaluación de la vía aérea (visualización de la glotis) bajo sedación con dexmedetomidina, remifentanilo y propofol. Al visualizar la glotis se pasó a la segunda etapa para realizar la intubación posterior a la inducción anestésica.El manejo exitoso se fundamentó en una sedación adecuada y la utilización de un videolaringoscopio con pala curva para la evaluación previa de la vía aérea y posterior intubación sin complicaciones

Treacher Collins Syndrome (TCS) constitutes a challenge for the anesthesiologist due to craniofacial malformations that make management of the airway and intubation difficult. We present a case of a patient (8-year-old) diagnosed with TCS who had to undergo surgery for the placement of a bone conduction implant under general anesthesia. She had a history of difficult intubation, marked micrognathia and a thyromental distance of 2 cm. An intubation scheme in two sequential stages was proposed. In the first stage, an evaluation of the airway (visualization of the glottis) was carried out under sedation with dexmedetomidine, remifentanil and propofol. When the glottis was visualized, we proceeded to the second stage to carry out intubation after anesthetic induction.The successful management of this case was based on adequate sedation and the use of a video laryngoscope with a curved blade for prior evaluation of the airway and subsequent intubation without complications

A síndrome de Treacher Collins (STC) constitui um desafio para o anestesiologista devido às malformações craniofaciais que dificultam o manejo da via aérea e a intubação. Apresentamos o caso de uma paciente (8 anos) com diagnóstico de STC que foi submetida a uma cirurgia para colocação de implante de condução óssea sob anestesia geral. Ela tinha história de intubação difícil, micrognatia acentuada e distância tiromentoniana de 2 cm. Foi proposto um esquema de intubação em duas etapas sequenciais. Na primeira etapa, foi realizada avaliação das vias aéreas (visualização da glote) sob sedação com dexmedetomidina, remifentanil e propofol. Quando a glote foi visualizada, a segunda etapa foi realizada para realização da intubação após a indução anestésica. O manejo bem-sucedido baseou-se na sedação adequada e no uso de videolaringoscópio com lâmina curva para avaliação prévia da via aérea e posterior intubação sem complicações

Anestesia en paciente pediátrico con Síndrome de Treacher Collins / Anesthesia in pediatric patient with Treacher Collins Syndrome

El Síndrome de Treacher Collins (STC) constituye un reto para el anestesiólogo por malformaciones craneofaciales que complican el manejo de su vía aérea e intubación. Presentamos el caso de una paciente (8 años) con diagnóstico de STC que debía someterse a una cirugía de colocación de implante de conducción ósea bajo anestesia general. Presentaba un antecedente de intubación difícil, marcada micrognatia y distancia tiromentoniana de 2 cm. Se planteó un esquema de intubación en dos etapas secuenciales. En la primera etapa se realizó una evaluación de la vía aérea (visualización de la glotis) bajo sedación con dexmedetomidina, remifentanilo y propofol. Al visualizar la glotis se pasó a la segunda etapa para realizar la intubación posterior a la inducción anestésica. El manejo exitoso se fundamentó en una sedación adecuada y la utilización de un videolaringoscopio con pala curva para la evaluación previa de la vía aérea y posterior intubación sin complicaciones.

Treacher Collins Syndrome (TCS) constitutes a challenge for the anesthesiologist due to craniofacial malformations that make management of the airway and intubation difficult. We present a case of a patient (8-year-old) diagnosed with TCS who had to undergo surgery for the placement of a bone conduction implant under general anesthesia. She had a history of difficult intubation, marked micrognathia and a thyromental distance of 2 cm. An intubation scheme in two sequential stages was proposed. In the first stage, an evaluation of the airway (visualization of the glottis) was carried out under sedation with dexmedetomidine, remifentanil and propofol. When the glottis was visualized, we proceeded to the second stage to carry out intubation after anesthetic induction. The successful management of this case was based on adequate sedation and the use of a video laryngoscope with a curved blade for prior evaluation of the airway and subsequent intubation without complications.

King Vision Videolaryngoscopy Versus Direct Laryngoscopy in Patients Requiring Endotracheal Intubation for General Anaesthesia: A Comparative Study

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.

