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Background
The efficacy of devices for difficult intubation in paediatric patients, especially with a Cormack-Lehane grade 4 view, has yet to be established. We compared intubating parameters among three devices (the Airtraq®, McGrath®, and Macintosh laryngoscopes).
Methods
This study is a randomised cross-over trial. Participants were 20 anaesthe...
Citations
... Both the devices were similar in terms of glottic view. On the other hand, some previous studies have reported a better view of the glottic inlet when assessed in terms of POGO score and CL grade with Airtraq ™ video-laryngoscope as compared to Macintosh laryngoscope (Bhandari et al. 2013;McElwain et al. 2010;Owada et al. 2017). Rendeki et al. also reported use of Airtraq ™ video-laryngoscope significantly improved the POGO scores compared to Macintosh laryngoscope for difficult and normal airway in mannequins (Rendeki et al. 2017). ...
Background
Airway management by intubation is considered a major responsibility and vital skill for anaesthesiologists. Direct laryngoscopy and endotracheal intubation under vision continues to be the gold standard for airway management. Though conventional laryngoscopy is done with Macintosh blade, it has its own drawbacks. The Airtraq™ is a tube/guide channelled video-laryngoscope and can be used in patients with normal as well as difficult airway. On literature review, studies comparing intubation time with Airtraq™ and Macintosh laryngoscopes have shown heterogeneous results. Therefore, the present study was designed to compare the Airtraq™ video-laryngoscope and Macintosh laryngoscope for tracheal intubation in adults.
Results
The median time to intubation was significantly longer in group A [45 (27–77) s] than in group M [24 (21–26) s] ( p < 0.001). In both groups, 96% patients had POGO score 75–100% and CL grade I. Intubation was noted to be easy in 88% cases in group A and 92% in group M ( p > 0.05). Three cases in group A required a second attempt for successful intubation, whereas in group M, all cases were intubated in the first attempt ( p > 0.05). Hemodynamic parameters and complications were comparable among the groups ( p > 0.05).
Conclusions
Airtraq™ video-laryngoscope took longer time for intubation than Macintosh laryngoscope. However, both the devices were similar in terms of glottic view, ease of intubation, number of intubation attempts, incidence of failed intubation, hemodynamic changes, and complications. The overall performance of Airtraq™ video-laryngoscope was similar to Macintosh laryngoscope in patients having normal airways.
... A previous study described the usefulness of the McGrath VL in easily intubating 100 children without complications [9]. In addition, the McGrath VL showed greater intubation effectiveness than direct laryngoscopes in pediatric manikins, such as those simulating cardiopulmonary resuscitation, Cormack-Lehane grade IV, and immobilized cervical spine [10][11][12]. In a prospective randomized study, the McGrath VL provided a better glottic view and lower intubation difficulty scale (IDS) than the Macintosh laryngoscope in children with normal airway [13]. ...
... However, our results are inconsistent with those of other studies on pediatric manikins simulating difficult intubation. In those studies, the intubation time was similar when performed by anesthesiologists and rather shorter in the McGrath VL than direct laryngoscopes when performed by paramedics [10][11][12]. It is interesting that, in our study, the intubation time was extended in McGrath VL compared to the Macintosh laryngoscope, despite children having torticollis and intubation being performed by an anesthesiologist with >15 years of experience. ...
... VLs are generally known to offer an improved glottic view compared to direct laryngoscopes, which was confirmed for the McGrath VL in adults requiring tracheal intubation [8]. In addition, the McGrath VL provided better laryngeal views than the Macintosh laryngoscope in children with normal airways or in pediatric manikins with simulated difficult intubation [11][12][13]. Generally, this improvement in glottic view results from no need for alignment of the oral, pharyngeal, and laryngeal axes. ...
We investigated the efficacy of the McGrath videolaryngoscope compared with the Macintosh laryngoscope in children with torticollis. Thirty children aged 1–10 years who underwent surgical release of torticollis were randomly assigned into the McGrath and Macintosh groups. Orotracheal intubation was performed by a skilled anesthesiologist. The primary outcome was the intubation time. The Cormack–Lehane grade, lifting force, intubation difficulty scale (IDS), difficulty level, and intubation failure rate were also assessed. The intubation time was significantly longer in the McGrath group than in the Macintosh group (31.4 ± 6.7 s vs. 26.1 ± 5.4 s, p = 0.025). Additionally, the Cormack–Lehane grades were comparable between the groups (p = 0.101). The lifting force and IDS were significantly lower in the McGrath group than in the Macintosh group (p < 0.001 and p = 0.022, respectively). No significant differences were observed with respect to endotracheal intubation difficulty and intubation success rate. Intubation-related complications were also not observed. In conclusion, compared with the Macintosh laryngoscope, the McGrath videolaryngoscope extended the intubation time and did not improve glottic visualization in children with torticollis, despite having a lesser lifting force, lower intubation difficulty scale, and similar success rate.
