scholarly journals Effectivity battle between C-MAC and McGrath® video laryngoscope in a patient with general anesthesia at Sanglah Hospital: A pilot study

2021 ◽  
Vol 4 (2) ◽  
pp. 47-50
Author(s):  
Jhoni Pardomuan Pasaribu ◽  
Tjokorda Gde Agung Senapathi ◽  
Pontisomaya Parami
Keyword(s):  
Pilot Study ◽  
Tracheal Intubation ◽  
General Anesthesia ◽  
Video Laryngoscope ◽  
Hemodynamic Change ◽  
Successful Intubation ◽  
Success Rates ◽  
Physical Status ◽  
Hemodynamic Stability ◽  
Pros And Cons

Background: Intubation is a common essential procedure to maintain the airway during general anesthesia. Various video laryngoscopes (VL) on the market today assist anesthesiologists in improving intubation success rates and also in complicated airway cases. There are two types of VL found in our institution, which are C-MAC and McGrath®. Each of them has its pros and cons, which withdrawn our curiosity to compare their effectiveness.  Methods: A pilot study was conducted in our center; we included all patients undergoing general anesthesia with physical status ASA I-III and consent to the study and divide them into two groups, C-MAC and McGrath®. We compare C-MAC and McGrath® VL effectiveness in terms of time for intubation, ease of intubation, total attempt, failure to intubate, Cormack Lehane degree, POGO Score, and hemodynamic stability.  Results: A total of 20 patients were intubated with two different VL, ten patients for each group. Both VLs accommodate ease of intubation, and overall first attempt successful intubation, though C-MAC showed better laryngeal and glottic visualization, shorter tracheal intubation times, and less hemodynamic change. Conclusion: C-MAC gives better results in laryngeal and glottic visualization, shorter tracheal intubation times, and less hemodynamic change.

scholarly journals Comparison of three types of intubation stylets for tracheal intubation with a McGrath MAC® video laryngoscope by novice intubators in simulated cervical immobilisation: A randomised crossover manikin study

2018 ◽  
Vol 25 (1) ◽  
pp. 27-32
Author(s):  
Sung-Wook Kim ◽  
Ji-Hoon Kim ◽  
Young-Min Kim ◽  
Jung Taek Park ◽  
Seung Pill Choi
Keyword(s):  
Tracheal Intubation ◽  
Dental Trauma ◽  
Video Laryngoscope ◽  
Trauma Patients ◽  
Successful Intubation ◽  
Success Rates ◽  
Manikin Study ◽  
Mcgrath Mac ◽  
Rigid Stylet ◽  
Post Hoc

Introduction: Tracheal intubation using video laryngoscopes has been a better approach for trauma patients requiring cervical immobilisation. The aim of this study was to compare the time to successful intubation by novice intubators using three types of intubation stylets with the new McGrath MAC video laryngoscope in a manikin model. Methods: This was a randomised crossover manikin study. The participants performed tracheal intubations using three intubation stylets (arcuate shape malleable stylet, McGrath MAC-shaped malleable stylet and McGrath MAC-shaped rigid stylet) in a difficult airway model with cervical immobilisation. The order of the stylets was randomised. The primary outcome was the time to successful intubation. The secondary outcomes were the overall success rates, incidence of dental trauma and ease of intubation. All intubation attempts were assessed by trained assistants. The data were analysed using a multilevel model followed by Tukey’s post hoc test. Results: A total of 68 nurses participated in this study. The time to successful intubation of the McGrath MAC-shaped malleable stylet was significantly shorter than that of the arcuate shape malleable stylet (24.5 (18.0–51.0) s vs 31.5 (21.0–89.0) s, p = 0.005). The overall success rate of the McGrath MAC-shaped malleable stylet was also higher than that of the arcuate shape malleable stylet ( p = 0.047). The participants indicated that intubation was easier using the McGrath MAC-shaped malleable stylet compared with the other stylets. Conclusion: The McGrath MAC-shaped malleable stylet, when used by novice intubators, may be an optimal stylet shape for tracheal intubation using the McGrath MAC in cervical immobilisation.

