Randomized comparison of the effectiveness of nasal intubation using a GlideScope video laryngoscope with Magill forceps versus vascular forceps in patients with a normal airway

Abstract

PurposeThe GlideScope® video laryngoscope (GVL) is widely used for nasotracheal intubation in dental and facial plastic surgery. The angle of the Magill forceps is different from that of the GVL blade, which suggests that the Magill forceps are not the ideal forceps for use with the GVL. The purpose of this study was to compare the effectiveness of the Magill forceps vs vascular forceps for nasotracheal intubation using the GVL.MethodsThis study included 60 patients scheduled to undergo elective surgery requiring nasotracheal intubation. Patients were assigned to one of two groups—i.e., Magill forceps (group M) or vascular forceps along with a tube exchanger (group V), by computer randomization. The primary outcome was total intubation time, defined as the time from when the anesthesiologist picked up the device to the time when three successive end-tidal CO2 waves were obtained following intubation. Secondary outcomes were blood in the endotracheal tube and trauma to the oral tissues or teeth. A blind observer assessed the presence of sore throat one hour and 24 hr after surgery.ResultsThe total intubation time was significantly different between group M and group V (96.1 sec and 78.1 sec, respectively; mean difference, 18 sec; 95% confidence interval (CI), 13.7 to 49.7). The incidence of epistaxis in group M was significantly greater than that in group V (46.7% vs 16.7%, respectively; relative risk, 2.8; 95% CI, 1.2 to 6.8).ConclusionThe total intubation time was significantly less with the vascular forceps (and tube exchanger) than with the Magill forceps. Using vascular forceps also reduced the incidence of epistaxis compared with that using the Magill forceps. Using a tube exchanger and vascular forceps offers advantages over use of Magill forceps when a GlideScope video laryngoscope is used for nasotracheal intubation.Trial registration: http://www.who.int/ictrp/network/cris2/en/, CRIS, KCT0001310. Registered 29 July 2014.

Comparison with tube core and Magill forceps for nasotracheal intubation: a randomized controlled trial

“…The total NTI time, which was de ned as the period from when the operator picked up the device to when three successive end-tidal carbon dioxide waves were obtained following intubation [12], was recorded. An observer blinded to the group assignments assessed epistaxis bleeding using direct laryngoscopy after five minutes of completing NTI, and it was scored as one of four grades according to the following modified criteria: no epistaxis (no blood observed on either the surface of the tube or the posterior pharyngeal wall); mild epistaxis (blood apparent on the surface of the tube or posterior pharyngeal wall); moderate epistaxis (pooling of blood on the posterior pharyngeal wall); and severe epistaxis (a large amount of blood in the pharynx that impeded NTI and necessitated urgent orotracheal intubation) [13].…”

In reply: Not which forceps, but whether forceps?

“…We appreciate the keen interest and thoughtful comments by Dr. Turkstra 1 on our study 2 where we found that using a forceps-guided tube exchanger could be advantageous when using the GlideScopeÒ videolaryngoscope (GVL; Verathon Medical Inc., Bothell, WA, USA) for oral endotracheal tube (ETT) intubation. The reason for an advantage might be the flexibility and pliability of a tube exchanger.…”

“…2 Before study implementation, three operators were trained in nasal intubation using a GVL. As mentioned above, the two different forceps were used in both groups.…”

Not which forceps, but whether forceps?

“…To the Editor, I read with interest and would like to comment on the recent randomized clinical trial reported by Yeom et al 1 regarding nasal intubation using a GlideScope videolaryngoscope (GVL; Verathon Medical Inc., Bothell, WA, USA). In that study, 1 the authors examined the time for nasal GVL intubation using vascular forceps and an airway exchange catheter compared with the standard Magill forceps originally described for direct laryngoscopy.…”

“…2,3 This seems intuitive as the Magill forceps was not designed for use with videolaryngoscopy and does not have suitable geometry for this task. [1][2][3] In addition, it is unfortunate that Yeom et al 1 do not specify the frequency of forceps use in either group of their study, particularly as forceps use (or lack thereof) is part of the intervention being studied. It would be helpful to know if forceps were used in either group.…”