Successful airway management with combined use of McGrath® MAC video laryngoscope and fiberoptic bronchoscope in a severe obese patient with huge goiter: a case report / 대한마취과학회지

Huge goitor can lead to tracheal compression and hence difficulty in intubation. This is compounded by severe obesity. Failed tracheal intubation in difficult intubation is a serious event that may lead to increased patient morbidity and mortality. Current intubation rescue techniques and combination of different rescue techniques may increase the success rate of difficult intubation. In a 47-year-old female patient, with severe obesity and a huge goiter, our attempts at intubation using direct laryngoscope, video laryngoscope, and awake fiberoptic bronchoscope had failed. We succeeded by applying video laryngoscope to improve visualization of the airway and fiberoptic bronchoscope as a stylet for endotracheal tube.

Airtraq Video Laryngoscope for Nasotracheal Intubation in Patients With Obstructive Sleep Apnea and Hyperpnoea Syndrome:Prospective Randomized Controlled Trial / 中国微创外科杂志

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.

Comparison of Clarus video stylet,HPHJ-A video laryngoscope and Airtraq laryngoscope for guiding oral tracheal intubation in patients with snoring / 临床麻醉学杂志

Objective To compare the effectiveness and feasibility of oral tracheal intubation with Clarus video stylet,HPHJ-A video laryngoscope and Airtraq laryngoscope and in snoring pa-tients.Methods Ninety patients undergoing elective snoring surgery with general anesthesia,3 9 males and 51 females,aged 22-55 years,BMI 25-29 kg/m2,ASA physical status Ⅰ-Ⅲ,were ran-domly divided into three equal-sized groups (n=30):Clarus Video Stylet group (group C),HPHJ-A video laryngoscope group (group H)and Airtraq laryngoscope group (group A).The time of success-ful endotracheal intubation and the success rate of initial intubation of all groups were observed.The mean arterial pressure (MAP),heart rate(HR)and Rate-pressure product(RPP)were also monitored before induction of anesthesia(T0),before tracheal intubation(T1),at 0 min(T2),1 min (T3),and 3 min (T4)after intubation,as well as the throat injury and hemorrhage were noted. Results Patients in group C were successful intubated.Two patients in group H and one patient in group A with failed intubation were successfully intubated by using Clarus video stylet.The time re-quired for successful intubation in group C was longer than groups H and A (P<0.05).Compared with T0,the increasing of hemodynamic parameters (MAP,HR,RPP)after induction of all groups were significant(P<0.05).Compared with T1,the HR,MAP and RPP were increased significantly at T2in all groups (P<0.05).Compared with T1,the MAP and RPP were increased significantly at T3in all groups,and the HR were increased significantly at T3in groups H and A (P<0.05).There was no significant difference in the HR between T1and T3in group C.The increase in the HR and RPP at T2 was lower in group C than that in both the groups H and A (P <0.05).The changes of hemodynamic parameters were no significant among the three groups at other time.The differences of sore throat score and hemorrhage were no significant.Conclusion Compared with HPHJ-A video laryngoscope and Airtraq laryngoscope,Clarus video stylet for guiding oral tracheal intubation in snoring patients have less influence on hemodynamic parameters,and have no limited mouth opening. But Clarus Video Stylet spends longer intubating times,and has no obvious advantages on preventing throat injury.

Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients / Comparação de diferentes métodos de inserção de sonda nasogástrica em pacientes anestesiados e intubados

Abstract Background Nasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. Material and methods 200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. Results Success rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. Conclusion Use of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.

Resumo Justificativa A inserção de sonda nasogástrica (NG) pode ser difícil em pacientes anestesiados e intubados com a cabeça em posição neutra. Há várias técnicas para a inserção bem-sucedida de sonda NG. O objetivo primário deste estudo foi investigar a diferença da taxa de sucesso na primeira tentativa de diferentes técnicas para inserção de sonda NG. O objetivo secundário foi investigar a diferença do tempo de inserção com o uso da técnica selecionada e as complicações durante a inserção (dobradura da sonda e sangramento da mucosa). Material e métodos 200 pacientes adultos que receberam anestesia geral para cirurgias abdominais eletivas que exigiam inserção de sonda NG foram randomicamente distribuídos em quatro grupos: grupo convencional (Grupo C), grupo com a cabeça posicionada lateralmente (Grupo L), grupo com assistência de tubo traqueal (Grupo TE) e grupo com videolaringoscópio McGrath (grupo MG). As taxas de sucesso, os tempos de inserção e as complicações foram registrados. Resultados As taxas de sucesso de inserção da sonda NG na primeira tentativa e em geral foram menores no Grupo C do que nos grupos TE e MG. As durações e os tempos totais de inserção bem-sucedida da sonda NG na primeira tentativa foram significativamente maiores no Grupo TE. Dobradura foi maior no Grupo C. Sangramento da mucosa foi estatisticamente menor no Grupo MG. Conclusão O uso de videolaringoscópio e de TE durante a inserção de sonda NG comparado com o uso da técnica convencional aumentou a taxa de sucesso e reduziu a dobradura da sonda em pacientes adultos anestesiados e intubados. O uso de videolaringoscópio durante a inserção de sonda NG em comparação com outras técnicas reduz o sangramento da mucosa em pacientes adultos anestesiados e intubados.