A COMPARISON OF EFFECT OF NEBULISED KETAMINE AND NEBULISED MAGNESIUM SULPHATE IN REDUCTION OF INCIDENCE AND SEVERITY OF POSTOPERATIVE SORE THROAT - A PROSPECTIVE RANDOMIZED DOUBLE BLINDED STUDY

2021 ◽  
pp. 38-40
Author(s):  
M. Selvi Annie Geeta ◽  
M. Ramesh Ram
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Sore Throat ◽  
Magnesium Sulphate ◽  
Success Rates ◽  
Postoperative Sore Throat ◽  
It Effectiveness ◽  
Duration Of Surgery ◽  
The Mean ◽  
Group B

Introduction: Postoperative sore throat (POST) is a common occurrence following general anesthesia with endotracheal intubation. The incidence of POST is estimated to be 21%-65% in various studies. Irritation and inammation of the air way are considered to be the cause of POST. Although considered a minor and self limiting complication, it may cause a signicant patient morbidity, dissatisfaction and increased the length of duration of hospital stay. Various pharmacological and non pharmacological methods have been tried to decrease POST with varying success rates. Among the interventions, the use of ketamine gargle or lozenges has highest success rates, but the problem with this is the bitter taste of the drug and the risk of aspiration, so aerosol route of drug administration gained popularity among the anesthesiologists with good acceptance from the patients. It is known that N-methyl-D-aspartate (NMDA) receptors have a role in nociception and inammation. Hence, this study is aimed at using the aerosol route of magnesium sulphate and ketamine and to nd it effectiveness in preventing POST. Aim Of The Study: To evaluate the effect of nebulized ketamine and nebulized magnesium sulphate for attenuation of postoperative sore throat in patients undergoing surgeries under general anesthesia with tracheal intubation. Materials And Methods: This study was done in the Department of Anesthesiology in collaboration with the Department of Surgery in Kanyakumari Government Medical College from January 2019 to December 2019. Patient planned for surgery under general anesthesia except head, neck & ENT surgeries were selected and randomized into two groups (35 each). Each group received nebulisation for 15 min before induction of general anaesthesia. Group M: Nebulization with 500mg magnesium sulphate in 5ml NS. Group K: Nebulization with 50mg ketamine in 5ml NS. The Parameters related to the study such as duration of laryngoscopy, time taken to intubate, duration of surgery, number of attempts to intubate were recorded. Incidence and severity of sore throat were assessed by four point scale. Incidence of sore throat is assessed for 24 hours. Complication were recorded. Results: We found that the demographic parameters were comparable and statistically insignicant. The mean duration of laryngoscopy difference between the two groups Group M - 24.54± 1.12 seconds and Group K - 24.49 ±1.15 seconds was not statistically signicant P= 0.834 (P>0.05). The mean time taken to intubate in Group M - 27.54± 1.12 seconds and Group K - 27.54± 1.12 seconds was not statistically signicant with P=1.000 respectively (P>0.05). The mean duration of surgery in Group M - 90.71±15.67 minutes and the Group K - 88.20 ±16.53 minutes between the two groups was not statistically signicant P= 0.516 (P>0.05). The mean difference of number of attempts taken to intubate between the two groups was statistically insignicant P=0.771 (P>0.05). The overall incidence of sore throat in Group M was 91% and in Group B was 34%. The severity of sore throat between Group M and Group K is statistically signicant at 2, 4, 6 hrs at grade 1 and grade 2. Conclusion: On the basis of our result, we can suggest that the use of perioperative ketamine nebulization when compared magnesium sulphate nebulization reduces the incidence and severity of post-operative sore throat at 4th and 6th hour during postoperative period in patients who had received general anesthesia with tracheal intubation.

