Figure - available from: Journal of Clinical Medicine
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Head positions for intubation. (A) Neutral position and (B) sniffing position. GVL, GlideScope videolaryngoscope; HP, hypopharynx; NP, nasopharynx; NTT, nasotracheal tube; OP, oropharynx.
Source publication
The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups acco...
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Background and aim:
Nasotracheal intubation is the main route to secure the airway in oral and maxillofacial surgery patients. This study was aimed to compare the intubation times and glottis visualization of McGrath video laryngoscope with the Macintosh laryngoscope for routine nasotracheal intubation.
Materials and methods:
Records of seventy-...
Citations
... We discarded case reports, articles on the paediatric population, mannequin studies and non-English language studies from the remaining 42 articles. Of the 19 articles selected for qualitative data synthesis, nine studies were excluded because of type of study participants [16,17], non RCT study [18,19], with only VL [20][21][22][23] and inadequate data [24]. For the systematic review and meta-analysis, a total of 10 studies (n = 597) were included (Table 2). ...
Background:
Nasotracheal intubation (NTI) is commonly performed in oro-maxillofacial surgeries. The comparative characteristics of video laryngoscope (VL) versus direct laryngoscope (DL) for NTI in such patients are unclear.
Methods:
We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oro-maxillofacial surgery. The primary outcome was time to intubation (TTI). Secondary outcomes included the first attempt success, overall success, the incidence of nasal bleeding, Cormack and Lehane grade and requirement for maneuvers for NTI.
Results:
Of the 456 studies identified following a systematic search, 10 were included. Meta-analysis showed a significantly less TTI favouring VL [ mean difference -9.04; (95% CI) -12.71 to -5.36; P < 0.001, I2 = 59%]. VL was also associated with a greater first attempt success [RR 1.10, (95% CI) 1.04 to 1.16; P = 0.001]. Maneuvers to facilitate intubation were less with VL [RR 0.22, 95% CI 0.10 to 0.51; P < 0.001]. There was no difference in overall intubation success [RR 1.04, (95% CI) 0.98 to 1.10; P = 0.17]. The incidence of bleeding was not different between DL and VL. [RR 0.59, (95% CI) 0.32 to 1.08; P = 0.09].
Conclusions:
In this systematic review and meta-analysis of RCT's, the use of a VL was associated with a significantly shorter time to NTI, a greater first attempt success rate and reduced need for maneuvers to facilitate NTI. However, there is no difference in overall success, glottic view obtained or bleeding between the two instruments.
Video laryngoscopy is often selected to assist nasotracheal intubation in allowing better laryngeal visualization, although there is no comparative study evaluating the effectiveness between auxiliary techniques by using Magill forceps and inflated cuff in GlideScope video laryngoscopy for nasotracheal intubation. Fifty‐one of 100 patients in a Magill forceps group and 47 of 100 patients in a cuff inflation group were included in the final analysis in this randomized, single‐blind, parallel, clinical trial study. Induction agents were routinely administered according to body weight, while intubation time spent, attempts, and related side effects were recorded. Compared to the Magill forceps group, the cuff inflation technique shortened the total intubation time (70.0 ± 24.5 s vs. 87.0 ± 25.0 s, p = 0.001) and the time of advancing the nasotracheal tube from oropharyngeal space into the trachea (25.9 ± 16.4 s vs. 42.3 ± 21.2 s, p < 0.001). However, the number of intubation attempts was not significantly different between groups. During tube advancement, the tube was rotated to accommodate the glottis and trachea more frequently in the cuff inflation group (p = 0.009), but the blade of the laryngoscope shifted and was adjusted to the proper position more frequently in the Magill forceps group (p < 0.001). In the Magill forceps group, the tube cuff might be clipped incidentally and the intubator might shift their gaze away from the screen during intubation, although there was no significant difference in intubation‐related side effects between groups. Unlike the conventional approach, nasotracheal intubation with the GlideScope® video laryngoscope using the auxiliary technique of cuff inflation could be more suited than using Magill forceps.
