Comparison of McGrath Series 3 and Macintosh Laryngoscopes for Tracheal Intubation in Patients With Normal Airway by Inexperienced Anesthetists

Abstract

Difficult and failed intubations account for the major causes of morbidity and mortality in current anesthetic practice. Several devices including McGrath Series 3 videolaryngoscope are available which may facilitate tracheal intubation by improving view of the larynx compared with Macintosh blade laryngoscopy. But no studies demonstrate whether McGrath Series 3 performs better than Macintosh laryngoscope in normal airway intubations by inexperienced anesthetists so far. We therefore designed this randomized controlled study to compare McGrath with Macintosh in routine tracheal intubation performed by inexperienced anesthetists.In total, 180 adult patients with normal-appearing airways requiring orotracheal intubation for elective surgery were randomly allocated to be intubated by 9 inexperienced anesthetists with McGrath or Macintosh. The primary outcome was time to intubation. Ease of intubation was assessed by a 5-point ordinal scale. Intubation attempts/failures, best laryngoscopy view using the Cormack–Lehane grade, associated complications and hemodynamic changes during intubation were recorded.We found that there was no significant difference between McGrath and Macintosh in the median time to intubation (P = 0.46); the Cormack–Lehane views attained using McGrath were superior (P < 0.001); the difference of ease of intubation was statistically significant (P = 0.01). No serious trauma occurred in both groups. And there was statistically significant difference in the systolic blood pressure changes between 2 groups (P < 0.05).We demonstrated that in orotracheal intubation in patients with normal airway by inexperienced anesthetists, McGrath compared with the Macintosh allows superior glottis views, greater ease of intubation, less complications, and hemodynamic changes with noninferior intubation time. And it remained a potential selection for inexperienced anesthetists in uncomplicated intubation.

Complications bucco-dentaires de l'intubation trachéale : apport des vidéolaryngoscopes

“…Chez les anesthésistes débutants, l'utilisation du VL McGrath série 3 par rapport au Macintosh permet d'obtenir une meilleure vue glottique, une intubation facilitée, moins de complications et de variations hémodynamiques, mais pas de temps d'intubation plus courts [22].…”

Neck Circumference and Mallampati Classification

“…Successfully intubating the anesthetized patient can be difficult at times but is a key component to safe anesthesia. Difficult and failed intubations account for considerable morbidity and mortality in anesthetic practice (Liu et al, 2016). Obesity is associated with a variety of comorbidities requiring increased vigilance when planning an intubation.…”

“…However, as is true within every discipline, practitioners tend to demonstrate individual variations in the way they assess and care for patients rather than consistently using an evidence-based approach. Difficult and failed intubations contribute to morbidity and mortality in anesthetic practice (Liu, Yi, Guo, Ma, & Huang, 2016). The need for a thorough and accurate airway assessment is pivotal to patient safety.…”

“…Novice anesthetists found the use of video laryngoscopy to be easier than direct laryngoscopy, rating it as one to two versus two to three. (Liu et al, 2016).…”

“…Traditional tracheal intubation is done under direct laryngoscopy using either a Macintosh or Miller blade (Liu et al, 2016). In a study completed by Liu et al, intubations on patients with normal appearing airways by the novice anesthetist using either direct laryngoscopy or a video assisted device were compared.…”