Intubating Through Supraglottic Airway Devices: A Narrative Review

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Say Yang Ong ◽  
Vanessa Moll ◽  
Berthold Moser ◽  
Amit Prabhakar ◽  
Elyse M. Cornett ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Airway Device ◽  
Narrative Review ◽  
Supraglottic Airway ◽  
Successful Intubation ◽  
Success Rates ◽  
Supraglottic Airway Device ◽  
Supraglottic Airway Devices ◽  
Consistent Performance

Implication Statement: Despite the increasing popularity of video laryngoscopes, the supraglottic airway device (SAD) remains a critical airway rescue tool. The SAD provides a conduit for tracheal intubation in failed laryngoscopy. This article aims to help the operator: (1) select an intubating SAD with consistent performance; (2) inform the appropriate SAD-endotracheal tube pairings; and (3) explain various SAD and endotracheal tube maneuvers available to increase chances of successful intubation. Objectives: The first supraglottic airway device (SAD) was introduced more than thirty years ago. Since then, SADs have undergone multiple iterations and improvements. The SAD remains an airway rescue device for ventilation and an intubation conduit on difficult airway algorithms. Data Sources: Several SADs are specifically designed to facilitate tracheal intubation, i.e., “intubating SADs,” while most are “non-intubating SADs.” The two most commonly reported tracheal intubation methods via the SADs are the blind and visualized passage of the endotracheal tube (ETT) preloaded on a fiberoptic scope. Fiberoptic guided tracheal intubation (FOI) via an intubating SAD generally has higher success rates than blind intubations and is thus preferred. However, fiberscopes might not always be readily available, and anesthesiologists should be skilled to successfully intubate blindly through a SAD. Summery: This narrative review describes intubating SAD with consistent performance, appropriate SAD-ETT pairings, and various SAD and ETT maneuvers to increase successful intubation chances.

scholarly journals Comparative Effectiveness of the C-MAC Video Laryngoscope versus  Direct Laryngoscopy in the Setting of the Predicted Difficult Airway

2012 ◽  
Vol 116 (3) ◽  
pp. 629-636 ◽  
Author(s):  
Michael F. Aziz ◽  
Dawn Dillman ◽  
Rongwei Fu ◽  
Ansgar M. Brambrink
Keyword(s):  
Tracheal Intubation ◽  
Difficult Airway ◽  
Difficult Intubation ◽  
Direct Laryngoscopy ◽  
Controlled Trial ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Success Rates ◽  
Intubation Success ◽  
Intubation Success Rate

Background Video laryngoscopy may be useful in the setting of the difficult airway, but it remains unclear if intubation success is improved in routine difficult airway management. This study compared success rates for tracheal intubation with the C-MAC® video laryngoscope (Karl Storz, Tuttlingen, Germany) with conventional direct laryngoscopy in patients with predicted difficult airway. Methods We conducted a two arm, single-blinded randomized controlled trial that involved 300 patients. Inclusion required at least one of four predictors of difficult intubation. The primary outcome was successful tracheal intubation on first attempt. Results The use of video laryngoscopy resulted in more successful intubations on first attempt (138/149; 93%) as compared with direct laryngoscopy (124/147; 84%), P = 0.026. Cormack-Lehane laryngeal view was graded I or II in 139/149 of C-MAC attempts versus 119/147 in direct laryngoscopy attempts (P < 0.01). Laryngoscopy time averaged 46 s (95% CI, 40-51) for the C-MAC group and was shorter in the direct laryngoscopy group, 33 s (95% CI, 29-36), P < 0.001. The use of a gum-elastic bougie and/or external laryngeal manipulation were required less often in the C-MAC intubations (24%, 33/138) compared with direct laryngoscopy (37%, 46/124, P = 0.020). The incidence of complications was not significantly different between the C-MAC (20%, 27/138) versus direct laryngoscopy (13%, 16/124, P = 0.146). Conclusion A diverse group of anesthesia providers achieved a higher intubation success rate on first attempt with the C-MAC in a broad range of patients with predictors of difficult intubation. C-MAC laryngoscopy seems to be a useful technique for the initial approach to a potentially difficult airway.

scholarly journals Evaluation of the McGrath MAC and Macintosh laryngoscope for tracheal intubation in 2000 patients undergoing general anaesthesia: the randomised multicentre EMMA trial study protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016907 ◽  
Author(s):  
Marc Kriege ◽  
Christian Alflen ◽  
Irene Tzanova ◽  
Irene Schmidtmann ◽  
Tim Piepho ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Case Reports ◽  
Controlled Trial ◽  
Macintosh Laryngoscope ◽  
Video Laryngoscope ◽  
Successful Intubation ◽  
First Choice ◽  
Mcgrath Mac ◽  
First Pass