... Journals discussing the comparison of McGrath® Mac videolaryngoscope with direct laryngoscope (Macintosh) have been included after reviewed through the titles and abstracts and the remaining 11 journals. (12,13,22,(14)(15)(16)(17)(18)(19)(20)(21) Then, 2 studies using patients, (12,13) 3 studies using a pediatric manikin, (14-16) one studies used manikin but the required data were incomplete because trials were conducted on normal airways, (17) and the other one studies did not include success rate in the results. (18) Figure 1 shows the PRISMA diagram. ...
Introduction: McGrath® MAC videolaryngoscope is a single-handed device designed to facilitate intubation in patients both in patients with normal airway conditions (without any complications) or airway conditions with complications such as cervical spine and/or anatomic abnormalities. Objective: This study aims to compare McGrath® MAC videolaryngoscope and direct laryngoscope using Macintosh blades as learning material or study simulators for medical personnel (including anesthesiologist and paramedics) and novice operator (medical students). Method: this study is a systematic review using the PRISMA method which was carried out systematically. Data was collected through Pubmed, direct science, EBSCOHost, and Proquest using the keywords ‘airway management ', ‘laryngoscopy', and 'manikin'. Journal included based on published publication time between 2008 and 2020, a study using SimMan Laerdal Airway manikin, a journal discussing intubation using McGrath® MAC videolaryngoscope and direct laryngoscope with Macintosh blades here, where it is normal airway (without complications) and difficult airway. Results: 1556 journals were collected through 4 journal search sites and then carried out a screening process for the publication year approved in 2008 to 2020. Four studies use adult manikin SimMan Laerdal Airway including 247 participants were included in this systematic review. Conclusion: Based on journals that have been reviewed, McGrath® MAC videolaryngoscope provides better and superior results compared to Macintosh in terms of the success rate and visualization of glottis. Also, the intubation time using McGrath® MAC videolaryngoscope is shorten compared to Macintosh both on the normal airway (without complication) and difficult airway. The participants (medical personnel and novice operators) in all studies that reviewed prefer to use McGrath® Mac videolaryngoscope instead of using direct laryngoscope with Macintosh blade for Endotracheal Intubation mainly used for learning or study simulators.
... Literatürde, Airtraq laringoskop ile Macintosh laringoskopun karşılaştırıldığı çalışmalar incelendiğinde Airtraq laringoskopun Macintosh laringoskopa göre daha iyi bir laringoskopik görünüm (daha düşük CLL skoru) sağladığına dair yayınlar bulunmaktadır (5,13,14) . Biz de çalışmamızda, Airtraq laringoskopun Macintosh laringoskopa göre anlamlı düzeyde daha iyi CLL görünümü sağladığını tespit ettik. ...
ABSTRACT
Objective: Successful airway management is the primary and most crucial step required for patient safety in anesthetic application. Due to the increase in the variety of materials used for ventilation and intubation in recent years, successful airway management has become more advantageous in difficult airway management. The development of Glidescope and Airtraq laryngoscopes are used as alternative laryngoscopy devices. The aim of the present prospective randomized study is to compare superiority of the success of endotracheal intubation performed with Macintosh, Glidescope and Airtraq laryngoscopes in terms of Cormack-Lehane laryngoscopic classification, intubation duration, number of attempts, and use of facilitating maneuvers required for intubation.
Methods: Totally 180 patients over 18 years of age, in ASA I-II physiological risk group, who would undergo elective surgery were included in the study. The patients were randomly divided into three groups. Cormack-Lehane laryngoscopic classification, intubation duration, number of intubation attempts, facilitating maneuvers required for intubation, and complications related to intubation were recorded and compared in patients who were intubated with Macintosh laryngoscope in Group-A, Glidescope laryngoscope in Group-B, and Airtraq laryngoscope in Group-C.