Application of HC video laryngoscope combined with fiberoptic bronchoscopy in tracheal intubation in patients with cervical spine immobilization / 中国内镜杂志

Objective To explore the application of HC video laryngoscope combined with fiberoptic bronchoscopy in tracheal intubation in patients with cervical spine immobilization.Methods 80 cases of cervical spine immobilization to surgery patients under general anesthesia were randomly divided into bronchoscopy group (F group), HC video laryngoscope composite fiber bronchoscope nasotracheal intubation group (H group), 40 cases in each group. Full of local anesthesia and intravenous anesthesia, spontaneous breathing, tracheal intubation. Recorded before induction (T0), immediately before intubation (T1), immediately after intubation (T2), 1 minutes after tracheal intubation (T3) mean arterial pressure (MAP), heart rate (HR) changes, record for the first time intubation success rate, intubation time of patients. The incidence of complications related to intubation operation.Results there were no significant differences between the two groups before and after tracheal intubation (T1) MAP and HR (t = 0.75,-0.51,P = 0.453, 0.611); After the two groups were intubated immediately (T2), MAP and HR than immediately before intubation (T1), the differences were statistically significant MAP (t = 5.08, 4.36,P = 0.021, 0.013) and HR (t = 7.22, 6.54,P = 0.026, 0.031), hemodynamics were maintained in the normal range, after intubation immediately (T2) between the two groups compared differences in MAP and HR had no statistical significance (t = -0.51, -0.31, P = 0.411, 0.518); There was no significant difference in HR and MAP between the two groups (t = 0.38, 0.26, P = 0.681, 0.372) in 1 min after intubation (T3). Patients with tracheal intubation success rate for the first time H group was obviously higher than that of group F, the difference was statistically significant (χ2 = 7.31,P = 0.007). The two group intubation time in H group was significantly less than that in F group, the difference was statistically significant (t = 5.75,P = 0.000). The incidence of sore throat in group F was significantly higher than H group, the difference was statistically significant (χ2 = 5.00,P = 0.025).Conclusions The patients with cervical spine immobilization of nasotracheal intubation, HC video laryngoscope combined with fiberoptic bronchoscopy, compared with the traditional fiberoptic intubation, intubation for the first time a higher success rate, shorter intubation time, no aggravation of hemodynamic lfuctuations, lower incidence of sore throats.

Application of video laryngoscope for endotracheal intubation in patients with pituitary adenoma / 临床麻醉学杂志

Objective To explore the application of video laryngoscope in patients with pituitary adenoma during endotracheal intubation.Methods Fifty-one patients (19 males, 32 females, aged 18-71 years, ASA physical status I or II) scheduled for resection of pituitary adenoma under general anesthesia were enrolled.These patients were randomly divided into two groups: Macintosh laryngoscope Group (group M, n=25) and Video laryngoscope Group (group VL, n=26).When performing endotracheal intubation, Macintosh laryngoscope was used to expose the glottis in group M, and video laryngoscope was used in group VL.Head tilted backward angle, mouth opening, thyromental distance, neck circumference, mandibular ramus length, modified Mallampati classification and the difficulty classification of mask ventilation of the patients in two groups were recorded during peri-operation period.The Cormark-Lehane grade, needed pressing of the cricoids cartilage, the ratio of a second attempt during intubation and the intubation time consumed were recorded.Results Less patients in group VL needed cricoids cartilage press (7.7% vs 48.0%) during the intubation than that in group M (P<0.01).Compared with group M, the Cormack-Lehane grade was significantly lower (P<0.01) and the intubation time consumed was significantly shorter in group VL [(32.4±11.7)s vs (45.8±12.6)s] (P<0.01).Conclusion In patients with pituitary adenoma,video laryngoscope may improve the glottis exposure and the success rate of intubation, as well as shorten the intubation time.

