Evaluation of ease of intubation using C-MAC Vs Macintosh laryngoscope in patients with the application of manual inline axial stabilization - A randomized comparative study (original) (raw)
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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.
Turkish Journal of Anesthesia and Reanimation, 2014
Objective: Recently, to further enhance the potential in the management of difficult airways, the highly angulated D-Blade was added to the C-MAC system. The purpose of this study was to investigate the laryngoscopic view and intubation parameters using the new C-MAC D-Blade in comparison to the conventional C-MAC video laryngoscope and Macintosh direct laryngoscope in simulated easy and difficult airways. Methods: We recruited 26 experienced anaesthesia providers into a randomized trial. Each performed tracheal intubation of a Laerdal SimMan ® manikin with each laryngoscope in the following laryngoscopy scenarios: (1) normal airway, (2) cervical spine immobilization, and (3) tongue edema. The intubation times, success rates, number of intubation attempts, laryngoscopic views, and severity of dental compression were recorded. Results: In all scenarios, video laryngoscopes provided better laryngeal exposure than the ML and appeared to produce less dental pressure. In the cervical spine immobilization scenario, D-Blade caused less dental pressure and showed better Cormack-Lehane (CL) classes than the other devices (p<0.001). There were no differences between video laryngoscopes in success of tracheal intubation (p>0.05). The CMAC provided the most rapid intubation. The rate of failure was 19% with ML. In the tongue edema scenario, the CMAC provided the most rapid and successful intubation (p<0.001). There were no differences between video laryngoscopes in laryngoscopic views according to CL classification and dental pressure (p>0.05). The rate of failure was 46% with the ML and 7% with the D-Blade. Conclusion: The CMAC D-Blade caused less dental pressure than the conventional C-MAC and ML in the cervical immobilization scenario. The conventional CMAC performed better than the D-Blade and ML in the tongue edema scenario. These two video laryngoscopes may complement each other in various difficult airway situations.
Academia Anesthesiologica International, 2019
Background: Aim: The aim of the present study is to assess and compare the efficacy of Macintosh laryngoscope with C-MAC video laryngoscope in attenuating the hemodynamic stress responses to laryngoscopy and endotracheal intubation. Subjects and Methods: A total of 60 patients of ASA grade I or II who were admitted in the hospital for general anaesthesia were included in the study. The total number of patients was randomly divided into two groups containing 30 patients each. In one of the group the endotracheal intubation was performed using the Macintosh laryngoscope while in the other group the endotracheal intubation was performed using the C-MAC video laryngoscope. After successful completion of the intubation process the various hemodynamic parameters were constantly recorded at regular time interval for any sign of hemodynamic response among the patients post intubation. Results: Hemodynamic parameters such as systolic, diastolic and mean arterial pressures and mean heart rate were found to be significantly higher among the Macintosh laryngoscope group in comparison to the C-MAC group. However, no significant difference was observed in the percentage of oxygen saturation among the two groups. The time taken for glottis view and total time taken for intubation was found to be significantly higher among the patients intubated with Macintosh laryngoscope in comparison to C-MAC laryngoscope. The increase in the total time taken for intubation was significantly found to increase the hemodynamic response among the patients signifying the increased risk of hemodynamic complications among patients intubated with Macintosh laryngoscope. Cormack-Lehane grading was found to be higher among the patients intubated with the Macintosh laryngoscope which might have resulted in the increased intubation time among the patients intubated with Macintosh laryngoscope. The percentage of successful intubation at the first attempt was also found to be higher in the C-MAC laryngoscope group in comparison to the Macintosh group.The percentage of glottis opening (POGO) was found to increase significantly with C-MAC video laryngoscope in comparison to the Macintosh laryngoscope. Conclusion: The study concluded that video guided C-MAC laryngoscope was a better alternative to conventional Macintosh laryngoscope with decreased hemodynamic response and increased successful intubation among the patients
Alexandria Journal of Medicine, 2012
Background: Airway management is a major responsibility for anesthetist. This study was carried out to evaluate and compare the efficacy of Airtraq (AL) and Macintosh Laryngoscopes (ML) in intubating patients with cervical spine immobilization using manual inline axial stabilization technique (MIAS). Methods: This randomized controlled study was carried out in Alexandria Main University Hospital on 40 adult ASA I and II patients after written informed consent and approval of the ethical committee, randomly categorized into two equal groups. All patients were subjected to same anesthetic protocol. Group I patients were intubated using AL and group II patients were intubated using ML. Hemodynamic measurements and oxygen saturation were recorded. Intubation criteria for both groups including (duration of intubation procedure, number of attempts, number of optimization maneuvers, Cormack and Lehane grade at laryngoscopy, Intubation Difficulty Scale score (IDS), rate of successful placement of endotracheal tube, neck mobility during laryngoscopy and intubation complications were recorded. Data statistically analyzed using SPSS R software using (t and v 2 tests) and P < 0.05 considered significant.
