Comparison of the McGrath videolaryngoscope and the Macintosh laryngoscope for double lumen endobronchial tube intubation in patients with manual in-line stabilization

Abstract

Background:Double lumen endobronchial tube (DLT) intubation is commonly used for one-lung ventilation in thoracic surgery. However, because of its large size and shape, it is difficult to perform intubation compared with a single lumen tube. The aim of this randomized controlled trial was to determine whether the McGrath videolaryngoscope has any advantage over the direct Macintosh laryngoscope for DLT intubation in patients with a simulated difficult airway.Methods:Forty-four patients (19–60 years of age); scheduled to undergo general anesthesia with one-lung ventilation were assigned to 1 of 2 groups: DLT intubation with the McGrath videolaryngoscope (ML group [n = 22]); or conventional Macintosh laryngoscope (DL group [n = 22]). After manual in-line stabilization was applied as a way of simulating a difficult airway, the time required for intubation and the quality of glottic view were evaluated.Results:The time to successful intubation was not different between the 2 groups (ML group, 45 s [interquartile range, 38–52 s] versus DL group, 54 s [45–59 s]; P = .089). The McGrath videolaryngoscope, however, provided a significantly better glottic view. Modified Cormack and Lehane grade was better (P < .001), and the percentage of glottis opening score was higher in the ML group (P < .001). Overall intubation difficulty scale score was lower in the ML group (1 [0–2]) versus the DL group (3 [2–4]) (P < .001).Conclusion:The McGrath videolaryngoscope improved glottic view and resulted in lower overall intubation difficulty scale score in patients with in-line stabilization.

Different classes of videoscopes and direct laryngoscopes for double-lumen tube intubation in thoracic surgery: A systematic review and network meta-analysis

“…Not only SV but also the other videoscopes showed better success rates than Mc. The results were consistent with the previous studies on DLT intubation [ 1 , 8 , 17 , 18 , 20 , 25 , 26 , 29 , 30 , 32 , 36 , 37 ]. However, the best choices differed according to the indicators.…”

“…For randomization, all of the 23 studies in our SR reported that the study was randomized; 20 of them (87%) reported that the method of random sequence generation was applied, whereas the other three studies (13%) did not provide adequate information [ 19 , 24 , 25 ]. The allocation concealment was adequately reported in 18 studies, four studies reported it inadequately [ 1 , 18 – 20 ], and one study checked as high risk [ 26 ]. For blinding, given that different devices were used in almost all RCT studies, all studies (100%) were evaluated as high risk in blinding of participants and personnel to the intervention of the studies (performance bias).…”

“…For blinding, given that different devices were used in almost all RCT studies, all studies (100%) were evaluated as high risk in blinding of participants and personnel to the intervention of the studies (performance bias). Eight studies (35%) that reported blinding of the outcome assessors were assessed as having unclear risk of bias [ 7 , 8 , 25 , 27 – 31 ], and the other thirteen studies (57%) were assessed as having high risk of bias [ 1 , 17 – 20 , 24 , 26 , 32 – 37 ]. For incomplete outcome data report, Twenty-two studies (96%) reported the completeness of outcome data for each main outcome and were assessed as having a low risk of bias.…”

“…Four groups of devices from 9 studies were available for the analysis [ 7 , 17 , 26 , 27 , 32 , 33 , 37 – 39 ]. Eligible comparisons in the NMA are shown in Figs 3F and 4F .…”

“…Success rate of the first attempt intubation of DLT. Four groups of devices from 21 studies were available for the analysis [1,7,8,17,18,20,[24][25][26][27][28][29][30][31][32][33][35][36][37][38][39]. Eligible comparisons in the NMA are shown in Figs 3A and 4A.…”