Advertisement

Randomized comparison of McGrath MAC videolaryngoscope, Pentax Airway Scope, and Macintosh direct laryngoscope for nasotracheal intubation in patients with manual in-line stabilization

  • Go Un Roh
  • Hyun Jeong Kwak
  • Kyung Cheon Lee
  • Sun Young Lee
  • Jong Yeop KimEmail author
Reports of Original Investigations

Abstract

Background

The objective of this study was to determine the clinical usefulness of videolaryngoscopes (VLs) by comparing the time to intubation (TTI) and the ease of intubation of McGrath MAC VL (MVL), Pentax Airway Scope VL (PVL), and Macintosh direct laryngoscope (DL) during nasotracheal intubation using manual in-line stabilization to simulate difficult airways.

Methods

One hundred and twenty patients were randomly assigned to the MVL group (n = 40), the PVL group (n = 40), and the DL group (n = 40). Nasotracheal intubation was performed using MVL, PVL, or DL, according to group assignments. The primary outcome was TTI and secondary outcomes were glottic view, ease of intubation, and bleeding.

Results

The TTI was significantly shorter in the MVL group than in the DL group (45 sec vs 57 sec; difference in means: − 12; 95% confidence interval [CI], − 21 to − 3; P = 0.01). The percentage of glottic opening and Cormack Lehane grade were significantly superior in the MVL and the PVL groups compared with the DL group (both P < 0.001). The intubation difficulty scale and numeric rating scale regarding ease of intubation were also significantly lower in the MVL and PVL groups than in the DL group (all P < 0.007). The incidence of bleeding was significantly lower in the MVL group than in the DL group (3 vs 15, relative risk 0.2; 95% CI, 0.06 to 0.64; P = 0.001).

Conclusion

This study showed that both MVL and PVL provided better visualization of the glottis and easier intubation, with less additional manipulation than DL during nasotracheal intubation in simulated difficult airways. Additionally, use of the MVL significantly shortened the TTI compared with the DL.

Trial registration

www.clinicaltrials.gov (NCT02647606); registered 6 January, 2016.

Comparaison randomisée des vidéolaryngoscopes McGrath MAC et Pentax Airway Scope et du laryngoscope avec lame Macintosh pour l’intubation nasotrachéale chez les patients avec stabilisation manuelle en ligne

Résumé

Contexte

L’objectif de cette étude était de déterminer l’utilité clinique des vidéolaryngoscopes (VL) en comparant le temps jusqu’à intubation (TTI) et la facilité d’intubation du VL McGrath MAC (MVL), du VL Pentax Airway Scope (PVL), et du laryngoscope avec lame Macintosh (DL) pour une intubation nasotrachéale avec stabilisation manuelle en ligne simulant des voies aériennes difficiles.

Méthode

Cent vingt patients ont été aléatoirement alloués au groupe MVL (n = 40), au groupe PVL (n = 40) ou au groupe DL (n = 40). L’intubation nasotrachéale a été réalisée à l’aide du MVL, du PVL ou du DL selon l’attribution de groupe. Le critère d’évaluation principal était le TTI et les critères secondaires comprenaient la visualisation glottique, la facilité d’intubation et les saignements.

Résultats

Le TTI était significativement plus court dans le groupe MVL que dans le groupe DL (45 sec vs 57 sec; différence de moyennes : -12; intervalle de confiance [IC] 95 %, -21 à -3; P = 0,01). Le pourcentage d’ouverture glottique et le grade de Cormack et Lehane étaient significativement supérieurs dans les groupes MVL et PVL par rapport au groupe DL (P < 0,001 pour les deux). L’échelle de difficulté d’intubation et l’échelle d’évaluation numérique concernant la facilité d’intubation étaient également significativement plus basses dans les groupes MVL et PVL que dans le groupe DL (tous P < 0,007). L’incidence de saignements était significativement plus basse dans le groupe MVL que dans le groupe DL (3 vs 15, risque relatif 0,2; IC 95 %, 0,06 à 0,64; P = 0,001).

