The Rigid Tube as an Alternative in Controlling the Problematic Airway (original) (raw)
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Pakistan Journal of Medical and Health Sciences, 2022
Introduction: The anaesthetist should protect the airways during induction, recovery and maintenance during anaesthesia. The Macintosh blade is the utmost prevalent blades with a slightly back curved that extends all the way to the tip. The McCoy blade is grounded on a normal Macintosh blade with a hinged tip and is functioned by a lever mechanism located at the handle back. Objective: This study attempts to compare McCoy and Macintosh blades to facilitate intubation for glottis imaging. Place and Duration: In the Department of Anesthesia, Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six months duration from June 2021 to November 2021. Method: The study included 70 Grade I and II ASA adults of both sexes (20 to 60 years) who endured planned surgery under GA necessitating intubation by endotracheal tube. Using a computer-generated randomization table, individuals were assigned randomly to any of the 2 groups contingent on the type of laryngoscope blades used while...
Background: Inability to view the larynx adequately during laryngoscopy is a major problem encountered during endotracheal intubation. The ability to pass an endotracheal tube under direct vision of the glottic structures is of utmost importance to the anaesthesiologist. Difficult laryngoscopy and failed intubation result in severe morbidity related to anaesthesia. This has forced the anaesthesiologists to persue their interests in developing newer gadgets to facilitate successful and safe endotracheal intubation.One of the many devices in this category is the C-MAC videolaryngoscope which is conceptually and structurally different from many other videolaryngoscopes. Rather than using blades with acute angles, like the glidescope, the CMAC incorporates a conventional Macintosh type blade, with the addition of a micro video camera on the distal portion of the blade. It carries the advantage of being used as both, direct and indirect laryngoscope Materials and Methods: In this prospective randomised controlled study, patients aged 20-60 years, of either gender, undergoing elective surgery in supine position, with general anaesthesia and endotracheal intubation, were selected with ASA physical status 1 and 2. Study was conducted over 12 months duration. Patients fulfilling the inclusion and exclusion criteria, were randomly chosen into the study group.Direct laryngoscopy (Macintosh scope) was performed with the neck collar in situ, (without applying external laryngeal pressure (BURP Maneuver). The best obtained CORMACK-LEHANE (C/L) view, modified by Yentis and Lee was identified.Immediately, laryngoscopy was performed using the C-MAC Videolaryngoscope.The two laryngoscopies were performed immediately one after the other, each taking a maximum time of 30-35 seconds. Intubation was carried out with the CMAC Videolaryngoscope, in presence of the collar The anaesthesiologist graded the subjective experience of intubation as easy (E) or difficult (D). Any situation leading to external laryngeal manipulation, more than one attempt, use of bougie etc were all categorised as 'D'. In the situation of difficulty namely inability to intubate in one attempt or inability to maintain oxygen saturation >90% with mask the neck collar was removed immediately, and patient was intubated by the conventional standard technique. Results: TIt was observed that Grade I and II were 23.3% (14/60) and grade III and IV (RESTRICTED) in 76.7% (46/60).Chi square = 16.408P< 0.001 Significant.In our study, the intubation was attempted with the cervical collar in situ, with the C-MAC Videolaryngoscope. The intubation experience was subjectively assessed as easy (E) or difficult (D). The intubation was found to be easy (E) in 73.3% cases. The remaining, 26.7% were those where intubation was not possible in the first attempt with collar, the collar was removed and the intubation was carried out by the conventional method. Conclusion:C-MAC videolaryngoscope, a new video device with original Maintosh blade design improved the glottic view in comparison to the conventional Macintosh direct laryngoscopy, for accomplishing endotracheal intubation in a simulated difficult airway setting.