Results: It was found that demographic data were similar between groups. Cormack-Lehane laryngoscopic score, intubation duration, number of attempts and use of facilitating maneuver parameters of the Glidescope and Airtraq laryngoscope groups were similar and superior to the Macintosh group. In terms of intubation success rates and complications related to intubation, the frequency of the Macintosh laryngoscope group was similar to the Glidescope and Airtraq laryngoscope groups.
Conclusion: According to the result of the study, it was concluded that Glidescope and Airtraq laryngoscopes provide a better view of glotis and ease intubation compared to Macintosh laryngoscope. However, we did not find any difference in intubation success and complication rates between the groups.
Keywords: Macintosh laryngoscope, glidescope laryngoscope, airtraq laryngoscope, intubation success
ÖZ
Amaç: Başarılı hava yolu yönetimi, anestezi uygulamalarında hasta güvenliğinde gerekli birincil ve en önemli adımdır. Son yıllarda ventilasyon ve entübasyon için kullanılan malzemelerin çeşitliliğinin artmasından dolayı zor hava yolu yönetiminde daha avantajlı duruma gelinmiştir. Glidescope ve Airtraq laringoskoplar da bu amaçla geliştirilmiş alternatif laringoskopi cihazlarıdır. Bu prospektif, randomize, klinik çalışmamızda Macintosh, Glidescope ve Airtraq laringoskoplar ile gerçekleştirilen endotrakeal entübasyon başarısını; Cormack-Lehane laringoskopik sınıflaması, entübasyon süresi, deneme sayısı, entübasyon için ihtiyaç duyulan kolaylaştırıcı manevra kullanımı yönünden birbirlerine olan üstünlüklerini karşılaştırmayı amaçladık.
Yöntem: Çalışmaya elektif cerrahi uygulanacak, 18 yaşından büyük, ASA I-II fizyolojik risk grubundaki 180 hasta dahil edildi. Hastalar rastgele üç gruba ayrıldı. Grup-A’ da Macintosh laringoskopla, Grup-B’de Glidescope laringoskopla ve Grup-C’de Airtraq laringoskopla entübe edilen hastaların Cormack-Lehane laringoskopik sınıflaması, entübasyon süresi, entübasyon deneme sayısı, entübasyon için ihtiyaç duyulan kolaylaştırıcı manevralar ve entübasyona ait komplikasyonlar kaydedildi ve karşılaştırıldı.
Bulgular: Demografik veriler gruplar arasında benzer bulundu. Glidescop ve Airtraq laringoskop gruplarının Cormack Lehane laringoskopik skoru, entübasyon süreleri, deneme sayıları ve kolaylaştırıcı manevra kullanımı parametreleri benzer olup Macintosh grubundan üstündü. Grupların entübasyon başarı oranları ve entübasyona bağlı komplikasyonlar açısından, Glidescope ve Airtraq laringoskopi grupları ile Macintosh laringoskopi grubu ile sıklığı benzerdi.
Sonuç: Çalışmamızın sonucunda Glidescope ve Airtraq laringoskoplarının Macintosh laringoskopa kıyasla daha iyi glotis görüntüsü sağladığı ve entübasyonu kolaylaştırdığı kanısına vardık. Bununla birlikte gruplar arasında entübasyon başarı oranlarında ve komplikasyon sıklıklarında ise farklılık tespit etmedik.
Anahtar
... Although the selection of airway simulators or patients, devices, operators, methods of measurement and outcome measures were various, a large part of these studies included Storz C-MAC PM or McGrath MAC for comparison with DL according as ours. 2,4,7,17,[22][23][24][25][26][27][28][29][30] It can be speculated that the reason for preference of these VLs is the nonchanneled and nonguided design with Macintosh type blade that provides an easy utilization because the technique is similar to an accustomed DL. 2,15 A Cochrane review declared that 24,31 However, we found an intubation success rate of 92% for McGrath MAC, though all intubation attempts of DL were successful in the child manikin. It can be explained by the shorter time limit for intubation success in our study. ...
Objectives:
Endotracheal intubation is an essential skill for the pediatric airway management. Although direct laryngoscopy (DL) is the standard method, several videolaryngoscopes (VLs) have been recently enhanced as an alternative especially for difficult intubations. We aimed to compare McGrath MAC (McG) and Storz C-MAC PM (ST) VLs with DL in terms of intubation success rate, time to intubation (TTI), and duration of obtaining glottis view of intubation attempts performed by pediatric residents on different pediatric airway manikins.
