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

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.

Comparison of a New Video Intubation Stylet and McGrath® MAC Video Laryngoscope for Intubation in an Airway Manikin with Normal Airway and Cervical Spine Immobilization Scenarios by Novice Personnel: A Randomized Crossover Study

The use of both a video laryngoscope and a video intubation stylet, compared with the use of a direct laryngoscope, is not only easier to learn but also associated with a higher success rate in performing endotracheal intubation for novice users. However, data comparing the two video devices used by novice personnel are rarely found in literature. Nondelayed intubation is an important condition to determine the prognosis in critically ill patients; hence, exploring intubation performance in various situations is of clinical significance. This study is aimed at comparing a video stylet and a video laryngoscope for intubation in an airway manikin with normal airway and cervical spine immobilization scenarios by novice personnel. We compared the performance of intubation by novices between the Aram Video Stylet and the McGrath® MAC video laryngoscope in an airway manikin. Thirty medical doctors with minimal experience of endotracheal intubation attempted intubation on a manikin five times with each device in each setting (normal airway and cervical spine immobilization scenarios). The order of use of the devices in each scenario was randomized for each participant. In the normal airway scenario, the Aram stylet showed a significantly higher rate of successful intubation than the McGrath® (98.7% vs. 92.0%; odds ratio (95% CI): 6.4 (1.4–29.3); p = 0.006 ). The intubation time was shorter using the Aram Stylet than that using the McGrath® video laryngoscope ( p < 0.001 ). In the cervical immobilization scenario, successful endotracheal intubation was also more frequent using the Aram stylet than with the McGrath® (96.0% vs. 87.3%; odds ratio (95% CI): 3.5 (1.3–9.0); p = 0.007 ). The Aram Stylet intubation time was shorter ( p < 0.001 ). In novice personnel, endotracheal intubation appears to be more successful and faster using the Aram Video Stylet than the McGrath® MAC video laryngoscope.

Comparison of VividTrac®, King Vision® and Macintosh laryngoscopy for normal and difficult airways during simulated cardiopulmonary resuscitation among novices

Background: Successful early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation. However, endotracheal intubation should not compromise cardiopulmonary resuscitation effectiveness and thus requires experience. The use of videolaryngoscopes might decrease the number of attempts as well as the time needed for intubation, especially among novice users. We sought to compare videolaryngoscopes with direct laryngoscopy in simulated cardiopulmonary resuscitation scenarios in mannequins by novices.Methods: Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students were asked to execute endotracheal intubation with each of the devices, including the King Vision®, the Macintosh laryngoscope and the VividTrac®, on acardiopulmonary resuscitation trainer (Ambu Man Advanced®) in normal and difficult airway scenarios. We evaluated the time to and the 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 (P < 0.05) were measured by King Vision®than by Macintosh laryngoscope. However, VividTrac® was proven to be similar (P > 0.05) to Macintosh laryngoscope in this regard in the normal airway scenario. In the difficult airway scenarios, we found VividTrac® superior (P < 0.05) to King Vision® and Macintosh laryngoscope regarding laryngoscopy times, but there were no significant differences between devices in intubation times. In both normal and difficult airway cardiopulmonary resuscitation scenarios, we noted no difference (P > 0.05) in first attempt success rates, the best view of the glottis and dental trauma, but esophageal intubation and the use of bougie were more frequent (P < 0.05) withMacintosh laryngoscopethan with videolaryngoscopes. The shortest tube insertion times were related to King Vision® in both scenarios.Conclusion: Based upon our results, King Vision®was superior to Macintosh laryngoscoperegarding intubation time in the normal airway cardiopulmonary resuscitation scenario for novice users. We noted significantly less esophageal intubationwhen using videolaryngoscopes compared to Macintosh laryngoscope in both scenarios; thus,videolaryngoscopes might be recommended for novice users for both cardiopulmonary resuscitation scenarios.

Systematic Review Comparison of Endotracheal Intubation Success Rate Using McGrath® Mac Videolaryngoscope with Direct Laryngoscope (Macintosh): A Manikin Studies

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.

Sedation and analgesia during manipulation in children

The article provides an overview of modern methods of sedation and analgesia during therapeutic and diagnostic manipulations in children, indicates indications and contraindications. Special attention is paid to the assessment of sedation and anaesthesia effectiveness, scales used for this purpose in children of different ages are described, criteria of sedation depth are given, equipment and measures necessary to ensure patient safety during manipulation are described. It has been noted that BIS index values correlate with sedation scales in children and adults, but values that determine deep sedation in children are currently not clearly defined, which requires further research. Drugs for sedation, their main characteristics and limitations for use are presented. The differences between sedation and monitored anesthesiology care (MAC), which can be provided only by a qualified anesthesiologist, are described in detail. It has been demonstrated that monitored anesthesiologic care implies deep sedation with control of vital functions, control of breathing and hemodynamics during manipulation, and it is noted that capnography is a mandatory element of monitoring in this type of anesthesiologic care in order to detect apnea as early as possible. Criteria for recovery of consciousness after completion of sedation are specified, which include normal airway, adequate ventilation, stability of hemodynamic, restoration of initial level of consciousness, motor activity and possibility to receive liquids through mouth in absence of vomiting. It is noted that the average time from the end of procedural sedation to the restoration of the original state is about 2 hours.

