Comparison between GlideRite® rigid stylet and Parker Flex-It™ stylet to facilitate GlideScope intubation in simulated difficult intubation: a randomized controlled study

Background: The GlideScope® videolaryngoscope (GVL) is widely used in patients with difficult airways and provides a good glottic view. However, the acute angle of the blade can make insertion and advancement of an endotracheal tube (ETT) more difficult than direct laryngoscopy, and the use of a stylet is recommended. This randomized controlled trial compared Parker Flex-It™ stylet (PFS) with GlideRite® rigid stylet (GRS) to facilitate intubation with the GVL in simulated difficult intubations. Methods: Fifty-four patients were randomly allocated to undergo GVL intubation using either GRS (GRS group) or PFS (PFS group). The total intubation time (TIT), 100-mm visual analog scale (VAS) for ease of intubation, success rate at the first attempt, use of laryngeal manipulation, tube advancement rate by assistant, and complications were recorded. Results: There was no significant difference between the GRS and PFS groups regarding TIT (50.3 ± 12.0 s in the GRS group and 57.8 ± 18.8 s in the PFS group, P = 0.108). However, intubation was more difficult in the PFS group than in the GRS group according to VAS score (P = 0.011). Cases in which the ETT was advanced from the stylet by an assistant, were more frequent in the GRS group than in the PFS group (P = 0.002). The overall incidence of possible complications was not significantly different. Conclusions: In patients with a simulated difficult airway, there was no difference in TIT using either the PFS or GRS. However, endotracheal intubation with PFS is more difficult to perform than GRS.

Effects of C-Mac Video Laryngoscope Aided Intubation Using D Blade on Incidence of Post-Operative Sore Throat

Conclusion: C-MAC video laryngoscope-aided intubations using D-blade significantly reduced the incidence and severity of POST, hoarseness of voice, and cough following orotracheal intubation as compared to use of traditional Macintosh laryngoscope. Our evidence suggests that C-MAC video laryngoscopes reduce intubation failure and make intubation easier, particularly in patients with a predicted or known difficult airway, Also, it was found, use of C-MAC video laryngoscope helps anaesthetist to improve the glottic view and reduce the number of laryngoscopies in which the glottis cannot be seen. C-MAC may serve as a standard intubation device for both routine airway management and educational Results: Our study was done in the Department of Anaesthesiology MM deemed to be university Mullana-Ambala Haryana. After approval from the competent ethical committee, Study includes 130 patients as per inclusion and exclusion criteria. Both groups were comparable with respect to demographic variables, distribution of ASA, Age, Sex, BMI, and Mallampatti grade. Percentage of patients who were intubated at the first attempt was similar among the groups. While Comparing the presence and absence of POST, cough, hoarseness of voice between the two groups. When compared with group A (Macintosh), total number of patients found having the above symptoms was found less in group B (C-MAC video laryngoscope). Keywords: Sore throat, Laryngoscope, Preoperative complications, Endotracheal intubation, C-MAC video laryngoscope, Macintosh D balde.

Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis

The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.

GlideScope® Versus C-MAC® Video Laryngoscopy in Pediatric Intubation. Does Time Matter?

Background: The emergence of video laryngoscopy in the management of pediatric airways has been invaluable as it has been known that these patients are prone to airway complications. Video laryngoscopes are proven to improve glottic view in both normal and difficult airways in pediatric patients. The time taken to intubate using these devices is inconsistent. Objectives: This study was designed to compare the time to intubate using two common video laryngoscopes, C-MAC®, and GlideScope®, aimed at pediatric patients age 3 - 12 years old. Methods: A Randomized controlled trial was conducted in 65 ASA I or II patients, aged 3 - 12 years old who underwent elective surgery using endotracheal tube. They were divided into group 1 patients who were intubated using C-MAC® video laryngoscope versus group 2 patients who were intubated with GlideScope® video laryngoscope. Laryngoscopists were all anesthetists with experience in both C-MAC® and GlideScope® intubation. Time to intubate and intubation attempts were measured. Any extra maneuver, airway complications, and laryngoscopist satisfaction scores were also recorded. Results: Total time to intubate was significantly longer in GlideScope® group than in C-MAC® group (P < 0.001). Both devices managed to achieve excellent glottic views. The first pass attempt success rate was similar between both devices. There was no difference between requirement of extra maneuvers to assist intubations. There were also no adverse events associated with all the intubations. The satisfaction score of anesthetists was comparable to each other. Conclusions: Even though intubation time using GlideScope® is longer, both devices give excellent glottic view, comparable success intubation, and anesthetists satisfaction score.

Comparison of Airtraq® Laryngoscope, Bonfils Endoscope and Fiberoptic Bronchoscope for Awake Tracheal Intubation: A Randomized, Controlled Trial

Over the last decades several indirect laryngoscopes have been developed to provide a significant better glottic view and improved the success rate in difficult intubations. Some case reports describe the use of indirect laryngoscopes for awake tracheal intubations under preserved spontaneous breathing. However, randomized clinical studies comparing indirect laryngoscopy to the standard of fiberoptic intubation under spontaneous breathing are rare. Therefore, we compared the intubation with the Airtraq® laryngoscope and the Bonfils endoscope, to the standard fiberoptic intubation in patients with an expected difficult intubation under local anesthesia and sedation. 150 patients with an expected difficult intubation were randomized to one of the three devices. All intubation attempts were performed under local anesthesia and sedation. We evaluated success rate, time for intubation and the satisfaction of anesthesiologists and patients. Fiberoptic intubation was significantly more successful (100%) than intubation with an Airtraq® laryngoscope (88%) or the Bonfils endoscope (88%). Time for intubation was quickest with the Airtraq® laryngoscope and significantly shorter than fiberoptic intubation (p=0.044). There was no difference in satisfaction of the anesthesiologists and none of the patients had a negative recall to one of the techniques. An expected difficult intubation can be managed using the Airtraq® laryngoscope or the Bonfils endoscope in 88% and shows the same satisfaction of anesthesiologists and patient. We conclude that these techniques represent an acceptable alternative for an awake tracheal intubation under sedation and preserved spontaneous breathing.

