McGrath MAC video laryngoscope versus direct laryngoscopy for the placement of double-lumen tubes: A randomised control trial

Abstract

Background and Aims: Role of video laryngoscopes (VLs) in the management of difficult airway with single-lumen tubes (SLTs) is established. VLs provide improved glottis view but are associated with longer time to intubate (TTI). We aimed to compare the TTI for double-lumen tube (DLT) insertion using the McGrath ® MAC VL versus direct Macintosh laryngoscope (DL). Methods: Eleven senior anaesthesiologists experienced in SLT insertion, but not DLT insertion with VL participated. Seventy-four adults belonging to American Society of Anesthesiologists physical status I–II posted for elective surgery needing lung isolation were randomised to both intubator and laryngoscope (VL/DL). Primary endpoint was TTI; secondary endpoints included glottic view assessed by the Cormack and Lehane (CL) grade, need for external laryngeal manipulation, ease of intubation [scored using Numeric Rating Scale (1 – easiest, 10 – most difficult)] and associated complications. TTI was compared using Student's t -test. Results: No difference was found in TTI with DL and VL [(56.6 ± 14) s vs (64.4 ± 24) s, P = 0.104] as well as ease of use of laryngoscope [median score of 2 (1–3) in both]. Use of VL resulted in more patients with CL I glottic view – 86.0% versus 58.0% ( P = 0.007). Fewer patients required external laryngeal manipulations (19% vs 47%, P = 0.013), and complications were fewer in the VL group (5% vs 24%, P = 0.023). Conclusion: TTI for DLT insertion was similar with VL and DL. However, VL was associated with better glottis visualisation, reduced need of external laryngeal manipulation and fewer complications.

Efficacy of double-lumen intubation performed by paramedics on patients with lung damage. Experimental, pilot simulation trial

“…The results are similar to other studies where videolaryngoscopes where used to facilitate endotracheal intubation [20,21]. Bakshi et al compared the time to intubation for double-lumen tube insertion using the McGrath® MAC VL versus direct Macintosh laryngoscope and revealed that this parameter was similar on both groups, however videolaryngoscopy was associated with better glottis visualization, reduced need of external laryngeal manipulation and fewer complications [22].…”

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

“…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. One study (4%) checked as unclear risk [32]. All studies (100%) were assessed as having a low risk of bias about Selective reporting and Other potential sources of bias.…”

“…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.…”

“…External manipulation. Four groups of devices from 9 studies were available for the analysis [7,17,26,27,32,33,[37][38][39]. Eligible comparisons in the NMA are shown in Figs 3F and 4F.…”

Comparative evaluation of mcgrath MAC, Truview video laryngoscopes and Macintosh laryngoscope for endotracheal intubation in patients undergoing surgery under general anaesthesia

“…Various studies have found that VL improves the ability to visualize the larynx and improves the intubation success. [ 4 5 6 7 ]…”