Methods:
The pediatric residents with no experience in videolaryngoscopy were included. After a brief demonstration, intubation attempts with 3 randomly handled different devices with 6 different blades were performed on a child manikin, an infant manikin, a Pierre-Robin sequence infant manikin, and a child manikin with cervical immobilization sequentially.
Results:
Fifty pediatric residents were enrolled. The attempts of DL on child manikin and attempts of all devices on child with cervical immobilization simulation were completely successful. For the attempts on both infant manikin and Pierre-Robin sequence infant manikin, the success rate of McG was significantly lower than ST and DL (P = 0.011 and P = 0.001). In the child manikin, McG and ST had prolonged TTI compared with DL (P = 0.016 and P = 0.001). For the child with cervical immobilization simulation, TTI of DL was significantly shorter than McG and ST (P = 0.011 and P = 0.001). Time to intubation of McG was significantly longer than DL and ST for the attempts on both 2 infant manikins. The rate of Cormack-Lehane grade I glottis view was similar for the attempts on both 2 child airway simulations. For infant manikin and Pierre-Robin sequence infant simulation, the rate of Cormack-Lehane grade I of ST was higher than attempts of DL and McG.
Conclusions:
The attempts of pediatric residents on infant normal airway and Pierre-Robin sequence infant airway simulations resulted with enhanced glottis view by the utilization of Storz C-MAC PM, but both 2 VLs did not provide the improvement of intubation success rate and TTI compared with DL on these 4 different pediatric manikins. Further clinical studies of different VLs in different clinical courses are required for a reliable utilization in children.
... Several authors report the blind technique to be time consuming, requiring multiple attempts and higher doses of anesthetic agents and leading to occasional failure (Smith et al. 2004;Johnson 2010;Engbers et al. 2017). Moreover, it can result in traumatic injuries of the larynx, leading to hemorrhage, edema and even respiratory arrest (Grint et al. 2006;Phaneuf et al. 2006). Allweiler et al. (2010) considered 'poor' blind intubation to occur in 8.8% of the rabbits in their study, defined as unsuccessful intubation within 5 minutes of induction or requiring more than four attempts. ...
... Tran et al. (2001) used a rigid endoscope through the tube and in 60 rabbits, intubation was successful within 2 minutes with no complications during intubation or for 30 days. Portable digital laryngoscopes are described in human medicine allowing easy identification of the epiglottis and rapid and easy intubation, especially in pediatric patients (Lee et al. 2016;Owada et al. 2017). Portable endoscope use has also been reported in veterinary medicine (Huynh 2019). ...
... Instillation of a small volume (0.2 mL) of 2% lidocaine solution through the tube may be a more efficient method of local anesthesia. Phaneuf et al. (2006) evaluated postintubation tracheal injury in rabbits, and lesions were more evident at the tip of the tracheal tube, not at the larynx. The present study only evaluated immediate laryngeal lesions through endoscope examination after extubation. ...
Objective:
To compare between blind and smartphone-based endoscope-assisted techniques for endotracheal intubation in rabbits.
Study design:
Prospective clinical study.
Animals:
A total of 34 rabbits.
Methods:
Rabbits were assigned to four groups: intubation by a veterinary anesthesiologist (VA) or an exotic pet medicine specialist (EPS) using blind or endoscope-assisted techniques. Propofol dose, number of attempts until successful intubation, total time for intubation, duration of the successful attempt and occurrence of lingual cyanosis/laryngeal lesions were recorded. Data were analyzed by t test, Wilcoxon-Mann-Whitney U test or chi-square test. Pearson correlation for body weight was performed.
Results:
The success rate of blind intubation was 88.9% and 77.8% for VA and EPS, respectively. Propofol dose, total and median number of attempts, total time for intubation and duration of the successful attempt were 3.1 (0-6.2) mg kg-1, 19, 2 (1-5), 79 ± 65 and 30 ± 20 seconds for VA and 1.5 (0-4.5) mg kg-1, 24, 3 (1-5), 136 ± 92 and 38 ± 16 seconds for EPS. The success rate of endoscope-assisted intubation was 87.5% for both operators. Propofol dose, total and median number of attempts, total time for intubation and duration of the successful attempt were 2.5 (1.3-7.4) mg kg-1, 22, 3 (1-5), 170 (65-368) and 46 (22-150) seconds for VA and 3.2 (0-6) mg kg-1, 11, 1 (1-4), 56 (27-432) and 55 (26-79) seconds for EPS. VA performed blind intubation more quickly, propofol dose was lower and cyanosis was less frequent than in the endoscope-assisted group.
