scholarly journals Macintosh laryngoscope and i-view™ and C-MAC® video laryngoscopes for tracheal intubation with an aerosol box: a randomized crossover manikin study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Toshiyuki Nakanishi ◽  
Yoshiki Sento ◽  
Yuji Kamimura ◽  
Kazuya Sobue

Abstract Background We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the disposable i-view™ video laryngoscope (i-view) with an integrated display or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box. Methods In this randomized, crossover manikin study, we recruited 37 medical personnel with > 2 years of dedicated anesthesia experience from five hospitals. After the three successful intubations within 60 s using each laryngoscope without a box, the participants performed tracheal intubation thrice with each laryngoscope with at least 2-h intervals in a determined order. The primary outcome was the intubation time. The secondary outcomes were success rate, Cormack-Lehane grade, and subjective difficulty scale score. Results Thirty-seven personnel (11 women and 26 men) with 12 [5–19] (median [interquartile range]) years of anesthesia and intensive care experience were enrolled. There was no significant difference in the intubation time: 30 [26–32] s for Macintosh, 29 [26–32] s for i-view, and 29 [25–31] s for C-MAC (P = 0.247). The success rate was 95–100%, without a significant difference (P = 0.135). The i-view and C-MAC exhibited superior Cormack-Lehane grades and lower subjective difficulty scale scores than the Macintosh; however, there were no differences between the i-view and C-MAC. Conclusions Rapid and highly successful tracheal intubation was possible with both Macintosh, i-view, and C-MAC on a normal airway manikin in an aerosol box. Improved Cormack-Lehane grade and the ease of performing the procedure may support the use of video laryngoscopes. Trial registration UMIN Clinical Trials Registry, UMIN000040269. Registered 30 April 2020.

2020 ◽  
Author(s):  
Toshiyuki Nakanishi ◽  
Yoshiki Sento ◽  
Yuji Kamimura ◽  
Kazuya Sobue

Abstract Background: The aerosol box was designed to prevent cough droplets from spreading, but it can impede tracheal intubation. We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the i-view™ video laryngoscope (i-view) with an integrated display, or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box.Methods: This prospective, randomized, crossover simulation study was conducted at an operating room of the two hospitals (a university hospital and a tertiary teaching hospital). We recruited 37 medical personnel (36 anesthesiologists and 1 dental anesthesiologist) who were working in the fields of anesthesia and intensive care with > 2 years of dedicated anesthesia experience from five hospitals. We divided the participants into six groups to use the laryngoscope in a determined order. After the training using each laryngoscope without a box, the participants performed tracheal intubation thrice with each laryngoscope with at least two-hour intervals. The primary outcome was the intubation time. The secondary outcomes were the success rate, Cormack-Lehane grade, and subjective difficulty scale score (numeric rating scale 0–10, 0: no difficulty, 10: highest difficulty). We used the Friedman test and the Wilcoxon signed-rank test with Bonferroni adjustment. Data are shown as median [interquartile range].Results: Thirty-seven personnel (11 women and 26 men) with 12 [5–19] (median [interquartile range]) years of anesthesia and intensive care experience were enrolled. There was no significant difference in the intubation time: 30 [26–32] s for Macintosh, 29 [26–32] s for i-view, and 29 [25–31] s for C-MAC (P=0.247). The success rate was 95%–100% without significant difference (P=0.135). The i-view and C-MAC video laryngoscopes exhibited superior Cormack-Lehane grades and lower subjective difficulty scale scores than the Macintosh laryngoscope; however, there were no differences between the i-view and C-MAC video laryngoscopes.Conclusions: Rapid and highly successful tracheal intubation was possible with Macintosh laryngoscope, i-view, and C-MAC video laryngoscopes on a manikin with an aerosol box. Improved Cormack-Lehane grade and ease of procedure may support the use of video laryngoscopes.Trial registration: UMIN Clinical Trials Registry, identifier UMIN000040269.


2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Ryosuke Mihara ◽  
Nobuyasu Komasawa ◽  
Sayuri Matsunami ◽  
Toshiaki Minami

Background.Videolaryngoscopes may not be useful in the presence of hematemesis or vomitus. We compared the utility of the Macintosh laryngoscope (McL), which is a direct laryngoscope, with that of the Pentax-AWS Airwayscope (AWS) and McGRATH MAC (McGRATH), which are videolaryngoscopes, in simulated hematemesis and vomitus settings.Methods.Seventeen anesthesiologists with more than 1 year of experience performed tracheal intubation on an adult manikin using McL, AWS, and McGRATH under normal, hematemesis, and vomitus simulations.Results.In the normal setting, the intubation success rate was 100% for all three laryngoscopes. In the hematemesis settings, the intubation success rate differed significantly among the three laryngoscopes (P=0.021). In the vomitus settings, all participants succeeded in tracheal intubation with McL or McGRATH, while five failed in the AWS trial with significant difference (P=0.003). The intubation time did not significantly differ in normal settings, while it was significantly longer in the AWS trial compared to McL or McGRATH trial in the hematemesis or vomitus settings (P<0.001, compared to McL or McGRATH in both settings).Conclusion.The performance of McGRATH and McL can be superior to that of AWS for tracheal intubation in vomitus and hematemesis settings in adults.


Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1171
Author(s):  
Min Hur ◽  
Jong Yeop Kim ◽  
Sang Kee Min ◽  
Kyuheok Lee ◽  
Young Ju Won ◽  
...  

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.


2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Prerana N. Shah ◽  
Kaveri Das

Background. Video laryngoscopes provide better view and can improve ease of intubation compared with standard laryngoscopes. Methods. A prospective randomized study was done on 60 patients, 18 to 65 years old, comparing McGrath video laryngoscope and Macintosh laryngoscope. The aim was to compare the ease, efficacy, and usability of them during routine airway management. The primary endpoint was duration of intubation and the secondary endpoints were Cormack and Lehane grade of laryngoscopic view, number of intubation attempts, and incidence of complications. Results. There was an increase in total duration of intubation with McGrath video laryngoscope with 42.9 ± 19.5 seconds compared to Macintosh laryngoscope with 17.9 ± 4.6 seconds. In Macintosh group, 73.3% had grade I, 20% had grade II, and 6.7% had grade III Cormack Lehane view, while in McGrath group, 83.3% had grade I, 13.3% had grade II, and 3.3% had grade III. In McGrath group, 6 patients (20%) required more than 120 seconds to get intubated and only 73.3% were intubated in 1 attempt, while patients in Macintosh group had 100% successful intubation in 1 attempt. Pharyngeal trauma was seen with McGrath videolaryngoscopy. Conclusion. Duration of laryngoscopy, intubation, and total duration of intubation were significantly higher in McGrath group than in Macintosh group. McGrath group required a higher number of intubation attempts.


2018 ◽  
Vol 28 (12) ◽  
pp. 322-333 ◽  
Author(s):  
Terrie-Marie Russell ◽  
Anil Hormis ◽  

The purpose of this study was to review literature that looked into the efficacy of the Glidescope video laryngoscope versus the Macintosh laryngoscope in oral endotracheal intubations. We aimed to answer the question ‘Should the Glidescope video laryngoscope laryngoscopes be used as first line intubation aids or only in the difficult airway?’ A systematic search of electronic databases was made. The inclusion criteria included: Glidescope, video laryngoscope, and Macintosh laryngoscope in human studies. The study aimed to compare first attempt success rate, glottic view and intubation time in papers dating between 2009 and 2017. Eleven trials with a total of 7,919 patients with both difficult and normal airways were included. The trials showed an improvement in first attempt success rate and glottic view with the Glidescope video laryngoscope especially in those with difficult airways. Overall time to intubate showed no significant differences between the Glidescope video laryngoscope and the Macintosh laryngoscope although it was identified that with increased training and experience with the Glidescope video laryngoscope, intubation time was reduced. Glidescope video laryngoscopes show advantages over the Macintosh laryngoscopes in obtaining better glottic views in those with difficult airways. However its use is not supported in all routine intubations.


2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Hyun Young Choi ◽  
Wonhee Kim ◽  
Yong Soo Jang ◽  
Gu Hyun Kang ◽  
Jae Guk Kim ◽  
...  

Purpose. This study aimed to compare intubation performances among i-gel blind intubation (IGI), i-gel bronchoscopic intubation (IBRI), and intubation using Macintosh laryngoscope (MCL) applying two kinds of endotracheal tube during chest compressions. We hypothesized that IGI using wire-reinforced silicone (WRS) tube could achieve endotracheal intubation most rapidly and successfully. Methods. In 23 emergency physicians, a prospective randomized crossover manikin study was conducted to examine the three intubation techniques using two kinds of endotracheal tubes. The primary outcome was the intubation time. The secondary outcome was the cumulative success rate for each intubation technique. A significant difference was considered when identifying p<0.05 between two devices or p<0.017 in post hoc analysis of the comparison among three devices. Results. The mean intubation time using IGI was shorter (p<0.017) than that of using IBRI and MCL in both endotracheal tubes (17.6 vs. 29.3 vs. 20.2 in conventional polyvinyl chloride (PVC) tube; 14.6 vs. 27.4 vs. 19.9 in WRS tube; sec). There were no significant (p<0.05) differences between PVC and WRS tubes for each intubation technique. The intubation time to reach 100% cumulative success rate was also shorter in IGI (p<0.017) than that in IBRI and MCL in both PVC and WRS tubes. Conclusions. IGI was an equally successful and faster technique compared with IBRI or MCL regardless of the use of PVC or WRS tube. IGI might be an appropriate technique for emergent intubation by experienced intubators during chest compressions.


