Does C-MAC ^® video laryngoscope improve the nasotracheal intubating conditions compared to Macintosh direct laryngoscope in paediatric patients posted for tonsillectomy surgeries?

Abstract

Background and Aims:C-MAC® video laryngoscope (VL) with Macintosh blade has been found to improve Cormack-Lehane (C-L) laryngoscopic view as well as intubating conditions for orotracheal intubation. However, studies done on the performance of C-MAC® VL for nasotracheal intubation (NTI) are very few in number. Hence, we compared laryngoscopy and intubating conditions between Macintosh direct laryngoscope and C-MAC® VL for NTI.Methods:Sixty American Society of Anesthesiologists Physical Status I, II patients, aged 8–18 years, posted for tonsillectomy surgeries under general anaesthesia with NTI were randomised, into two groups. Patients in group 1 were intubated using Macintosh direct laryngoscope and group 2 with C-MAC® VL. C-L grading, time required for intubation, need for additional manoeuvres and haemodynamic changes during and after intubation were compared between the groups.Results:C-L grade 1 views were obtained in 26 and 29 patients in group 1 and group 2, respectively (86.7% vs. 96.7%). Remaining patients were having C-L grade 2 (13.3% vs. 3.3%). Duration of intubation was less than a minute in group 2 (93.3%). Need for additional manoeuvres (M1–M5) were more in group 1 (97% vs. 77%). M1 (external manipulation) was needed more in group 2 compared to group 1 (53.3% vs. 30%). Magill's forceps alone (M4) and M4 with additional external manipulation (M5) were needed more in group 1 compared to group 2 (60% vs. 16%).Conclusion:The overall performance of C-MAC® VL was better when compared to conventional direct Macintosh laryngoscope during NTI in terms of glottis visualisation, intubation time and need for additional manoeuvres.

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

“…Videolaryngoscopy requires less force on the base of the tongue than direct laryngoscopy to achieve a good glottic view. Thus, videolaryngoscopy is less likely to incite a pressor-response and causes laryngeal tissue injury [33]. The McCoy laryngoscope also has been reported to result in less hemodynamic change compared to the Macintosh laryngoscope [34,35].…”

Ease of intubation and hemodynamic responses to nasotracheal intubation using C-MAC videolaryngoscope with D blade: A comparison with use of traditional Macintosh laryngoscope

“…[ 8 ] In pediatric patients undergoing tonsillectomy, Storz C-MAC ® videolaryngoscope provided better glottic visualization and less intubation time with less need for Magill's forceps during nasal intubation compared to the conventional Macintosh direct laryngoscope, but with a high need for external manipulations. [ 9 ] In a case series Das et al . [ 10 ] concluded that the use of McGrath ® videolaryngoscope produced excellent laryngoscopic views in patients with normal airways.…”

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

“…In studies using Magill forceps as a navigation method, the incidence of the use of Magill forceps with Macintosh laryngoscopes ranged between 34% and 49%, while with video laryngoscopes, the incidence ranged between 0% and 6% 6 , 7 . In patients aged 8–18 years, the cuff inflation method and Magill forceps were used in 6.7% to 60% of patients when using the Macintosh laryngoscope and in 6.7% to 17% of patients using the C-MAC video laryngoscope 13 . Therefore, most existing evidence suggests that compared to Macintosh laryngoscopies, video laryngoscopies require less use of Magill forceps and are associated with reduced intubation times.…”