Conclusions and clinical relevance:
Both techniques were reliable for rabbit endotracheal intubation. Best results were achieved when the operator was experienced in the technique. The smartphone-based endoscope is a useful aid for rabbit intubation.
... Another option may be the insertion of the laryngoscope blade lateral to the tongue. Video laryngoscopes are becoming more popular and are also recommended in the youngest patients [51][52][53][54][55]. The use of introducers and stylets does not improve laryngoscopic view per se, but both of these adjuncts may be useful during tracheal tube insertion into the trachea when the laryngeal inlet is only partially visible. ...
Children form a specific group of patients, as there are significant differences between children and
adults in both anatomy and physiology. Difficult airway may be unanticipated or anticipated. Difficulties
encountered during intubation may cause hypoxia, hypoxic brain injury and, in extreme situations, may
result in the patient’s death. There are few paediatric difficult-airway guidelines available in the current
literature, and some of these have significant limitations. This position paper, intended for unanticipated
difficult airway, was elaborated by the panel of specialists representing the Polish Society of
Anaesthesiology and Intensive Care as well as the Polish Neonatal Society. It covers both elective
intubation and emergency situations in children in all age groups. An integral part of the paper is an
algorithm. The paper describes in detail all stages of the algorithm considering some modification in
specific age groups, i.e. neonates.
... It is not just the duration of the successful intubation attempt which is of interest. If first-attempt intubation is not successful, subsequent repeated intubation attempts can be related to complications such as airway trauma, hypoxia, vomiting and pulmonary aspiration, esophageal intubation with delayed recognition, the situation of Bcan't intubate can't ventilate,^and cardiac arrest [21]. Compared with the GlideScope®, the Airtraq™ demonstrated superior characteristics of first-attempt intubation and required a fewer number of intubation attempts to succeed. ...
Airway management in children is associated with anatomical and physiological challenges compared with adults. Pierre Robin sequence (PRS) is a condition characterized by micrognathia, glossoptosis, and cleft palate and related to a difficult airway. Both the Airtraq™ and GlideScope® have never been previously directly compared in PRS. Our aim was to evaluate the performance of these two airway devices in a PRS manikin for ethical and practical reasons. Between April and July 2017, 26, pediatric intensive care clinical fellows or trainees from a tertiary pediatric center were recruited to participate. In this prospective and randomized crossover trial, all participants first set up the Airtraq™ and the GlideScope® and then used these videolaryngoscopes to intubate an AirSim® PRS manikin. Our primary outcome measure was the duration of the successful intubation attempt. Duration of the successful intubation attempt was 18.1 (14.2–34.9 [10.2–51.3]) s for the Airtraq™ compared to 31.1 (18.7–55.6 [6.2–119]) s for the GlideScope® (p = 0.045). Setup time was 50.0 ± 6.9 s for the Airtraq™ and 27.8 ± 8.6 s for the GlideScope® (p < 0.001).Conclusion: Even though setup time was longer, the characteristics of intubation performance were superior with the Airtraq™ relative to the GlideScope® in an AirSim® PRS manikin.
What is Known:
• Several case reports have described the successful use of Airtraq™ to intubate children with Pierre Robin sequence.
• The GlideScope® has demonstrated similar rates of first-attempt successful intubation to flexible fiberoptic bronchoscopy in a Pierre Robin sequence manikin.What is New:
• In the hands of pediatric non-airway specialists, the characteristics of intubation performance, including the duration of the successful intubation attempt, are superior with the Airtraq™ compared with the GlideScope® in a Pierre Robin sequence manikin.
• Setup time for the Airtraq™ is, however, longer relative to that for the GlideScope®.
... However, one study completed by Caridad et al. demonstrated a greater variation in heart rate during intubation with VL. The study suggests that rather than the curvature of the blade being a factor the most likely cause for this variation in heart rate with VL could be due to a shortened TTI [17][18]. There are some limitations of our study. ...
... 18 However some studies have observed a higher dental trauma score with McGrath as compared to the Airtraq ® . 19 This could be explained by the fact the McGrath ® needs to lever back excessively to align the line of vision with the laryngeal axis, which leads to the dental trauma. ...
