Successful intubation with Macintosh laryngoscope after failed intubation with  McGrath videolaryngoscope in post burn contracture of the neck

Objectives. To assess the advantages and disadvantages of videolaryngoscopy as one of methods of tracheal intubation which is being widely used as an alternative to direct laryngoscopy in anesthesiologist’s practice.Material and methods. Over 100 of tracheal intubations were conducted with the use of videolaryngoscope, along with a routine use of the direct laryngoscopy. The results of 48 intubations are discussed. 4 clinical cases are presented in this article.Results. Cormack-Lehane grade I view was obtained in 39 cases (81,3%), Cormack-Lehane grade II - in 9 patients (18,8%). First attempt intubation was performed in 43 cases (89,6%), in 4 cases intubation was successful after second attempt (8,3%), failed intubation was in 1 case (2,1%). The mean duration of successful intubation was 36,9 sec. Certain difficulties occured during intubation related with the advancement of the endotracheal tube. Technical solutions are given for some of intraprocedural conditions.Conclusions. Videolaryngoscopy is a safe and effective method of tracheal intubation. Although this method is not lacking in disadvantages it has a number of advantages, main of which is the improved larynx visualization. In our opinion, this method can not completely replace direct laryngoscopy in anesthesiolodist’s practice, but may serve as an adjuvant in case of difficult intubation.

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Modified Infant Feeding Tube as an Indigenous Endotracheal Tube in Unanticipated Congenital Subglottic Stenosis

Indonesian Journal of Anesthesiology and Reanimation ◽

10.20473/ijar.v3i12021.1-9 ◽

2021 ◽

Vol 3 (1) ◽

pp. 1

Author(s):

Rahul Gupta ◽

Rama Chatterjee ◽

Neelam Dogra ◽

Dinesh Kumar Barolia ◽

Pratibha Rathore ◽

...

Keyword(s):

Endotracheal Tube ◽

Infant Feeding ◽

Feeding Tube ◽

Subglottic Stenosis ◽

Surgical Patients ◽

Successful Intubation ◽

Failed Intubation ◽

Shunt System ◽

Emergency Airway ◽

Infant Feeding Tube

Introduction: In neonates with an unanticipated difficult airway, there is an increased probability of failed intubation even with highly trained hands while performing direct laryngoscopy. Aims: We describe our experience of using a modified infant feeding tube (IFT) as an indigenous endotracheal tube (ETT) in a series of paediatric surgical patients with congenital subglottic stenosis (SGS). Material and Methods: A retrospective study was performed in our institute from January 2018 to December 2019. ETT with modified 6 and 8 French (Fr) sized IFT’s were used. A stylet obtained from the VP shunt system was used to aid in intubation. Results: Out of 12,500 admissions in our department, there were 5 pediatric cases with SGS which were managed using modified IFT. Four were neonates and 1 infant (M:F = 2:3). Modified IFT(s) were used after failed intubation with ETT of size 2.5 mm in 4 patients (non-availability of ETT of size 2 mm), while in one neonate, even 2 mm ETT could not be negotiated due to SGS. In all the 5 children, successful intubation was finally performed with modified 8 French (Fr) IFT in 3, and with modified 6 Fr IFT in two cases. The surgical procedure was completed in 4 neonates out of 5 cases, while in one infant it was deferred due to the clinical condition of the patient and significant SGS. Conclusion: All 5 patients with SGS were managed without performing a tracheostomy. Modified IFT(s) is an effective alternative if smaller sized ETT(s) cannot be negotiated or unavailable in difficult neonatal and paediatric airway. This modified IFT as ETT has to be an important part of the emergency airway tray. It should not be considered as a replacement for routine use of standard ETT.

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Efficacy of Pentax airway scope versus Macintosh laryngoscope when used by novice personnel: A prospective randomized controlled study

Journal of International Medical Research ◽

10.1177/0300060517726229 ◽

2017 ◽

Vol 46 (1) ◽

pp. 258-271 ◽

Cited By ~ 3

Author(s):

Kyu Nam Kim ◽

Mi Ae Jeong ◽

You Na Oh ◽

Soo Yeon Kim ◽

Ji Yoon Kim

Keyword(s):