Combined application of GlideScope video laryngoscope and fiberoptic bronchoscope for double-lumen en-dobronchial tube intubation in patients with difficult glottis exposure / 临床麻醉学杂志

Objective To explore the clinical application of GlideScope video laryngoscope combined with fiberoptic bronchoscope for double-lumen endobronchial tube intubation in patients with difficult glottis exposure.Methods Forty patients undergoing scheduled for thoracic surgery (24 males,1 6 females,aged 24-78 years,falling into ASA Ⅰ or Ⅱ,Mallampati classification Ⅲ or Ⅳ, were randomly divided into two groups (n=20 each):GlideScope video laryngoscope combined with fiberoptic bronchoscope group (group GF)and Macintosh laryngoscope group (group M).In group GF,GlideScope video laryngoscopy combined with fiberoptic bronchoscope was used to guide the double-lumen tube bronchial intubation and then bronchoscope was used to check the placement of the tube.In group M,the double-lumen endobronchial tube was intubated with conventional macintosh laryngoscope,and then the placement of the tube was checked by bronchoscope.The results of the Cormack and Lehane grade measuring the degree of glottic opening during laryngoscopy,the intuba-tion time consumed,one-time intubation success rate,patients manoeuvre needed to aid tracheal intu-bation and endotracheal intubation related complications within 48 hours after operation were recorded and compared between the two groups.Results Compared with group M,the Cormack and Lehane grade was significantly better (P < 0.01 ), intubation time consumed was significantly shorter [(104.3±1 1.1)s vs.(138.6 ± 33.0)s](P < 0.01 ),one-time intubation success rate was higher (90% vs.55%)(P <0.05 ),fewer patients needed manoeuvre to aid tracheal intubation (20% vs. 90%)(P < 0.01 )and postoperative complications of hoarseness and pharyngalgia within 48 hours were significantly fewer (5% vs.35%,25% vs.75%)in group GF(P <0.05 ).Conclusion Com-pared with conventional method, GlideScope video laryngoscope combined with fiberoptic bronchoscope used to guide double-lumen endobronchial tube intubation in patients with difficult glottis exposure may improve the success rate of intubation,reduce the stress response of intubation and postoperative complications of hoarseness and pharyngalgia.

Successful use of C-MAC® video laryngoscope following failure of multiple intubation attempts during laryngomicroscopic surgery in an infant: A case report

A 6-month-old boy was scheduled for a laryngeal mass excision and tracheal bougienage for secondary subglottic stenosis. Following successful excision of the laryngeal mass, a tracheal tube was temporarily extubated for tracheal bougination. However, tracheal re-intubation using a direct laryngoscope with the Miller blade failed because of mucosal swelling and bloody secretions. Following multiple intubation attempts, the patient's peripheral oxygen saturation had decreased to 52%. Immediately, a video laryngoscope was requested, and, by using the C-MAC® video laryngoscope, the patient was successfully re-intubated. Because pediatric patients are more vulnerable to desaturation, extreme caution should be used in securing airways even during a short apneic period. Using a video laryngoscope at the first intubation attempt would be useful for successful tracheal intubation.

Successful use of C-MAC® video laryngoscope following failure of multiple intubation attempts during laryngomicroscopic surgery in an infant: A case report

A 6-month-old boy was scheduled for a laryngeal mass excision and tracheal bougienage for secondary subglottic stenosis. Following successful excision of the laryngeal mass, a tracheal tube was temporarily extubated for tracheal bougination. However, tracheal re-intubation using a direct laryngoscope with the Miller blade failed because of mucosal swelling and bloody secretions. Following multiple intubation attempts, the patient's peripheral oxygen saturation had decreased to 52%. Immediately, a video laryngoscope was requested, and, by using the C-MAC® video laryngoscope, the patient was successfully re-intubated. Because pediatric patients are more vulnerable to desaturation, extreme caution should be used in securing airways even during a short apneic period. Using a video laryngoscope at the first intubation attempt would be useful for successful tracheal intubation.