Borneo Journal of Medical Sciences (BJMS)
Tracheal intubation is an essential skill for doctors. Tracheal intubation is done in patients with questionable airway patency, poor respiratory drive, hypercarbia, or hypoxia. The objective of this study was to compare the ease of tracheal intubation using MacintoshLaryngoscopes, C-MAC, and McGrath on a simulated difficult airway mannequin. The rationale of the study was to identify the easiest device to use for tracheal intubation. This randomized clinical trial was done at the Teluk Intan Hospital, Perak, Malaysia, from March 2020 to February 2021. Sixty-five medical officers participated in this study. The results showed that the mean time for tracheal intubation was significantly shorter when the participants were using the C-MAC than the conventional direct laryngoscope and McGrath. (C-MAC: 20.8 seconds, Direct Laryngoscope: 27.7 seconds, McGrath: 34.6 seconds) The results showed that C-MAC andMcGrath had a better first-attempt success rate than conventional direct laryngosco...
Comparison of the Macintosh and Airtraq Laryngoscopes in Endotracheal Intubation Success
Turkish Journal of Anesthesia and Reanimation, 2015
Endotracheal intubation of patients is an effective method for controlling airway and breathing. However, laryngoscopy and endotracheal intubation is not easy in every case. There is a recent abundance of equipment used for controlling ventilation and intubation. Airtraq is one of those equipments. In this study, our main objective is to compare the success rates of the Airtraq and Macintosh (direct and classic) laryngoscopes in endotracheal intubation. Methods: In this single-center, prospective, randomized, clinical study was performed on 80 patients who were operated under general anesthesia, ASA I-II, 18-65 years old. Patients were intubated using two different endotracheal intubation tools. Group A was intubated using the Macintosh (direct and classic) laryngoscope, meanwhile Group B was intubated using the Airtraq laryngoscope. Patients' snoring complaints, modified Mallampati scores, sternomental distances, thyromental distances, interincisor distance measurements and Cormack-Lehane (C-L) laryngoscopic classification, upper lip bite test results, intubation time, number of intubation attempts, maneuvers and techniques used for facilitating intubation and complications arising from intubation were recorded. Results: There was a statistically significant difference between the groups in terms of C-L scores (p=0.041). In all, 8 patients in the Macintosh group, and 2 patients in the Airtraq group were C-L grade III. In intubation of the Airtraq group, only 3 patients required facilitating techniques, meanwhile in intubation of the Macintosh group 15 patients we had to use one or more facilitating maneuver. The rate of Mallampati scoring "difficult" was 4/6 in the Macintosh and 2/11 in Airtraq laryngoscopy groups (p=0.553). Conclusion: In cases with seemingly difficult intubations, we believe the Airtraq laryngoscope has an advantage over the Macintosh laryngoscope, owing to its better view of the oropharyngeal and glottic areas in addition to facilitating intubation in patients with limited head extension.
British Journal of Anaesthesia, 2009
Background. The purpose of this study was to evaluate the effectiveness of the Pentax AWS w , and the LMA CTrach w , in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization. Methods. Ninety patients undergoing anaesthesia who required tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n¼30), LMA CTrach w (n¼30), or AWS w (n¼30) laryngoscope. All patients were intubated by one of the three anaesthetists familiar with the use of each laryngoscope. Results. The intubation difficulty scores were significantly higher with the Macintosh laryngoscope and were significantly lower with the AWS w compared with the LMA CTrach. All 30 patients were successfully intubated with the Macintosh and the AWS w device, compared with 27 patients with the LMA CTrach w. The duration of both the first and the successful tracheal intubation attempts was significantly longer with the LMA CTrach w compared with the AWS w and Macintosh laryngoscopes. A greater number of optimization manoeuvres were required to facilitate tracheal intubation with the LMA CTrach w compared with the AWS w laryngoscope. The AWS w group had a significantly better Cormack and Lehane glottic view obtained at laryngoscopy compared with both other devices. Conclusions. The AWS w laryngoscope has several advantages over the Macintosh laryngoscope, or LMA CTrach w , in patients undergoing cervical spine immobilization.
C-MAC D-blade laryngoscope: A saviour for difficult intubation in lateral position
IP Innovative Publication Pvt. Ltd., 2017
Video laryngoscopes are the latest addition in an anaesthesiologist's armamentarium. They are comparable to fiberoptic bronchoscope in terms of ease of visualization of vocal cords especially in awake intubation and in those with difficult airway. They have an added advantage of having an easier learning curve than fiberoptic bronchoscope guided intubation. There are several studies where video-laryngoscopes have been used in manikins and normal patients for intubation in both supine and lateral position successfully. Of these C-Mac D-Blade laryngoscope has an added advantage of having a blade like Macintosh with camera at the tip which gives good results. In our case report we describe an emergent scenario of successful awake nasal intubation in lateral position using C-Mac D-blade laryngoscope in a patient with documented difficult intubation.