Background and Aims: Securing the airway with an endotracheal tube is considered the standard of care for surgeries requiring general anaesthesia. The Macintosh laryngoscope is the most commonly used device for directly visualising the structures of the larynx and facilitating tracheal intubation. Video laryngoscopes (VLS) which work on the principles of indirect laryngoscopy is found to improve the visualisation of larynx and increase success rate with laryngoscopy and intubation in manikin studies and difficult airway scenarios. Its usefulness in routine intubations in operative settings is yet to be evaluated. Material and Methods: After institutional ethical committee approval and patient consent, eighty ASA I/II patients, aged 18 to 60 years, with normal airway, who underwent elective surgeries under general anaesthesia were included in the study. Patients were randomly allocated into two groups of 40 each, to undergo laryngoscopy and oro-tracheal intubation using either Macintosh direct laryngoscope (group D) or C MAC ® video Laryngoscope (Group V) following induction of general anaesthesia. Cormack Lehane laryngoscopy grading, number of attempts required for intubation, need for stylet, backwards upwards rightwards pressure (BURP) manoeuvre, duration of intubation, haemodynamics during laryngoscopy and intubation, and overall ease of intubation were compared. Results: Duration of intubation was more in group V in contrast to group D which was statistically significant (29.5±19.12 s Vs 12.22±9.25 s). There was also a significant increase in the usage of stylet in group V in comparison to group D (12 Vs 1). Combined usage of both BURP and Stylet was required in 8 patients of group V in contrast to one patient in group D. Conclusion: C-MAC ® Video laryngoscope though improved the Cormack and Lehane grading, its use is associated with longer time for intubation, higher combined use of stylet and BURP manoeuvres to negotiate the endotracheal tube through the vocal cords in comparison with Macintosh laryngoscope in adult patients with normal airway.
Saudi Journal of Anaesthesia, 2014
Purpose: External laryngeal manipulation (ELM) is used to get better laryngeal view during direct laryngoscopy. This study was designed to test the hypothesis that ELM done by the intubating anesthetist (laryngoscopist) offers the best laryngeal view for tracheal intubation. Materials and method: A total of 160 patients underwent different surgical procedures were included in this study. Percentage of glottic opening (POGO) score and Cormack and Lehane scale were used as outcome measures for comparison between different laryngoscopic views. Four views were described; basic laryngoscopic view and then views after ELM done by the assistant, by the laryngoscopist and fi nally by the assistant after the guidance from the laryngoscopist respectively. The last three views compared with the basic laryngoscopic view. Results: ELM done by the laryngoscopist or by the assistant after guidance from the laryngoscopist showed signifi cant improvement of Cormack grades and POGO scores compared with basic laryngoscopic view. Number of patients with Cormack grade1 increased from 39 after direct laryngoscopy to 97 and 96 patients (P < 0.001 by Fisher's exact test), after ELM done by the laryngoscopist and that done by the assistant after guidance from the anesthetist respectively. Furthermore, the number of patients with POGO scores of 100% increased from 39 after direct laryngoscopy to 78 and 61 (P < 0.01) patients after ELM done by the laryngoscopist and that done by the assistant after guidance from the anesthetist respectively. Conclusion: It appeared from this study that ELM done by the anesthetist makes the best laryngeal view for tracheal intubation.
Annals of Emergency Medicine, 2010
Study objective: Glottic visualization with video is superior to direct laryngoscopy in controlled operating room studies. However, glottic exposure with video laryngoscopy has not been evaluated in the emergency department (ED) setting, where blood, secretions, poor patient positioning, and physiologic derangement can complicate laryngoscopy. We measure the difference in glottic visualization with video versus direct laryngoscopy.