Conclusion

Cette étude a démontré que le MVL et le PVL procuraient tous deux une meilleure visualisation glottique et une intubation plus facile, avec moins de manipulations supplémentaires qu’un DL pendant l’intubation nasotrachéale de voies aériennes difficiles simulées. En outre, l’utilisation d’un MVL a significativement réduit le TTI par rapport à un DL.

Enregistrement de l’étude

www.clinicaltrials.gov (NCT02647606); enregistrée le 6 janvier 2016.

Notes

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Associate Editor, Canadian Journal of Anesthesia.

Author contributions

Go Un Roh and Jong Yeop Kim were involved in the study design, acquisition and interpretation of data, and writing of the manuscript. Hyun Jeong Kwak wrote the manuscript. Kyung Cheon Lee interpreted the data. Sun Young Lee analyzed the data.

Funding

No external funding, solely departmental source.

References

  1. 1.
    Pieters BM, Eindhoven GB, Acott C, van Zundert AA. Pioneers of laryngoscopy: indirect, direct and video laryngoscopy. Anaesth Intensive Care 2015; 43(Suppl): 4-11.CrossRefGoogle Scholar
  2. 2.
    Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management: a topical review of the literature. Acta Anaesthesiol Scand 2010; 54: 1050-61.CrossRefGoogle Scholar
  3. 3.
    Pieters BM, Wilbers NE, Huijzer M, Winkens B, van Zundert AA. Comparison of seven videolaryngoscopes with the Macintosh laryngoscope in manikins by experienced and novice personnel. Anaesthesia 2016; 71: 556-64.CrossRefGoogle Scholar
  4. 4.
    Shippey B, Ray D, McKeown D. Case series: the McGrath videolaryngoscope–an initial clinical evaluation. Can J Anesth 2007; 54: 307-13.CrossRefGoogle Scholar
  5. 5.
    Shippey B, Ray D, McKeown D. Use of the McGrath videolaryngoscope in the management of difficult and failed tracheal intubation. Br J Anaesth 2008; 100: 116-9.CrossRefGoogle Scholar
  6. 6.
    Komasawa N, Kido H, Mihara R, Minami T. Comparison of cricoid pressure effect between McGRATH(R) MAC and Pentax-AWS Airwayscope(R): a prospective randomized trials. Am J Emerg Med 2017; 35: 576-8.CrossRefGoogle Scholar
  7. 7.
    Asai T, Enomoto Y, Shimizu K, Shingu K, Okuda Y. The Pentax-AWS video-laryngoscope: the first experience in one hundred patients. Anesth Analg 2008; 106: 257-9.CrossRefGoogle Scholar
  8. 8.
    Malik MA, Maharaj CH, Harte BH, Laffey JG. Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth 2008; 101: 723-30.CrossRefGoogle Scholar
  9. 9.
    Kwak HJ, Lee SY, Lee SY, Cho SH, Kim HS, Kim JY. McGrath video laryngoscopy facilitates routine nasotracheal intubation in patients undergoing oral and maxillofacial surgery: a comparison with Macintosh laryngoscopy. J Oral Maxillofac Surg 2016; 74: 256-61.CrossRefGoogle Scholar
  10. 10.
    Suzuki A, Onodera Y, Mitamura SM, et al. Comparison of the Pentax-AWS airway scope with the Macintosh laryngoscope for nasotracheal intubation: a randomized, prospective study. J Clin Anesth 2012; 24: 561-5.CrossRefGoogle Scholar
  11. 11.
    Jones PM, Armstrong KP, Armstrong PM, et al. A comparison of Glidescope videolaryngoscopy to direct laryngoscopy for nasotracheal intubation. Anesth Analg 2008; 107: 144-8.CrossRefGoogle Scholar
  12. 12.
    Hirabayashi Y. GlideScope® videolaryngoscope facilitates nasotracheal intubation. Can J Anesth 2006; 53: 1163.CrossRefGoogle Scholar
  13. 13.
    Xue F, Zhang G, Liu J, et al. A clinical assessment of the Glidescope videolaryngoscope in nasotracheal intubation with general anesthesia. J Clin Anesth 2006; 18: 611-5.CrossRefGoogle Scholar
  14. 14.