2021 ◽  
Vol 44 (1) ◽  
pp. 21-28
Author(s):  
Phatthranit Phattharapornjaroen ◽  
Promphet Nuanprom ◽  
Prayoot Suk-um ◽  
Manina Thilarak ◽  
Chaiyaporn Yuksen

Background: Trauma patients who entrapped in the accident vehicle are predispose to have cervical spine injuries and they needed to be intubated with face-to-face intubation technique using Macintosh laryngoscope. Nowadays, video laryngoscope has been introduced to improve the intubation technique. Objective: To compare the effectiveness of video laryngoscope and Macintosh laryngoscope for face-to-face intubation in sitting manikin model with limitation of neck motion. Methods: The study was performed in a randomized experimental study. Subjects were divided into 2 groups both did face-to-face intubation using video laryngoscope and Macintosh laryngoscope in a sitting manikin model with limitation of neck motion. The success rate of intubation, time to finish intubation, and vocal cord visualization were analyzed. Results: Of 41 subjects including 2nd and 3rd year paramedic students, 21 subjects went to video laryngoscope group, and 20 subjects went to Macintosh laryngoscopes group. The Macintosh laryngoscope intubation technique showed significantly better success rate compared to video laryngoscope (100% and 25%, P < .001). In addition, intubation time of Macintosh laryngoscope was significantly less than video laryngoscope (mean [SD], 27 [24.7] and 75 [66.3] seconds, P < .001). However, vocal cord visualization from both laryngoscope techniques showed no statistically significant (P = .08). Conclusions: Intubation training of Macintosh laryngoscope for in sitting model with neck motion limitation showed better success rate and less time than video laryngoscope, with the same vocal cord visualization.  


2019 ◽  
Vol 11 (5) ◽  
pp. 3
Author(s):  
Beatriz Pilo Carbajo ◽  
Juan Ricardo Caro González ◽  
Juan Pedro Macías Pingarrón ◽  
Roberto Bajo Pesini

La intubación orotraqueal (IOT) con fibrobroncoscopio es a menudo considerada la técnica de elección cuando nos encontramos ante una vía aérea difícil prevista. Sin embargo, los videolaringoscopios se usan con más frecuencia. Se realizaron búsquedas en la literatura actual y se realizó un metaanálisis para comparar el uso de la videolaringoscopia y la fibrobroncoscopia para la intubación traqueal despierta.  El principal objetivo fue el tiempo necesario para intubación. Los objetivos secundarios incluyeron: intubación fallida; la tasa de intubación exitosa en el primer intento; satisfacción informada por el paciente con la técnica; y cualquier complicación resultante de la intubación. Ocho estudios donde se examinaron a 429 pacientes se incluyeron en esta revisión. El tiempo de intubación fue más corto cuando se utilizó la videolaringoscopia en lugar de la fibrobroncoscopia (siete ensayos, 408 participantes, diferencia significativa [IC del 95%] 45,7 (66,0 a 25,4) s, p <0,0001, bajo nivel de evidencia). No hubo diferencias significativas entre las dos técnicas en la tasa de fracaso (seis estudios, 355 participantes, riesgo relativo [IC 95%] 1,01 (0,24-4,35), p = 0,99, bajo nivel de evidencia) o la tasa de éxito de primer intento (seis estudios, 391 participantes, riesgo relativo (IC 95%) 1,01 (0,95-1,06), p = 0,8, nivel de evidencia moderado). El nivel de satisfacción del paciente fue similar entre ambos grupos. No se encontraron diferencias en los eventos adversos informados: ronquera / dolor de garganta (tres estudios, 167 participantes, riesgo relativo [IC 95%] 1,07 (0,62-1,85), p = 0,81, bajo nivel de evidencia) y baja saturación de oxígeno (cinco estudios, 337 participantes, riesgo relativo (IC 95%) 0,49 (0,22-1.12), p = 0,09, bajo nivel de evidencia). En resumen, la videolaringoscopia para la intubación traqueal despierta se asocia con un tiempo de intubación más corto. También parece tener una tasa de éxito y un perfil de seguridad comparable a la fibrobroncoscopia. ABSTRACT Could videolaryngoscopy be the chosen technique for awaken patient intubation? Awake fibreoptic intubation is often considered the technique of choice when a difficult airway is anticipated. However, videolaryngoscopes are being used more commonly. We searched the current literature and performed a meta-analysis to compare the use of videolaryngoscopy and fibreoptic bronchoscopy for awake tracheal intubation. Our primary outcome was the time needed to intubate the patient’s trachea. Secondary outcomes included: failed intubation; the rate of successful intubation at the first attempt; patient-reported satisfaction with the technique; and any complications resulting from intubation. Eight studies examining 429 patients were included in this review. The intubation time was shorter when videolaryngoscopy was used instead of fibreoptic bronchoscopy (seven trials, 408 participants, mean difference(95%CI) - 45.7 (- 66.0 to -25.4) s, p<0.0001, low-quality evidence). There was no significant difference between the two techniques in the failure rate (six studies, 355 participants, risk ratio (95%CI) 1.01 (0.24–4.35), p=0.99, low-quality evidence) or the first-attempt success rate (six studies, 391 participants, risk ratio (95%CI) 1.01 (0.95–1.06), p=0.8, moderate quality evidence). The level of patient satisfaction was similar between both groups. No difference was found in two reported adverse events: hoarseness/sore throat (three studies, 167 participants, risk ratio (95%CI) 1.07 (0.62–1.85), p=0.81, low-quality evidence),and low oxygen saturation (five studies, 337 participants, risk ratio (95%CI) 0.49 (0.22–1.12), p=0.09,low-quality evidence). In summary, videolaryngoscopy for awake tracheal intubation is associated with a shorter intubation time. It also seems to have a success rate and safety profile comparable to fibreoptic bronchoscopy.


