Efficacy of stylet angulation at the holding position during tracheal intubation with a videolaryngoscope: a randomized controlled trial

The aim of this randomized controlled trial was to determine the efficacy of stylet angulation at the holding position during tracheal intubation with a McGRATH MAC videolaryngoscope. Patients were randomized to a group for intubation without stylet angulation at the holding position (non-angulation group) and to a group for intubation with stylet angulation at the holding position (angulation group). The primary outcome was the time for placement of the tracheal tube. Sixty patients were analyzed. The mean (standard deviation) times for tube placement were 21.3 (5.6) s in the non-angulation group and 16.9 (3.8) s in the angulation group (P < 0.001). The scores of operator's perception of difficulty in tube delivery, number of attempts for tube delivery, and degrees of extension, abduction, internal rotation of the right upper arm and extension of the right wrist during tube placement in the angulation group were significantly smaller than those in the non-angulation group (P < 0.001, P = 0.002, P < 0.001, P < 0.001, P < 0.001, P < 0.001, respectively). Our results suggest that stylet angulation at the holding position improves maneuverability of the tracheal tube and enables easy, smooth, and swift tube placement during tracheal intubation with a McGRATH MAC videolaryngoscope.

Tracheal intubation skill retention using a McGRATH® MAC video laryngoscope with real-time feedback by faculty in novice first-year residents: A randomized controlled trial

BackgroundDuring endotracheal intubation training, only providing verbal guidance to students may result in inadequate recognition of the inner larynx and cause delays in mastering endotracheal intubation. Therefore, we introduced a deliberate practice approach to the education of residents in endotracheal intubation. For this purpose, a video laryngoscope was used to give the residents detailed feedback of the anesthesiology faculty. We hypothesized that if the anesthesiology faculty could provide sufficient and precise feedback of the larynx through the video monitor, the residents’ intubation skills would be retained for a more extended period.MethodsThis cluster randomized controlled study enrolled first-year residents who completed a two-month rotation at our department. Each rotation group (2–4 residents) was assigned to the Macintosh laryngoscope (ML) group or the McGRATH MAC video laryngoscope (MML) group. Endotracheal intubation skills were evaluated on a simulated mannequin immediately after the rotation, three months later, and six months later. The primary endpoint was the time required for intubation. The secondary endpoint was the percentage of glottic opening (POGO) score.ResultsForty-six residents participated in this study and were assigned to the ML group (n = 23) or the MML group (n = 23). The time required for intubation was significantly shorter in the MML group than in the ML group. The POGO score did not show any significant differences between the two groups; however, the POGO score of the MML group had a relatively narrower confidence interval than the ML group.ConclusionsWhen comparing endotracheal intubation training using the Macintosh laryngoscope and video laryngoscope, the McGRATH MAC video laryngoscope shortened the intubation procedure and facilitated long-term skill retention.Trial registrationClinical registry and trial number, URL: https://www.umin.ac.jp, UMIN000036643 date of registration: 2019/05/03, This study was retrospectively registered.

Comparison of two different shapes of stylets for intubation with the McGrath MAC® video laryngoscope: a randomized controlled trial

Objective This study was performed to compare two different shapes of stylets, 60° and J-shaped stylets, for intubation using the McGrath MAC® video laryngoscope (MVL). Methods Two hundred twenty-two patients undergoing surgery under general anesthesia were randomly allocated to Group J (n = 111) or Group 60° (n = 111) and intubated using the MVL with the stylet bent into the allocated shape. The time to intubation (TTI) and other intubating profiles were compared between the groups. Multivariate regression analysis was used to determine the relationship between factors related to difficult intubation and TTI. Results The TTI was not different between the two groups. There were also no differences in the intubating profiles between the two groups. In both groups, the TTI was longer with a modified Mallampati score (mMS) of ≥3 and percentage of glottic opening (POGO) score of <50. In Group J, the TTI was longer with a body mass index (BMI) of ≥30 kg/m2. Conclusion The TTI during tracheal intubation with the MVL was not different between the two groups. The TTI was longer with an mMS of ≥3 and POGO score of <50. In Group J, the TTI was longer with a BMI of ≥30 kg/m2.

A Case of Successful Tracheal Tube Exchange With McGrath MAC for Tube Damage During Oral Surgery

A patient undergoing a bilateral sagittal split and LeFort 1 maxillary osteotomy performed under general anesthesia required emergent intraoperative exchange of a potentially damaged nasotracheal tube. This exchange was smoothly performed under constant indirect visualization using the McGrath MAC video laryngoscopy system. After the exchange, ventilation of the patient dramatically improved. The removed endotracheal tube was torn 19 cm from the distal tip. The McGrath MAC was useful for visualizing the glottis and confirming the entire course of the tube exchange despite the patient's having a difficult airway (Cormack-Lehane grade 3).