The midline approach for endotracheal intubation with GlideScope video laryngoscopy could provide a better glottis exposure in adults:A randomised controlled trial

Abstract

Background: Previous studies demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although a midline approach is commonly recommended for video laryngoscopy (VL) in clinical, lacking of published evidences to support it. The study aimed to evaluate the effects of different video laryngoscopic approach on intubation. Methods: Two hundred and sixty-two patients aged 18 years who underwent elective surgery in general anesthesia, requiring endotracheal intubation, were included in the prospective, randomized, controlled study. Participants were randomly and equally allocated to right approach (Group R) or midline approach (Group M). All intubations were conducted with GlideScope video laryngoscopy by experienced anaesthetists. The primary outcomes were Cormack-Lehane laryngoscopic views (CLV) and first-pass success (FPS) rate. The secondary outcomes were time to glottis exposure, time to tracheal intubation, hemodynamic response and other adverse events. Comparative analysis was performed between the both groups. Results: All patients ultimately were successfully intubated. No significant differences were observed in patient characteristics and airway assessments (P＞0.05). Compared with Group R, Group M had a better CLV (χ2=14.706, P=0.001) and shorter time to glottis exposure (8.82±2.04 vs 12.38±1.81, t=14.94, P<0.001) and tracheal intubation (37.19±5.01 vs 45.23±4.81, t=13.25, P<0.001), but no difference in FPS rate (70.2% vs 71.8%, χ2=0.074, P=0.446). Between groups, the rates of hoarseness or sore throat, minor injury, hypoxemiaand changes of SBP and HR were noted no significant difference (P＞0.05). Conclusion: Although FPS rate did not differ based upon laryngoscopic approach type; however, the midline approach could provide a better glottis exposure, shorter time to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation. Trial registration: The study was registered in Chinese Clinical Trial Registry (ChiCTR-RNC-13003898). Keywords: endotracheal intubation; video laryngoscopic; laryngoscopic approach