Truview PCDTM Video Laryngoscope versus McCOY Laryngoscope for Tracheal Intubation: A Comparative Study.

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.

Comparison of hemodynamic responses to laryngoscopy and intubation with Truview PCDTM, McGrath® and Macintosh laryngoscope in patients undergoing coronary artery bypass grafting: A randomized prospective study.

Context: We hypothesized that reduced oropharyngolaryngeal stimulation with video laryngoscopes would attenuate hemodynamic response to laryngoscopy and intubation. Aim: Comparison of hemodynamic response to laryngoscopy and intubation with video laryngoscopes and Macintosh (MC) laryngoscope. Setting and Design: Superspecialty tertiary care public hospital; prospective, randomized control study. Methods: Sixty adult patients undergoing elective coronary artery bypass grafting (CABG) were randomly allocated to three groups of 20 each: MC, McGrath (MG), and Truview (TV). Hemodynamic parameters were serially recorded before and after intubation. Laryngoscopic grade, laryngoscopy, and tracheal intubation time, ST segment changes, and intra‑/post‑operative complications were also recorded and compared between groups. Statistical Analysis: SPSS version 17 was used, and appropriate tests applied. P < 0.05 was considered significant. Results: Heart rate and diastolic arterial pressure increased at 0 and 1 min of intubation in all the three groups (P < 0.05) while mean arterial pressure increased at 0 min in the MG and TV groups and at 1 min in all three groups (P < 0.05). A significant increase in systolic arterial pressure was only observed in TV group at 1 min (P < 0.05). These hemodynamic parameters returned to baseline by 3 min of intubation in all the groups. The intergroup comparisons of all hemodynamic parameters were not significant at any time of observation. Highest intubation difficulty score was observed with MC (2.16 ± 1.86) as compared with MG (0.55 ± 0.88) and TV (0.42 ± 0.83) groups (P = 0.003 and P = 0.001, respectively). However, duration of laryngoscopy and intubation was significantly less in MC (36.68 ± 16.15 s) as compared with MG (75.25 ± 30.94 s) and TV (60.47 ± 27.45 s) groups (P = 0.000 and 0.003, respectively). Conclusions: Video laryngoscopes did not demonstrate any advantage in terms of hemodynamic response in patients with normal airway undergoing CABG.

Video laryngoscope: A boon for airway management in severe facial trauma.

We report the use of video laryngoscope for the exchange of orotracheal tube to nasotracheal tube needed for mandibular repair in a case of oromaxillofacial injury.

Comparison of McGrath-5 video-laryngoscope and McCoy laryngoscope guided double-lumen tube intubation in patients with difficult airway / 中国内镜杂志

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.

Comparison of video laryngoscope, direct laryngoscopy and fibreoptic bronchoscope nasal intubation on hemodynamics, inflammatory and stress response / 中国内镜杂志

Objective To analyze the differences of video laryngoscope, direct laryngoscopy and fibreoptic bron﹣choscope nasal intubation on hemodynamics, inflammatory and stress response. Methods 117 patients underwent surgery from November 2013 to March 2015 were chose as research subjects and randomly divided into video laryn﹣goscope group, direct laryngoscopy group, fiberoptic bronchoscope group based on different cannula enrolled way. Then compared the hemodynamics, inflammation, stress level after intubation among the three groups. Results Com﹣pared with the T0, the three groups patients' systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), C-reactive protein (CRP), interleukin -6 (IL-6), tumor necrosis factor (TNF-α), norepinephrine (NE), plasma cortisol (Cor), angiotensinⅡ(ATⅡ) differences had no significant difference (P>0.05);compared with direct laryn﹣goscopy group, video laryngoscope group, fiberoptic bronchoscope group patients' T1, T2, T3 SBP, DBP, HR, CRP, TNF-α, IL-6, NE, Cor, ATⅡ levels were lower; compared with the video laryngoscope group, optical fiber bron﹣choscopy group patients SBP, DBP, HR, CRP, TNF-α, IL-6, NE, Cor, ATⅡ low levels at T1, T2, T3 were lower (P<0.05). Conclusions Fibreoptic bronchoscope nasal intubation has less influence on patients, will not cause severe stress and inflammatory response, it is one of the ideal instrument anesthesia induction intubation.