2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Sanghyun Lee ◽  
Wonhee Kim ◽  
Hyunggoo Kang ◽  
Jaehoon Oh ◽  
Tae Ho Lim ◽  
...  

Purpose. Rapid advanced airway management is important in maternal cardiopulmonary resuscitation (CPR). This study aimed to compare intubation performances among Pentax-AWS (AWS), Glidescope (GVL), and Macintosh laryngoscope (MCL) during mechanical chest compression in 15° and 30° left lateral tilt.Methods. In 19 emergency physicians, a prospective randomized crossover study was conducted to examine the three laryngoscopes. Primary outcomes were the intubation time and the success rate for intubation.Results. The median intubation time using AWS was shorter than that of GVL and MCL in both tilt degrees. The time to visualize the glottic view in GVL and AWS was significantly lower than that of MCL (allP<0.05), whereas there was no significant difference between the two video laryngoscopes (in 15° tilt,P=1; in 30° tilt,P=0.71). The progression of tracheal tube using AWS was faster than that of MCL and GVL in both degrees (allP<0.001). Intubations using AWS and GVL showed higher success rate than that of Macintosh laryngoscopes.Conclusions. The AWS could be an appropriate laryngoscope for airway management of pregnant women in tilt CPR considering intubation time and success rate.


2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Kurt Ruetzler ◽  
Lukasz Szarpak ◽  
Jacek Smereka ◽  
Marek Dabrowski ◽  
Szymon Bialka ◽  
...  

Introduction. Airway management plays an essential role in anaesthesia practice, during both elective and urgent surgery procedures and emergency medicine. Aim. The aim of the study was to compare Macintosh laryngoscope (MAC), McGrath, and TruView PCD in 5 separate airway management scenarios. Methods. This prospective cross-over simulation study involved 93 paramedics. All paramedics performed intubation using direct laryngoscope (MAC), McGrath, and TruView PCD video laryngoscopes. The study was performed in 5 different scenarios: (A) normal airway, (B) tongue oedema, (C) pharyngeal obstruction, (D) cervical collar stabilization with tongue oedema, and (E) cervical collar stabilization with pharyngeal obstruction. Results. In scenario A, the success rate was 99% with MAC, 100% with McGrath, and 94% with PCD. Intubation time was 17 s (IQR: 16–21) for MAC, 18 s (IQR: 16–21) for McGrath, and 27 s (IQR: 23–34) for PCD. In scenario B, the success rate was 61% with MAC, 97% with McGrath, and 97% with PCD (p<0.001). Intubation time was 44 s (IQR: 24–46) for MAC, 22 s (IQR: 20–27) for McGrath, and 39 s (IQR: 30–57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p<0.001). Intubation time was 21 s (IQR: 19–29) for MAC, 18 s (IQR: 18–24.5) for McGrath, and 30 s (IQR: 23–39) for PCD. In scenario D, the success rate with MAC was 32%, 69% with McGrath, and 58% with PCD (p<0.001). Intubation time was 26 s (IQR: 20–29) for MAC, 26 s (IQR: 20–29) for McGrath, and 45 s (IQR: 33–56) for PCD. In scenario E, the success rate with MAC was 32%, but 64% with McGrath and 62% with PCD (p<0.001). Intubation time was 28 s (IQR: 25–39) for MAC, 19 s (IQR: 18–26) for McGrath, and 34 s (IQR: 27–45) for PCD. Conclusions. The McGrath video laryngoscope proved better than Truview PCD and direct intubation with Macintosh laryngoscope in terms of success rate, duration of first intubation attempt, number of intubation attempts, Cormack-Lehane grade, percentage of glottis opening (POGO score), number of optimization manoeuvres, severity of dental compression, and ease of use.


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