Difficult airway predictors were associated with decreased use of neuromuscular blocking agents in emergency airway management: a retrospective cohort study in Thailand

Background It is recommended that difficult airway predictors be evaluated before emergency airway management. However, little is known about how patients with difficult airway predictors are managed in emergency departments. We aimed to explore the incidence, management and outcomes of patients with difficult airway predictors in an emergency department. Methods We conducted a retrospective study using intubation data collected by a prospective registry in an academic emergency department from November 2017 to October 2018. Records with complete assessment of difficult airway predictors were included. Two categories of predictors were analyzed: predicted difficult intubation by direct laryngoscopy and predicted difficult bag-mask ventilation. The former was evaluated based on difficult external appearance, mouth opening and thyromental distance, Mallampati score, obstruction, and limited neck mobility as in the mnemonic “LEMON”. The latter was evaluated based on difficult mask sealing, obstruction or obesity, absence of teeth, advanced age and reduced pulmonary compliance as in the mnemonic “MOANS”. The incidence, management and outcomes of patients with these difficult airway predictors were explored. Results During the study period, 220 records met the inclusion criteria. At least 1 difficult airway predictor was present in 183 (83.2%) patients; 57 (25.9%) patients had at least one LEMON feature, and 178 (80.9%) had at least one MOANS feature. Among patients with at least one difficult airway predictor, both sedation and neuromuscular blocking agents were used in 105 (57.4%) encounters, only sedation was used in 65 (35.5%) encounters, and no medication was administered in 13 (7.1%) encounters. First-pass success was accomplished in 136 (74.3%) of the patients. Compared with patients without predictors, patients with positive LEMON criteria were less likely to receive neuromuscular blocking agents (OR 0.46 (95% CI 0.24–0.87), p = 0.02) after adjusting for operator experience and device used. There were no significant differences between the two groups regarding glottic view, first-pass success, or complications. The LEMON criteria poorly predicted unsuccessful first pass and glottic view. Conclusions In emergency airway management, difficult airway predictors were associated with decreased use of neuromuscular blocking agents but were not associated with glottic view, first-pass success, or complications.

A Novel Test, the Sternomental Distance Ratio, Used as a Predictor of Difficult Laryngoscopy in a Normal Population and in Thyroid Tumor Surgery Patients: A Preliminary Study

<p class="Default"><strong><span>Objective. </span></strong><span>The aim of the present preliminary study was to assess whether the sternomental distance ratio (SMDR) could be suitable as a predictor of difficult laryngoscopy, in both normal surgical patients and patients scheduled to undergo thyroid tumor surgery. </span></p><p class="Default"><strong><span>Methods. </span></strong><span>Two hundred and twenty-one consecutive adult patients (among them 122 patients with presumed normal airways and 33 patients with thyroid tumors), scheduled to undergo elective surgery under general anesthesia, were included in this study. Physical and airway characteristics, SMDR, difficult laryngoscopy (using Cormack-Lehane scale) and any kind of assisted intubation were assessed. </span></p><p class="Default"><strong><span>Results. </span></strong><span>Decreased SMDR demonstrated a strong correlation with difficult laryn­goscopy in both thyroid tumor (Kendall’s tau-b -0.578 (P=0.004) and normal patients -0.362 (P&lt;0.001). Difficult laryngoscopy was 0 at SMDR&gt;1.9 and 33% at SMDR &lt;1.55 (P&lt;0.001). The higher the SMDR was, the better the glottic view obtained. </span></p><p class="Default"><strong><span>Conclu­sions. </span></strong><span>Α SMDR&gt;1.9 indicates an easy laryngoscopy, whereas SMDR &lt;1.55 indicates a difficult one in both thyroid tumor and normal patients. SMDR is an objective test to assess difficult airway in thyroid surgery.</span></p>

The influence of a Perspex intubation box on time to intubation: a simulation-based randomised crossover study

Background: Standard personal protective equipment guidelines are insufficient to prevent contamination of healthcare workers with droplet spread during the COVID-19 crisis. The added challenge of adequate aerosol protection has led to the development of an initial prototype intubation box. The primary objective was to determine the impact of an intubation box on the mean time to completion of intubation in a simulated airway. Secondary objectives included the best laryngoscopic view, the effect of intubator seniority and mode of laryngoscopy on intubation. Methods: This was a randomised crossover study of the influence of an intubation box on mean time to completion of intubation of an airway management part-task trainer. Senior anaesthesiology staff were assigned to two groups and recordings of their attempts at intubation were analysed by two independent observers. Results: The intubation box led to a significantly longer mean time to completion of intubation of 7.6 seconds (95% CI 3.1; 12.2; p = 0.001) with direct laryngoscopy and 9.2 seconds (95% CI 3.8; 14.7; p = 0.001) with videolaryngoscopy. It did not influence best glottic view. Conclusion: We found that the use of an intubation box significantly prolonged the time to completion of intubation, but the clinical significance of the effect size is uncertain.