IntroductionThe direct laryngoscopy technique using a Macintosh blade is the first choice globally for most anaesthetists. In case of an unanticipated difficult airway, the complication rate increases with the number of intubation attempts. Recently, McGrath MAC (McGrath) video laryngoscopy has become a widely accepted method for securing an airway by tracheal intubation because it allows the visualisation of the glottis without a direct line of sight. Several studies and case reports have highlighted the benefit of the video laryngoscope in the visualisation of the glottis and found it to be superior in difficult intubation situations. The aim of this study was to compare the first-pass intubation success rate using the (McGrath) video laryngoscope compared with conventional direct laryngoscopy in surgical patients.Methods and analysisThe EMMA trial is a multicentre, open-label, patient-blinded, randomised controlled trial. Consecutive patients requiring tracheal intubation are randomly allocated to either the McGrath video laryngoscope or direct laryngoscopy using the Macintosh laryngoscope. The expected rate of successful first-pass intubation is 95% in the McGrath group and 90% in the Macintosh group. Each group must include a total of 1000 patients to achieve 96% power for detecting a difference at the 5% significance level. Successful intubation with the first attempt is the primary endpoint. The secondary endpoints are the time to intubation, attempts for successful intubation, the necessity of alternatives, visualisation of the glottis using the Cormack & Lehane score and percentage of glottic opening score and definite complications.Ethics and disseminationThe project was approved by the local ethics committee of the Medical Association of the Rhineland Palatine state and Westphalia-Lippe. The results of this study will be made available in the form of manuscripts for publication and presentations at national and international meetings.Trial registration numberClinicalTrials.gov NCT 02611986; pre-results.

Wheezing during Induction of General Anesthesia in Patients with and without Asthma 

1995 ◽  
Vol 82 (5) ◽  
pp. 1111-1116 ◽  
Author(s):  
Reuven Pizov ◽  
Robert H. Brown ◽  
Yuval S. Weiss ◽  
Dimitry Baranov ◽  
Hans Hennes ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
General Anesthesia ◽  
Physical Status ◽  
Inhalational Anesthesia ◽  
Exact Test ◽  
Asthmatic Patients ◽  
Anesthetic Agents ◽  
Increased Risk ◽  
Chi Squared ◽  
Double Blinded

Background Patients with asthma who require general anesthesia and tracheal intubation are at increased risk for the development of bronchospasm during induction. The incidence of wheezing during induction with different intravenously administered agents is unknown. A randomized, double-blinded prospective study was undertaken to evaluate the incidence of wheezing in asymptomatic asthmatic and nonasthmatic patients receiving three commonly used intravenous anesthetic agents for induction of anesthesia. Methods Fifty-nine asymptomatic asthmatic and 96 nonasthmatic patients of ASA physical status 1 and 2 were studied. All patients received 1.5 micrograms/kg fentanyl, oxygen, followed by either 5 mg/kg thiopental or thiamylal, 1.75 mg/kg methohexital or 2.5 mg/kg propofol, 1.5 mg/kg succinylcholine, tracheal intubation, and inhalational anesthesia. Wheezing was assessed by an independent blinded observer, auscultating the lungs at 2 and 5 min postintubation. Data were analyzed by Pearson's chi-squared, Fisher's exact test, and multiple logistic regression with significance set at P < 0.05. Results Both asthmatic and nonasthmatic patients who received a thiobarbiturate for induction had a greater incidence of wheezing than did patients receiving propofol. In asthmatic patients, 45% (23, 67) (mean and 95% confidence interval) who received a thiobarbiturate, 26% (8, 44) who received an oxybarbiturate, and none (0, 17) who received propofol wheezed after intubation. In nonasthmatic patients, 16% (3, 28) who received thiobarbiturate and 3% (0, 9) who received propofol wheezed. Conclusions This study suggests that propofol should be considered for induction of anesthesia in patients, particularly those with asthma, who require timely intubation.