Macintosh Laryngoscope ◽

Controlled Study ◽

Successful Intubation ◽

Intubation Technique ◽

Airway Scope ◽

Direct Laryngoscope ◽

Randomized Controlled ◽

The Mean ◽

Time Required ◽

Dental Injuries

Objective To determine whether intubation education using the Pentax Airway Scope (AWS) in normal airways is more useful than direct laryngoscopy (Macintosh laryngoscope) in novice personnel. Methods Eleven intern doctors without intubation experience performed 60 sequential intubations with each device on a manikin and 10 sequential intubations in adult patients. The time required for successful intubation, percentage of glottic opening (POGO) score, number of intubation attempts, and number of dental injuries were analyzed for each intubation technique. Results The mean (standard deviation) time required for successful intubation decreased as the number of intubations increased and was significantly shorter with the Pentax AWS than direct laryngoscope [22.6 (7.3) vs. 29.6 (10.0) and 33.0 (8.0) vs. 44.7 (5.6) s, respectively] in both the manikin and clinical studies. The Pentax AWS was also associated with higher POGO scores than the direct laryngoscope [81.7 (8.9) vs. 55.1 (13.2) and 80.9 (9.7) vs. 49.6 (16.5), respectively] and fewer intubation attempts. Fewer dental injuries occurred with the Pentax AWS in the manikin study. Conclusions Novices performed intubation more rapidly and easily with an improved laryngeal view using the Pentax AWS. We suggest that intubation education with video laryngoscopy should be mandatory along with direct laryngoscope training.

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Comparison of VividTrac, King Vision and Macintosh laryngoscopes in normal and difficult airways during simulated cardiopulmonary resuscitation among novices

PLoS ONE ◽

10.1371/journal.pone.0260140 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260140

Author(s):

Dóra Keresztes ◽

Ákos Mérei ◽

Martin Rozanovic ◽

Edina Nagy ◽

Zoltán Kovács-Ábrahám ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Difficult Airway ◽

Success Rate ◽

Endotracheal Intubation ◽

Macintosh Laryngoscope ◽

Dental Trauma ◽

Esophageal Intubation ◽

Successful Intubation ◽

Normal Airway ◽

Novice Users

Introduction Early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation, although cardiopulmonary resuscitation is initially carried out by personnel with limited experience in a significant proportion of cases. Videolaryngoscopes might decrease the number of attempts and time needed, especially among novices. We sought to compare videolaryngoscopes with direct laryngoscopes in simulated cardiopulmonary resuscitation scenarios. Materials and methods Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students executed endotracheal intubation with the King Vision®, Macintosh and VividTrac® laryngoscopes, on a cardiopulmonary resuscitation trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction. Results In the normal airway scenario, significantly shorter intubation times were achieved using the King Vision® than the Macintosh laryngoscope. In the difficult airway scenario, we found that the VividTrac® was superior to the King Vision® and Macintosh laryngoscopes in the laryngoscopy time. In both scenarios, we noted no difference in the first-attempt success rate, but the best view of the glottis and dental trauma, esophageal intubation and bougie use were more frequent with the Macintosh laryngoscope than with the videolaryngoscopes. The shortest tube insertion times were achieved using the King Vision® in both scenarios. Conclusion All providers achieved successful intubation within three attempts, but we found no device superior in any of our scenarios regarding the first-attempt success rate. The King Vision® was superior to the Macintosh laryngoscope in the intubation time in the normal airway scenario and noninferior in the difficult airway scenario for novice users. We noted significantly less esophageal intubation using the videolaryngoscopes than using the Macintosh laryngoscope in both scenarios. Based on our results, the KingVision® might be recommended over the VividTrac® and Macintosh laryngoscopes for further evaluation.

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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 ◽

10.1136/bmjopen-2017-016907 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016907 ◽

Cited By ~ 1

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.

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Fifteen-minute consultation: Intubation of the critically ill child presenting to the emergency department

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2021-322520 ◽

2021 ◽

pp. edpract-2021-322520

Author(s):

Constantinos Kanaris ◽

Peter Croston Murphy

Keyword(s):

Emergency Department ◽

Critically Ill ◽

Critically Ill Children ◽

Successful Intubation ◽

Patient Harm ◽

Failed Intubation ◽

Drug Choice ◽

Critically Ill Child ◽

Adequate Oxygenation ◽

Selection Of

Intubation of critically ill children presenting to the emergency department is a high-risk procedure. Our article aims to offer a step-by-step guide as to how to plan and execute a rapid, successful intubation in a way that minimises risk of adverse events and patient harm. We address considerations such as the need for adequate resuscitation before intubation and selection of equipment and personnel. We also discuss drug choice for induction and peri-intubation instability, difficult airway considerations as well as postintubation care. Focus is also given on the value of preintubation checklists, both in terms of equipment selection and in the context of staff role designation and intubation plan clarity. Finally, in cases of failed intubation, we recommend the application of the Vortex approach, highlighting, thus, the importance of avoiding task fixation and maintaining our focus on what matters most: adequate oxygenation.

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