Introduction: The aim of laryngoscopy is to obtain good visualization of the vocal cords to facilitate smooth endotracheal intubation. To reduce hemodynamic response to Intubation, laryngoscope blades of different shapes have been designed and studied. We tried to evaluate efficacy of MacCoy laryngoscope blade (straight) versus conventional Mcintosh (curved) blade in providing good glottic view and reducing hemodynamic response during endotracheal intubation. Material and methods: 200 American Society of Anaesthesia grade I and II patients requiring general anaesthesia were randomly divided in two groups; Group I (macintosh blade) and group II (MacCoy blade). Laryngoscopy was done by the attending anaesthesiologist by either of the blade to intubate the trachea. The Cormac-lehane grade was obtained from anaesthesia charts maintained by anaesthesiologist at the end of the procedure. Haemodynamic parameters were also recorded at periodic intervals during the procedure. Results: When Cormack-lehane(C & L) grading was compared between two groups we found that in group I; Grade I was 36%, Grade II was 38% and Grade III was 13%. In group 2, 82% patients had C and L grading I, 18% C & L grade II and zero C&L grade III. Rise in mean arterial blood pressure following intubation was more in Macintosh group as compared to the MacCoy group which was found to be statistically significant. Conclusion: MacCoy blade provides better visualization of larynx and intubating conditions with minimal Hemodynamic response to laryngoscopy and intubation as compared to Macintosh blade.
Journal of Clinical Anesthesia, 2011
Study Objective: To assess the performance and cervical (C)-spine movement associated with laryngoscopy using the Bullard laryngoscope (BL), GlideScope videolaryngoscope (GVL), Viewmax, and Macintosh laryngoscopes during conditions of a) unrestricted and b) restricted C-spine and temporomandibular joint (TMJ) mobility. Design: Prospective, controlled, randomized, crossover study. Setting: University teaching hospital. Subjects: 21 cadavers with intact C-spine anatomy. Interventions: Each cadaver underwent to total of 8 intubation attempts to complete the intubation protocol using all four devices under unrestricted and restricted C-spine and TMJ mobility. Measurements: Laryngoscopic view was graded using the modified Cormack-Lehane system. Time to best laryngoscopic view and total time to intubation were recorded. C-spine movement was measured between McGregor's line and each vertebra from radiographs taken at baseline and at best laryngoscopic view. Main Results: During both intubating conditions, the BL achieved the highest number of modified Cormack-Lehane grade 1 and 2A laryngoscopic views as compared to the other three devices (P b 0.05) and had fewer intubation failures than the Viewmax or Macintosh laryngoscopes (P b 0.05). The GVL had superior laryngoscopic performance as compared to the Viewmax and Macintosh laryngoscopes (P b 0.05) and had fewer intubation failures than those two devices (P b 0.05). All devices except the Macintosh laryngoscope in restricted mobility achieved median times to intubation in less than ☆ 30 seconds. For both conditions, BL showed the least total absolute movement between Occiput/C1 and C3/C4 of all the devices (all P b 0.05). Most of the difference was seen at C1/C2. Conclusions: In cadavers with unrestricted and restricted C-spine mobility, the BL provided superior laryngoscopic views, comparable intubating times, and less C-spine movement than the GVL, Viewmax, or Macintosh laryngoscopes.
British Journal of Anaesthesia, 2008
Background. We studied whether laryngoscopy and tracheal intubation were easier when using the Pentax-AWS (Tokyo, Japan), a new videolaryngoscope, than when applying the Macintosh laryngoscope, during manual in-line neck stabilization. Methods. In 203 anaesthetized patients with manual in-line neck stabilization, we inserted the Pentax-AWS and a Macintosh laryngoscope, in turn, and recorded the view of the glottis and time taken to laryngoscopy. The success rate of tracheal intubation (within 120 s) and time to intubation were also recorded. Results. The view of the glottis was significantly better with the Pentax-AWS than with the Macintosh laryngoscope (P,0.001). For the Macintosh laryngoscope, the view was obscured in 22 of 203 patients (11%) (Grade 3 in 21 patients and Grade 4 in one patient), whereas for the Pentax-AWS, the glottis was always clearly seen (Grade 1). Time taken to see the glottis with the Pentax-AWS [mean (SD): 6.0 (3.1) s] was significantly shorter than with the Macintosh laryngoscope [11.0 (5.0) s] (95% CI for difference: 4-6 s). The success rate of tracheal intubation with the Pentax-AWS (all of 99 patients) was significantly higher than with the Macintosh laryngoscope (93 of 104 patients) (P¼0.001). Time taken for intubation was similar between the Macintosh laryngoscope [51 (27) s] and the Pentax-AWS [54 (14) s] (95% CI for difference: 29 to 3 s). Conclusions. In patients with stabilized neck, the Pentax-AWS provided a better view of the glottis and a higher success rate of tracheal intubation, compared with the conventional Macintosh laryngoscope.
