A comparison of the Macintosh laryngoscope, McGrath video laryngoscope, and Pentax Airway Scope in paediatric nasotracheal intubation

Abstract

We evaluated the performance of the McGrath video laryngoscope and Pentax Airway Scope in comparison with the Macintosh laryngoscope for nasotracheal intubation in paediatric patients. For this, 108 patients were enrolled in an open-label, randomized controlled trial. Patients were randomly allocated to one of three groups based on use of the Macintosh laryngoscope, McGrath video laryngoscope, or Pentax Airway Scope. Time to intubation, the intubation difficulty, and the quality of navigation were compared among groups. The median nasotracheal intubation time [interquartile range] in the Macintosh group (33.5 [28.3–39.8] s) was significantly shorter than those of the McGrath (39.0 [32.0–43.0] s) and Pentax groups (43.0 [35.0–52.0] s). The difficulty of nasotracheal intubation was similar among all groups. When navigating and aligning the tube from the oropharynx into the glottic inlet, the cuff inflation method was required in significantly fewer patients for the Macintosh group (11.1%) than for the McGrath (48.6%) and Pentax (51.4%) groups. Thus, compared to the McGrath video laryngoscope and Pentax Airway Scope, the Macintosh laryngoscope allowed shorter nasotracheal intubation times and better facilitated tracheal navigation, requiring less use of the cuff inflation method to navigate the tracheal tube into the glottic inlet.

Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis

“…A further 202 studies were excluded for the following reasons: non-RCT (n = 56), manikin study (n = 41), case report (n = 33), review or meta-analysis (n = 22), different outcomes (n = 16), use of a flexible fiberscope (n = 11), use of a laryngeal mask (n = 7), observational study design (n = 7), adult patients (n = 4), guidelines (n = 3), and resuscitation research (n = 3). The remaining 34 articles met the inclusion criteria and contained the data necessary for the planned analysis ( Figure S3 ) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

“…Patients included in these studies were aged 0 to 10 years. Based on pre-intubation airway assessment, 26 of 34 studies included patients with a normal airway [ 15 , 16 , 17 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 46 , 47 ], and 3 included patients with a difficult airway [ 35 , 36 , 45 ]. Five studies did not provide information on airway status [ 18 , 19 , 21 , 34 , 44 ].…”

<p>A comparison of McGrath MAC, Pentax AWS, and Macintosh direct laryngoscopes for nasotracheal intubation: a randomized controlled trial</p>

“…The second step here starts from the moment the laryngoscope passed the incisors, which meant that the laryngoscope-insertion time was included in the second step. In addition, the narrow view provided by the Pentax AWS may have made navigation in the oropharynx difficult, as it may take longer for the tube to appear in sight 11. on the other hand, the duration of the third step (laryngeal inlet to vocal cord) was shorter in the Pentax AWS group than the other two groups.…”

“…The McGrath MAC has shown shorter intubation time over Macintosh laryngoscopy, while Pentax AWS has not 10. There have been few studies9,11 comparing different types of videolaryngoscope during nasotracheal intubation, and the most suitable type of videolaryngoscope for nasotracheal intubation remains unknown. The current study thus compared two types of videolaryngoscope — the McGrath MAC and Pentax AWS — with a Macintosh direct laryngoscope during nasotracheal intubation.…”

Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs) Revealing the Future of Airway Management: Video Laryngoscopy vs. Macintosh Laryngoscopy for Enhanced Clinical Outcomes

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