scholarly journals A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods

2021 ◽  
Author(s):  
Ji Youn Oh ◽  
Ji Hye Lee ◽  
Yu Yil Kim ◽  
Seung Min Baek ◽  
Da Wa Jung ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Comparative Study ◽  
Prospective Study ◽  
General Anesthesia ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Lehane Grade ◽  
Significant Difference ◽  
Blade Tip ◽  
The Difference

Background: The direct entry of the camera under the epiglottis may provide a better view of the glottis than the indirect lifting of the epiglottis by placing the Macintosh blade tip on the vallecula when using the video laryngoscope. This study aimed to compare the efficiency of two different methods of lifting the epiglottis during the visualization of glottis using video laryngoscopy in the same patient.Methods: This prospective study enrolled 60 patients who underwent general anesthesia with tracheal intubation. In each patient, glottic views were obtained by directly (group DE) and indirectly lifting the epiglottis (group IE). These two methods were compared using the modified Cormack and Lehane grade and the percentage of glottis opening (POGO) score as assessment parameters.Results: Modified Cormack and Lehane grade showed significant difference between the groups DE and IE (P = 0.004). The difference in the POGO score between the groups DE and IE was also statistically significant (87.5% and 64.4%, respectively; P < 0.001).Conclusions: Our results, therefore, revealed that the method of directly lifting epiglottis was better at exposing glottis than the method of indirectly lifting epiglottis using a video laryngoscope.

scholarly journals Comparison of Standard Polyvinyl Chloride Tracheal Tubes and Straight Reinforced Tracheal Tubes for Tracheal Intubation through Different Sizes of the Airtraq Laryngoscope in Anesthetized and Paralyzed Patients

2009 ◽  
Vol 111 (6) ◽  
pp. 1265-1270 ◽  
Author(s):  
Vassilios K. Dimitriou ◽  
Ioannis D. Zogogiannis ◽  
Amalia K. Douma ◽  
Nikolaos D. Pentilas ◽  
Despoina G. Liotiri ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Polyvinyl Chloride ◽  
Odds Ratio ◽  
Successful Intubation ◽  
Success Rates ◽  
Tube Size ◽  
Straight Wire ◽  
Intubation Success ◽  
Intubation Success Rate ◽  
Tube Type

Background The authors compared the intubation success rate of straight reinforced tracheal tubes emerging from the Airtraq laryngoscope (Prodol Meditec S.A., Vizcaya, Spain) with standard preformed polyvinyl chloride tracheal tubes in anesthetized patients. Methods The authors randomly allocated 347 adult patients to be intubated with standard polyvinyl chloride tracheal tubes, standard straight wire-reinforced tracheal tubes, or silicone straight wire-reinforced tubes, through either the larger or the smaller adult laryngoscope sizes. The possible influence of laryngoscope size, tube size, and tube type on intubation failure was examined. Results Success rates were 100% for polyvinyl chloride tracheal tubes, 78.5% for standard wire-reinforced tracheal tubes, and 75.4% for silicone wire-reinforced tubes (P &lt; 0.01). Compared with the former, patients in the straight standard and silicone wire-reinforced tube groups required more optimization maneuvers (4.1% vs. 42.1%; P &lt; 0.01) and more attempts at successful intubation (0% vs. 7.3%; P &lt; 0.01). The angle created by the tube emerging from the Airtraq guiding channel was inversely correlated to the ratio of the endotracheal tube OD to the width of the channel in the standard and silicone wire-reinforced tube groups (r = -0.95 and r = -0.82, respectively; P &lt; 0.01). Finally, a decrease in 0.1 of the above ratio was associated with a 3.1 (95% confidence interval, 1.9-5.2; P &lt; 0.01) times increase in the odds ratio of intubation failure. Conclusions Standard polyvinyl chloride tracheal tubes were found to be superior compared with standard and silicone straight wire-reinforced tubes for intubation through the Airtraq laryngoscope. In the latter groups, a decrease of the ratio of their OD to the width of the Airtraq guiding channel resulted in increased intubation failure.

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