Assessment of the Storz Video Macintosh Laryngoscope for Use in Difficult Airways: A Human Simulator Study (original) (raw)
Related papers
Academic Emergency Medicine, 2007
Introduction: A number of devices, including video laryngoscopy, are used to aid in managing difficult airways. The goal of this study was to compare timing and success of video laryngoscopy to standard laryngoscopic intubation using a simulation mannequin in normal and difficult airway scenarios. Methods: Residents and attending physicians of a PGY 2-4 emergency medicine residency program participated. A single, high-fidelity simulation mannequin was used. Each participant received an in-service on the video laryngoscope (GlideScope). Three airway settings were used: standard, decreased neck mobility, and tongue edema. Participants intubated with a Macintosh blade and video laryngoscope in each scenario, and graded the best view achieved using the Cormack-Lehane classification. Outcome measures included time to view the vocal cords, time to intubation, grading of view, and intubation success or failure. Institutional Review Board approval was obtained. Results: Fifty-two participants were enrolled. Participants successfully intubated the mannequin faster using the Macintosh blade in both the normal and neck immobility settings (9.4 seconds faster, 95% CI 3.2-15.7, P ϭ 0.004, 16.1 seconds faster, 95% CI 3.6-28.7, P ϭ 0.01). In the tongue edema setting, however, video laryngoscopy provided a better grade view of the cords, a higher success rate of viewing the cords at time of intubation (50% vs. 12%), and a higher rate of successful intubations (83% vs. 23%). The GlideScope also significantly reduced the time needed to view the cords (89 seconds reduction, 95% CI 54.4-123.7, P Ͻ 0.0001) and intubate (131.3 seconds reduction, 95% CI 99.1-163.6, P Ͻ 0.0001) for the tongue edema setting. Conclusions: In the most difficult airway case, tongue edema, the video laryngoscope provided an enhanced view of the cords using less time, increased intubation success, and decreased the time to 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.
Internal and emergency medicine, 2016
The purpose of this investigation was to investigate the association between first attempt success and intubation-related complications in the Intensive Care Unit after the widespread adoption of video laryngoscopy. We further sought to characterize and identify the predictors of complications that occur despite first attempt success. This was a prospective observational study of consecutive intubations performed with video laryngoscopy at an academic medical Intensive Care Unit. Operator, procedural, and complication data were collected. Multivariable logistic regression was used to examine the relationship between the intubation attempts and the occurrence of one or more complications. A total of 905 patients were intubated using a video laryngoscope. First attempt success occurred in 739 (81.7 %), whereas >1 attempt was needed in 166 (18.3 %). One or more complications occurred in 146 (19.8 %) of those intubated on the first attempt versus 107 (64.5 %, p < 0.001) of those r...
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Orotracheal intubation is the most common method used to secure and maintain airway. Macintosh laryngoscope is the most popular device used for intubation. Video laryngoscopy is a recent development that attempts to improve the success of tracheal intubation. Therefore, we compared Macintosh and Medan video laryngoscope during routine intubation by anaesthetists experienced with Macintosh, but novice to video laryngoscope. The aim of the study is to evaluate the laryngeal visualisation and ease of intubation with Macintosh and video laryngoscope. MATERIALS AND METHODS The study included 60 subjects of age group 18-50 years with apparently normal airway, randomly allotted in 2 groups of 30 each. The parameters like C-L grade, ease of intubation, time to intubation and number of attempts were recorded. Statistical Analysis-Statistical analysis was done by using Student's unpaired t-test and Chi-square test and p<0.05 is considered as level of significance. RESULTS Glottic visualisation assessed using Cormack-Lehane grading was significantly better with video laryngoscope (90%, Grade I views) as compared to Macintosh blade (60%, Grade I views). The ease of intubation was found to be comparable between the two. The mean time to intubation was more with video laryngoscope (33.9s) than with Macintosh laryngoscope (22.63s). CONCLUSION The video laryngoscope may not be advantageous over Macintosh laryngoscope for intubations performed in apparently normal airway in elective surgeries.
Western Journal of Emergency Medicine
Introduction: Previous studies suggest improved intubation success using video laryngoscopy (VL) vs direct laryngoscopy (DL), yet recent randomized trials have not shown clear benefit of one method over the other. These studies, however, have generally excluded difficult airways and rapid sequence intubation. In this study we looked to compare first-pass success (FPS) rates between VL and DL in adult emergency department (ED) patients with difficult airways. Methods: We conducted a secondary analysis of prospectively collected observational data in the National Emergency Airway Registry (NEAR) (January 2016–December 2018). Variables included demographics, indications, methods, medications, devices, difficult airway characteristics, success, and adverse events. We included adult ED patients intubated with VL or DL who had difficult airways identified by gestalt or anatomic predictors. We stratified VL by hyperangulated (HAVL) vs standard geometry VL (SGVL). The primary outcome was FP...
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.
Comparison of video laryngoscopes with direct laryngoscopy for tracheal intubation
European Journal of Anaesthesiology, 2011
Background Video laryngoscopes have been introduced in recent years as an alternative choice to facilitate tracheal intubation. We conducted a meta-analysis to assess their value when compared with direct laryngoscopy. Methods PubMed and EMBASE were searched up until 24 September 2010. Randomised trials that reported data on the comparison of video laryngoscopes with direct laryngoscopy for tracheal intubation were included. Results Eleven trials with a total of 1196 participants were identified. During tracheal intubation, video laryngoscopes can achieve a better view of the glottis and have a similar success rate [rate ratio 1.0; 95% confidence interval (CI) 0.99-1.01].
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
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.