    Taylor AM, Peck M, Launcelott S, et al. The McGrath® Series 5 videolaryngoscope vs the Macintosh laryngoscope: a randomised, controlled trial in patients with a simulated difficult airway. Anaesthesia 2013; 68: 142-7.CrossRefGoogle Scholar
  15. 15.
    Adnet F, Borron SW, Racine SX, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 1997; 87: 1290-7.CrossRefGoogle Scholar
  16. 16.
    Lili X, Zhiyong H, Jianjun S. A comparison of the GlideScope with the Macintosh laryngoscope for nasotracheal intubation in patients with ankylosing spondylitis. J Neurosurg Anesthesiol 2014; 26: 27-31.CrossRefGoogle Scholar
  17. 17.
    Asai T. Videolaryngoscopes: do they truly have roles in difficult airways? Anesthesiology 2012; 116: 515-7.CrossRefGoogle Scholar
  18. 18.
    Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev 2016; 11: CD011136.Google Scholar
  19. 19.
    Hwang SM. A good laryngeal view does not guarantee perfectly successful tracheal intubation. Korean J Anesthesiol 2016; 69: 111-2.CrossRefGoogle Scholar
  20. 20.
    Koh LK, Kong CE, Ip-Yam PC. The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population. Anaesth Intensive Care 2002; 30: 48-51.CrossRefGoogle Scholar
  21. 21.
    Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Anesthesiology 2005; 103: 429-37.CrossRefGoogle Scholar
  22. 22.
    Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Can J Anesth 2016; 63: 928-37.CrossRefGoogle Scholar
  23. 23.
    Sato Boku A, Sobue K, Kako E, et al. The usefulness of the McGrath MAC laryngoscope in comparison with Airwayscope and Macintosh laryngoscope during routine nasotracheal intubation: a randomaized controlled trial. BMC Anesthesiol 2017; 17: 160.CrossRefGoogle Scholar
  24. 24.
    Tseng KY, Lu IC, Shen YC, Lin CH, Chen PN, Cheng KI. A comparison of the video laryngoscopes with Macintosh laryngoscope for nasotracheal intubation. Asian J Anesthesiol 2017; 55: 17-21.CrossRefGoogle Scholar
  25. 25.
    Lee J, Kwak HJ, Lee JY, Chang MY, Lee SY, Kim JY. Comparison of the Pentax AirwayScope and McGrath MAC videolaryngoscope for endotracheal intubation in patients with a normal airway. Medicine (Baltimore) 2017; 96: e8713.CrossRefGoogle Scholar
  26. 26.
    Xue FS, Liu JH, Liao X, Yuan YJ. Use of cuff inflation to facilitate nasotracheal intubation with the Airway Scope. Anaesthesia 2011; 66: 754.CrossRefGoogle Scholar
  27. 27.
    Li RP, Xue FS, Wang SY. Nasotracheal intubation with airway scope. J Anesth 2016; 30: 360.CrossRefGoogle Scholar
  28. 28.
    Heath KJ. The effect of laryngoscopy of different cervical spine immobilisation techniques. Anaesthesia 1994; 49: 843-5.CrossRefGoogle Scholar
  29. 29.
    Hoshijima H, Kuratani N, Hirabayashi Y, Takeuchi R, Shiga T, Masaki E. Pentax Airway Scope® vs Macintosh laryngoscope for tracheal intubation in adult patients: a systematic review and meta-analysis. Anaesthesia 2014; 69: 911-8.CrossRefGoogle Scholar
  30. 30.
    Alhomary M, Ramadan E, Curran E, Walsh SR. Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: a systematic review and meta-analysis. Anaesthesia 2018; 73: 1151-61.Google Scholar
  31. 31.
    Piepho T, Thierbach A, Werner C. Nasotracheal intubation: look before you leap. Br J Anaesth 2005; 94: 859-60.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain Medicine, CHA Bundang Medical CenterCHA University School of Medicine, Bundang CHA General HospitalSeongnamKorea
  2. 2.Department of Anesthesiology and Pain MedicineGachon University, Gil Medical CenterIncheonKorea
  3. 3.Department of Anesthesiology and Pain MedicineAjou University School of MedicineSuwonKorea

Personalised recommendations