McGrath MAC Videolaryngoscope Versus Optiscope Video Stylet for Tracheal Intubation in Patients With Manual Inline Cervical Stabilization: A Randomized Trial

Abstract

BACKGROUND: Manual inline stabilization of the head and neck is a recommended maneuver for tracheal intubation in patients with a suspected cervical injury. However, because applying this maneuver inevitably restricts neck flexion and head extension, indirect intubating devices such as a videolaryngoscope or a video stylet could be required for successful tracheal intubation. In this study, we compared the clinical performance of the McGrath MAC videolaryngoscope versus the Optiscope video stylet in patients with manual inline cervical stabilization during tracheal intubation. METHODS: In 367 consecutive patients undergoing elective cervical spine surgery, tracheal intubation was randomly performed with manual inline stabilization using either the McGrath MAC videolaryngoscope (group M, n = 183) or the Optiscope video stylet (group O, n = 184) by 2 experienced anesthesiologists in a single institution. The primary outcome was the first-attempt success rate of tracheal intubation. Secondary outcomes were intubation time and the incidence of postoperative airway complications, such as sore throat, hoarseness, blood in the oral cavity, and blood staining on the endotracheal tube. RESULTS: The first-attempt success rate of tracheal intubation was significantly higher in group M compared with group O (92.3% vs 81.0%; risk difference [95% confidence interval], 0.11 [0.05–0.18]; P = .002). The intubation time was significantly shorter in group M than in group O (35.7 ± 27.8 vs 49.2 ± 43.8; mean difference [95% confidence interval], 13.5 [5.9–21.1]; P = .001). The incidence of postoperative airway complications was not significantly different between the 2 groups. CONCLUSIONS: The McGrath MAC videolaryngoscope showed a higher first-attempt success rate for tracheal intubation and a shorter intubation time than the Optiscope video stylet in cervical spine patients with manual inline stabilization during tracheal intubation. These results suggest that the McGrath MAC videolaryngoscope may be a better option for tracheal intubation in such patients.

Sheet Barrier and Intubating Stylet

“…Because of its slim profile, the video stylet is more easily sanitized compared to other videolaryngoscopes. Even prior to the COVID-19 pandemic, at many institutions, the video intubating stylet had become the preferred modality for performing tracheal intubation [34][35][36][37]. Table 1 and Figure 5 show examples of high use coverage of videoassisted intubating stylets in the departments of anesthesia in Taiwan.…”

Tracheal Tube-Mounted Camera Assisted Intubation vs. Videolaryngoscopy in Expected Difficult Airway: A Prospective, Randomized Trial (VivaOP Trial)

“…In particular, a restricted epiglottis motion with the epiglottis being adherent to the pharynx [grade 3 view according to Cook ( 27 )] is a pitfall and possible limitation of VL and rather a domain of flexible intubation methods ( 28 ). Beyond bronchoscopic and videolaryngoscopic intubation techniques further video-guided techniques using tube or stylet mounted cameras have been introduced but their role for the management of the expected or unexpected difficult intubation remains unclear ( 29 ).…”

“…Recently, a video stylet inserted into a tracheal tube providing camera guidance has been evaluated for intubation in patients with cervical immobilization showing a significantly lower first attempt success rate and prolonged time to intubation as compared with VL ( 29 ). As the basic principles of intubation with camera guidance resemble the VST approach, and the results are comparable with our study results, tube-camera guided intubation might indeed be inferior to a laryngoscope approach in the clinical settings, but further data are required.…”

No radiographic index predicts difficult intubation using the Optiscope™ in cervical spine surgery patients: a retrospective study

“…2). The participants were previously enrolled in a randomized controlled trial previously conducted at our institution to compare the clinical performance of the Optiscope™ and the McGrath™ MAC videolaryngoscope (Medtronic, Minneapolis, MN, USA) in patients undergoing cervical spine surgery [19]. Patients who were intubated with other intubation devices, and those who had any missing radiographic data, were excluded.…”