Learning curve and performance in simulated difficult airway for the novel C-MAC® video-stylet and C-MAC® Macintosh video laryngoscope: A prospective randomized manikin trial

Difficult airways can be managed with a range of devices, with video laryngoscopes (VLs) being the most common. The C-MAC® Video-Stylet (VS; Karl-Storz Germany), a hybrid between a flexible and a rigid intubation endoscope, has been recently introduced. The aim of this study is to investigate the performance of the VS compared to a VL (C-MAC Macintosh blade, Karl-Storz Germany) with regards to the learning curve for each device and its ability to manage a simulated difficult airway manikin. This is a single-center, prospective, randomized, crossover study involving twenty-one anesthesia residents performing intubations on a Bill 1™ (VBM, Germany) airway manikin model. After a standardized introduction, six randomized attempts with VL and VS were performed on the manikin. This was followed by intubation in a simulated difficult airway (cervical collar and inflated tongue) with both devices in a randomized fashion. The primary end-point of this study was the total time to intubation. All continuous variables were expressed as the median [interquartile range] and analyzed using the Mann-Whitney U test. A 2-way ANOVA with Bonferroni’s post hoc test was used to compare both devices at each trial. All reported p values are two sided. The median total time to intubation on a simulated difficult airway was faster with the VS compared to VL (17 [13.5–25] sec vs 23 [18.5–26.5] sec, respectively; 95% CI; P = 0.031). Additionally, on a normal airway manikin, the VS has a comparable learning curve to the VL. In this manikin-based study, the novel VS was comparable to the VL in terms of learning curve in a normal airway. In a simulated difficult airway, the total time to intubation, though likely not clinically relevant, was faster with the VS to the VL. However, given the above findings, this study justifies further human clinical trials with the VS to see if similar benefits–faster time to intubation and similar learning curve to VL–are replicated clinically.

Comparison between video-lighted stylet (Intular Scope™) and direct laryngoscope for endotracheal intubation in patients with normal airway

Objective The Intular Scope™ (Medical Park, South Korea) (IS) is a video-lighted stylet that can be used for endotracheal intubation with excellent visualization by adding a camera to its end. We compared the efficacy of a direct laryngoscope (DL) with that of the IS based on hemodynamic changes, ease of intubation, and postoperative airway morbidities. Methods Seventy patients with expected normal airways were randomized for intubation using an IS (n = 35) or DL (n = 35). The primary outcome was the mean arterial pressure during intubation. The secondary outcomes were the time to intubation (TTI), percentage of glottic opening (POGO) score, and number of intubation attempts. The incidence and severity of bleeding, hoarseness, and sore throat after intubation were also recorded. Results Hemodynamic changes during intubation were not significantly different between the groups. The TTI was longer in the IS than DL group. The POGO score was higher in the IS than DL group. Hoarseness and sore throat were significantly less severe in the IS than DL group. Conclusions Using the IS did not significantly improve hemodynamics and resulted in a longer TTI. However, the IS was associated with less severe postoperative airway morbidities compared with the DL.

Ultrasound-guided versus Shikani optical stylet-aided tracheal intubation: a prospective randomized study

Background: To compare ultrasound-guided tracheal intubation (UGTI) versus Shikani optical stylet (SOS)-aided tracheal intubation in patients with anticipated normal airway.Methods: Sixty patients aged 18-65 years old who presented for elective surgery under general anesthesia were recruited in this prospective randomized study. They were assigned into two equal groups, either an ultrasound-guided group (Group UG, n=30) or an SOS-aided group (Group SOS, n=30). After the induction of anesthesia, the tracheal intubation was performed by a specified skilled anesthesiologist. The number of tracheal intubation attempt and the duration of successful intubation on the first attempt were recorded. Complications relative to tracheal intubation including desaturation, hoarseness and sore throat were also recorded.Results: The first-attempt success rate is 93.3% (28/30) in Group UG and 90% (27/30) in Group SOS (P=0.640). The second-attempt was all successful for the 2 and 3 patients left in the two groups, and the overall success rate of both groups was 100%. The duration of successful intubation on the first attempt of Group UG was not significantly different from that of Group SOS (34.0±20.8s vs 35.5±23.2s, P=0.784). One patient in Group SOS had desaturation (P=0.313), and there was none hoarseness in the two groups. Sore throat was detected in both group (4 in Group UG, 5 in Group SOS, P= 0.718).Conclusion: Ultrasound-guided tracheal intubation was as effective as Shikani optical stylet-aided tracheal intubation in adult patients with anticipated normal airway.Trial registration: Chinese Clinical Trial Registry, ChiCTR-IIC-17010875. Date of Registration: 15 March 2017.