A randomized controlled trial comparing C Mac D Blade and Macintosh laryngoscope for nasotracheal intubation in patients undergoing surgeries for head and neck cancer

Abstract

Purpose:Several devices are available to take care of difficult airway, but C-MAC D-Blade has scant evidence of its use in nasotracheal intubation in a difficult airway scenario.Aims and Objectives:We compared the C-MAC D-Blade videolaryngoscope™, and the standard Macintosh laryngoscope for nasal intubation in patients with difficult airways selected by El-Ganzouri risk index using parameters of time and attempts required for intubation, glottic view in terms of Cormack–Lehane grade, ease of intubation, success rate, use of accessory maneuvers, incidence of complications, and hemodynamic changes.Methods:One hundred American Society of Anesthesiologists (ASA) I–III patients aged 20–70 years with EGRI score 1–≤7 scheduled for head and neck surgery requiring nasal intubation. ASA IV patients, patients with mouth opening <2.5 cm, patients difficult to mask ventilate, and patients with hyperkalemia and history of malignant hyperthermia were excluded from the study. Primary outcome was time taken to intubation, and secondary outcomes were a number of attempts, glottic view in terms of C/L grade, use of accessory maneuvers, success rate, incidence of trauma, ease of intubation, and hemodynamic changes before and after intubation.Results:Time required for intubation was less (39.56 ± 15.65 s) in Group C than in Group M (50.34 ± 15.65 s). Cormack–Lehane Grade I and II view were more in C-MAC D-Blade group (P < 0.05). Success rate and ease of intubation were found to be more in C-MAC D-Blade group than in Macintosh group (P < 0.05). A number of attempts and incidence of complications such as trauma, bleeding, and failed intubation were greater in Macintosh group than in C-MAC D-Blade group. Hemodynamic changes were observed to be comparable in both the groups.Conclusion:C-MAC D-Blade videolaryngoscope™ is a better tool in anesthetic management of difficult airway for nasal intubation compared to conventional Macintosh laryngoscope.

Comparison of C-MAC D-blade videolaryngoscope and McCoy laryngoscope efficacy for nasotracheal intubation in simulated cervical spinal injury: a prospective randomized comparative study

“…Tseung et al [28]. reported that use of the GlideScope or Pentax AWS leads to reduced application of BURP, and Hazarika et al [29]. reported that use of the C-MAC D-Blade videolaryngoscope resulted in less need for additional maneuvers such as tube rotation, cuff inflation, and the use of Magill forceps than use of Macintosh direct laryngoscopy.…”

“…Numerous trials have suggested that several intubating devices that provide non-line-of-sight views show a significantly improved conditions for NTI than conventional direct laryngoscopes. This is because these devices help to avoid deviation of the larynx from its original position and allow for easy placement of the ETT tip through the glottic inlet [29,31,32].…”

“…A necessary sample size calculation was conducted based on the primary outcome (the time taken for NTI) using G power. A pilot study revealed a time taken for NTI in the McCoy group of 48 s. A 10-s difference in the time taken for NTI between the C-MAC and McCoy groups was considered clinically significant based on a previous study [22], and the effect size was computed as 0.80. Based on this, we determined that forty-two patients were required in each group to detect 10-s difference in the total intubation time with 95% power, a significance level of 5%, and two-sided testing.…”

Novel Video-Laryngoscope with Wireless Image Transmission via Wi-Fi towards a Smartphone

“…Clinically, the video laryngoscope (VDL) is a piece of medical equipment that supports intubating COVID-19 patients; its use is indicated in the guidelines for the treatment of such patients, as they provide a lower probability of contamination for medical staff who are in direct risk of contact with SARS-CoV-2 [4] It is well recognized that the use of VDLs has optimized the management of patients with difficult airways, and accordingly it has been included as part of the management of the airway guides of the American Society of Anesthesiologists (ASA) and the Difficult Airway Society (DAS) [5,6]. Furthermore, VDLs have had a great boom in developed countries, because they can help to better visualize the airways of patients who need to be intubated, since their use has shown great success in endotracheal intubation (EI) [7][8][9][10]. However, in developing countries, like ours, the approximate cost of VDL devices is between USD $2,000 and USD $22,000, while the cost of conventional laryngoscopes is within the range of USD $65 to USD $110.…”

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

“…A recent systematic review comparing VL versus DL for NTI showed that VL is particularly beneficial for patients with difficult airways [16]. However, only two randomized controlled trials (Airtriq and C-MAC versus Macintosh) were enrolled [7, 17]. It remains unclear whether non-channeled King Vision or McGrath MAC VL, compared with conventional laryngoscope, provide shorter intubation time and a higher first success rate for NTI when used by experienced provider in management of predicted difficult intubation.…”