Is Duration of Endotracheal Tube Intubation Using a Video Laryngoscope Different with a Direct Laryngoscope in Elective Surgery Patients During Pandemic Covid-19?

Introduction: Aerosol box is a usefull tools to prevent aerosol and droplet contaminations during laryngoscopy and intubation in COVID-19 pandemic. Video laryngoscope is recommended during this era to increase the operator and patient’s distance during the procedure. However, many anesthesiologists still use direct laryngoscopes due to their availability and familiarity. This study aims to compare endotracheal tube intubation with video laryngoscope compared to direct laryngoscope in elective surgery patients. Methods: This study was a quasi-experimental study. The sample size in each group (video and direct laryngoscope) was 35 subjects. The primary outcome of this study was to compare the duration of intubation between video laryngoscope and direct laryngoscope, while the secondary outcome was to evaluate complications such as broken teeth and sore throat 24 hours post intubation. Results: Direct laryngoscope had shorter intubation duration than video laryngoscope [12.3 (8.9-21.0) vs 13.3 (11.4 – 21.6; p =0.07) respectively. Two complication reported on video laryngoscope groups. Conclusion: Duration of ETT intubation using a direct laryngoscope was shorter during intubation with aerosol box compared to video laryngoscope in elective surgery patients. The box which was being used may limit the space of movement making it difficult to intubate.

Efficacy of RAMA Mobile Video Laryngoscope (RAMA-mVL) Versus McGrath® for Tracheal Intubation in Manikin. A Randomized Study

Background: Video laryngoscope (VL) has increased the success rate of intubation but the commercial VL is unaffordable for community hospitals. Therefore, Ramathibodi mobile VL (RAMA-mVL) was invented to close the gap and expected that it would be equivalent to the current device and lower price.Objective: To determine the effectiveness of intubation, compare by using RAMA-mVL and McGrath®Methods: The randomized, single-blinded study of the success intubation between RAMA-mVL and McGrath® was conducted in a manikin. Medical personnel with intubation experiences was included and trained before performing the procedure. The success rate for one best shot of intubation, time to intubation, satisfaction, and value between both VL were recorded and analyzedResults: A total of 208 persons entered the research, 104 in each group. The success rate for intubation by using both VL is 100%. The mean of time to intubation using RAMA-mVL was significantly less than that of McGrath®, which were 9.12 (±4.28) and 11.19 (±5.04) seconds, respectively (95% CI 0.001 - 0.9, P = .002). The satisfaction with innovation that is easy to build between RAMA-mVL and McGrath® was 4.88 (±0.32) and 4.23 (±0.96) points (95% CI 0.46 - 0.85, P < .001). Additionally, the cost of RAMA-mVL was cheaper than McGrath®.Conclusions: RAMA-mVL performed equivalent and even better than McGrath® compared by intubation success rate, mean intubation time, satisfaction, and cost-effectiveness.

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.

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.

Difficult Airway Management in Pediatric with a Large Cystic Hygroma Colli Undergoing One-Stage Excision Surgery

Background: A large cystic hygroma colli is a complicating factor in airway management in pediatric. Proper preparation, planning, and anticipation can reduce the risk of complications, morbidity, and mortality during difficult airway management. The fundamental principle of difficult airway management is to maintain adequate oxygenation and avoid hypoxemia by maintaining spontaneous ventilation. Case: A 22-month-old girl, weighing 9 kg, diagnosed with a large cystic hygroma colli who underwent single-stage excision surgery. Cystic hygroma was experienced since birth and with age, the cysts enlarge to a size of 25 x 17 x 12 cm which extends towards the face and shoulders. The patient did not experience stridor and symptoms of airway obstruction. The chest x-ray reveals no expansion of the cyst into the chest cavity and showed minimal tracheal deviation to the right. The difficult airway management was accomplished while maintaining the patient's spontaneous breathing. Sedation and analgesia obtained with intravenous administration of dexmedetomidine, ketamine, and nebulized lidocaine. A video laryngoscope is used to facilitate intubation. Awake extubation was performed after confirming that there was no risk of complications of laryngeal edema, laryngeal nerve injury, and tracheomalacia using a cuff-leak test. Conclusion: Maintaining spontaneous breathing, optimal levels of sedation and analgesia by administering dexmedetomidine, ketamine, and nebulizing lidocaine, and the use of a video laryngoscope can provide successful management of difficult airways due to a large cystic hygroma colli in pediatric patients.