A randomized controlled comparison of non-channeled king vision, McGrath MAC video laryngoscope and Macintosh direct laryngoscope for nasotracheal intubation in patients with predicted difficult intubations

Abstract

Background King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the performance of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators. Methods Ninety nine ASA I or II adult patients, scheduled for oral maxillofacial surgeries with El-Ganzouri risk index 1–7 were enrolled. Patients were randomly allocated to intubate with one of three laryngoscopes (non-channeled King Vision, McGrath MAC and Macintosh). The intubators were experienced with more than 100 successful nasotracheal intubations using each device. The primary outcome was intubation time. The secondary outcomes included first success rate, time required for viewing the glottis, Cormack-Lehane grade of glottis view, the number of assist maneuvers, hemodynamic responses, the subjective evaluating of sensations of performances and associated complications. Results The intubation time of King Vision and McGrath group was comparable (37.6 ± 7.3 s vs. 35.4 ± 8.8 s) and both were shorter than Macintosh group (46.8 ± 10.4 s, p < 0.001). Both King Vision and McGrath groups had a 100% first attempt success rate, significantly higher than Macintosh group (85%, p < 0.05). The laryngoscopy time was comparable between King Vision and McGrath group (16.7 ± 5.5 s vs. 15.6 ± 6.3 s) and was shorter than Macintosh group (22.8 ± 7.2 s, p < 0.05) also. Compared with Macintosh laryngoscope, Glottis view was obviously improved when exposed with either non-channeled King Vision or McGrath MAC VL ( p < 0.001), and assist maneuvers required were reduced ( p < 0.001). The maximum fluctuations of MAP were significantly attenuated in VL groups (47.7 ± 12.5 mmHg and 45.1 ± 10.3 mmHg vs. 54.9 ± 10.2 mmHg, p < 0.05 and p < 0.01). Most device insertions were graded as excellent in McGrath group, followed by Macintosh and King Vision group ( p = 0.0014). The tube advancements were easier in VLs compared with the Macintosh laryngoscope ( p < 0.001). Sore throat was found more frequent in Macintosh group compared with King Vision group ( p < 0.05). Conclusions Non-channeled King Vision and McGrath MAC VLs were comparable and both devices facilitated nasotracheal intubation in managing predicted difficult intubations compared with Macintosh laryngoscope. Trial registration ClinicalTrials registration number NCT03126344 . Registered on April 24, 2017. Electronic supplementary material The online version of this article (10.1186/s12871-019-0838-z) contains ...

Video laryngoscopy vs. direct laryngoscopy for nasotracheal intubation in oromaxillofacial surgery: a systematic review and meta-analysis of randomized controlled trials

“…The operator criteria were defined in all studies except in one [ 32 ]. The types of video laryngoscopes used included Glidescope (three studies) [ 26 , 33 , 34 ], C-MAC D-blade (one study) [ 25 ], McGrath (four studies) [ 27 – 29 , 31 ], True View EVO2 (one study) [ 30 ], and Pentax Airway scope (two studies) [ 32 , 33 ]. ( Table 1 )…”

“…The definition of time to intubation varied from the mouth opening until the detection of ETCO 2 [ 25 , 27 , 30 ], end of mask ventilation until detection of ETCO 2 [ 26 ], intranasal placement until detection of ETCO 2 [ 28 ], insertion through nostril until detection of ETCO 2 [ 29 ], passing through the nasal cavity until chest rise [ 31 ], placement of the endotracheal tube [ 32 , 33 ], or as not clear [ 34 ]. Pooled analysis showed a significantly shorter time to intubation favoring VL (MD: −9.04, 95% CI [ –12.71, –5.36], n = 597, P < 0.001, I 2 = 59%) ( Fig.…”

Evaluation of Glottic Visualization and Ease of Intubation at Induction of General Anesthesia

“…Recently, Haozhen Zhu and colleagues have shown that both non-channeled King Vision and McGrath MAC Video laryngoscopes took significant lesser time for nasotracheal intubation in patients with predicted difficult intubations compared with Macintosh laryngoscope 17 . Use of Macintosh laryngoscope has been conventionally accepted as the first choice for tracheal intubation.…”

Adding Flexible Instrumentation to a Curved Videolaryngoscope: A Novel Tool for Laryngeal Surgery

“…Various manufacturers have specialized in the development of videolaryngoscopes, including the King Vision (Ambu, Copenhagen, Denmark), McGrath MAC (Medtronic, Dublin, Ireland), and the C‐MAC videolaryngoscope (Karl Storz, Tuttlingen, Germany) with the hyper‐angulated D‐blade, which was designed for intubation in patients with difficult anatomical airway conditions. They offer a simpler, faster, and optimal visibility of the vocal cords compared to the conventional Macintosh laryngoscope 21,22 . The aim of the following user study is to examine whether surgical manipulation of the larynx is possible with a modified videolaryngoscope prototype in a porcine ex vivo laryngeal model.…”