First clinical evaluation of the C-MAC D-Blade videolaryngoscope during routine and difficult intubation.

In the present preliminary study we evaluated the C-MAC® D-Blade (Karl Storz, Tuttlingen, Germany), a new videolaryngoscopic C-MAC blade for difficult intubation, during both routine and difficult intubations. First, both the conventional direct laryngoscopy and the D-Blade were used in 15 consecutive patients with normal airways during routine induction of anesthesia. Second, the D-Blade was used as a rescue device in 20 of 300 (6.7%) consecutive patients, when conventional direct laryngoscopy failed. In the 15 patients during routine induction of anesthesia, with direct laryngoscopy, a Cormack-Lehane (C/L) grade 1 and grade 2a view was seen in 7 and 8 patients, respectively. It was possible to insert the D-Blade and to get a video view of the glottis on the first attempt in all patients; with the D-Blade, all 15 patients had a C/L 1 view. The time to successful intubation with the D-Blade was 15 (8-26) seconds (median (range)). In the 20 patients, in whom unexpected difficulty with direct laryngoscopy was observed, C/L grades 3 and 4 were present in 15 and 5 patients, respectively. With the use of the D-Blade, indirect C/L video view improved to C/L class 1 in 15 patients, and to 2a in 5 patients, respectively. The time from touching the laryngoscope to optimal laryngoscopic view was 11 (5-45) seconds and for successful intubation 17 (3-80) seconds. In all 35 patients, with the D-Blade no direct view of the glottis was possible and subsequently a semiflexible tube guide was required.

Laryngeal tube S II, laryngeal tube S disposable, Fastrach laryngeal mask and Fastrach laryngeal mask disposable during elective surgery: a randomized controlled comparison between reusable and disposable supraglottic airway devices.

BACKGROUND AND OBJECTIVE: Analogue disposable devices of the laryngeal tube S II (LTS II) and the Fastrach laryngeal intubation mask (ILMA, Fastrach), namely the laryngeal tube disposable (LTS-D) and the Fastrach laryngeal intubation mask disposable (Fastrach-D), have recently been introduced. The purpose of this study was to compare each reusable device with the corresponding disposable one, during routine surgery. METHODS: After informed consent, 120 American Society of Anesthesiologists I-III patients scheduled for routine minor surgery were randomly allocated to the LTS II (n = 30), the LTS-D (n = 30), the Fastrach (n = 30) and the Fastrach-D (n = 30) groups, respectively. Overall insertion success rates, time to first sufficient ventilation (V(e)t > or = 200 ml), resulting airway leak pressures (ALPs), subjective assessment of handling as well as patient comfort were determined. RESULTS: Insertion success rates of the LTS II, LTS-D, Fastrach and Fastrach-D were 30/30, 29/30, 30/30 and 30/30, respectively. Time to successful insertion in the LTS II vs. the LTS-D group, as well as in the Fastrach vs. the Fastrach-D group, showed significant differences [median (min-max) s: 38 (13-187), 23 (9-108), P < 0,05; 27.5 (6-110), 16 (8-82), P < 0.05]. The highest ALP could be observed in the LTS-D group [median (min-max): 40 (16-40), P < 0.001 vs. all other devices] and the lowest ALP in the Fastrach-D group [median (min-max): 24.5 (12-40)]. ALP did not differ significantly in any group during variation of cuff volume by +/-20 ml. Subjective assessment of handling was significantly (P < 0.001) better in the LTS-D group than in the LTS II, Fastrach and Fastrach-D groups. CONCLUSION: LTS II, LTS-D, Fastrach and Fastrach-D were all suitable for routine airway management. The LTS-D showed the best properties in terms of airway sealing and handling.

Laryngeal tube S II, ProSeal laryngeal mask, and EasyTube during elective surgery: a randomized controlled comparison with the endotracheal tube in nontrained professionals.

BACKGROUND AND OBJECTIVE: EasyTube (EZT), ProSeal laryngeal mask airway (PLMA), and Laryngeal tube S II (LTS II) have recently been introduced as supraglottic airway devices and have been proposed as emergency airway alternatives. The purpose of this study was to compare the performance of the three devices, if used by anaesthesiologists without extensive hands-on training, with the endotracheal tube during routine surgical procedures. METHODS: After informed consent, 88 ASA I-II patients scheduled for routine minor surgery were randomly allocated to EZT (n=22), PLMA (n=22), and LTS II (n=22) groups and the endotracheal tube (n=22) group, respectively. Overall success rates, insertion times, cuff pressures, and resulting airway leak pressures as well as subjective assessment of handling were determined. RESULTS: Overall insertion success rate of the EZT, PLMA, LTS II, and endotracheal tube was 14 out of 22 (64%), 20 out of 22 (91%), 21 out of 22 (96%), and 21 out of 22 (96%), respectively. Time to first successful ventilation with the EZT was significantly (P<0.05) longer than that with PLMA, LTS II, and endotracheal tube [median (minimum-maximum): 56 (27-150), 25 (12-70), 24 (11-150), and 20 (8-74) s, respectively]. The lowest airway leak pressure could be observed with the EZT [median (minimum-maximum), 19 (9-40) cmH2O] and the highest airway leak pressure with the LTS II [median (minimum-maximum), 40 (22-40) cmH2O]. Subjective assessment of handling was significantly (P<0.05) poorer in the EZT group compared with PLMA, LTS II, and endotracheal tube groups, respectively. CONCLUSION: In contrast to the EZT, both PLMA and LTS II proved to be suitable for routine airway management by anaesthesiologists without extensive hands-on device training.