IP Innovative Publication Pvt. Ltd., 2018
Introduction and Aims: Currently wide arrays of video laryngoscopes are available to facilitate laryngoscopy and endotracheal intubation in routine and difficult airway patients, intensive care units (ICU) and emergency settings. This study is undertaken to compare the efficacy of C-MAC and King Vision video laryngoscope for easy laryngoscopy and endotracheal intubation in patients with no predictors of difficult airway. Materials and Methods: 60 adult patients undergoing elective surgery were randomly allocated into 2 groups for intubation using either King Vision laryngoscope (KVL group) or C-MAC video laryngoscope (C-MAC group). The parameters recorded were need for external laryngeal manipulation, percentage of glottis opening (POGO score), Cormack Lehane grading, number of attempts and time taken for successful endotracheal intubation and the airway morbidity. Systolic, diastolic, mean blood pressure and heart rate were measured preoperatively and at 1 and 2 min following endotracheal intubation in both the groups. The obtained data were analysed using chi-square test and Student’s t-test using SPSS software. Results: The use of Kings Vision laryngoscope or CMAC video laryngoscope did not differ significantly with respect to good laryngoscopy and intubating conditions. But airway morbidity was significantly lower in the KVL group (10%) when compared with the C-MAC group (40%) p<0> Conclusions: The use of C-MAC or KVL provided excellent laryngoscopy and intubating conditions except for the airway morbidity and haemodynamic stability which were better with the use of KVL. Keywords: Video laryngoscopes, Endotracheal intubation, Airway morbidity, Haemodynamic changes
Journal of Experimental and Clinical Medicine, 2011
This study aims to compare Macintosh laryngoscope and Truview EVO2 video-laryngoscope with respect to the quality of glottic image, the success rate of intubation and their impact on the duration of intubation, hemodynamic responses and also related complications in patients with expected difficult intubation according to the Mallampati scoring system. Sixty patients in ASA I-II group ranging from 18-65 years of age were included in the study. Patients were randomly divided into two groups of 30 cases as group M (the group intubated with Macintosh laryngoscope) and Group V (the group intubated with Truview EVO2 video-laryngoscope). C-L (Cormack-Lehanne) score detected during intubation, duration of intubation, neck extansion needs, the success of intubation, complications, and antihypertensive requirement were recorded. Preoperatively, before induction, after induction, immediately after intubation, after intubation, 1st, 2nd, 3rd, 4th and 5 minute heart rate, systolic artesial pressure, diastolic arterial pressure, mean arterial pressure, peripheral oxygen saturation were recorded. There was a significant difference between both groups as for the quality of glottic images obtained. C-L III score was rated for 1 patient in Group M, and 10 patients in Group V (p<0.05). Duration of intubation was 23 secs in Group M, and 42 secs in Group V, respectively (p<0.05). During intubation neck extension was significantly higher in Group M (p<0.05). Bleeding complication was observed in one patient's mouth during intubation in Group M while no complications were observed in Group V (p>0.05). Number of attempts of intubation, hemodynamic parameters and need for antihypertensive showed no significant difference between the two groups (p>0.05). Truview EVO2 video-laryngoscope may be preferred to Macintosh blade laryngoscope because of better glottic and orafaringeal image acquisition in patients expected with difficult intubation and providing successful intubation in patients with contraindicated neck extension.