Utilization of C-MAC videolaryngoscopy for direct and indirect assisted endotracheal intubation

Abstract

Background: The experiences of seasoned practitioners with the new C-MAC indirect videolaryngoscope system have shown promising results in the management of difficult airways. However, a comparison of direct and indirect laryngoscopy utilizing the C-MAC system as its own control has not been performed in a cohort of anesthesiologists-in-training. The primary aim was to compare direct and indirect laryngoscopy in terms of intubation time with secondary outcomes including laryngoscopy time and airway view with the same size 3 blade. Methods: The study was registered with www.clinicaltrials.gov (NCT01104090). Oral and written informed consent was obtained from 50 adult patients with BMI < 40 kg/m 2 who required general anesthesia for elective surgery with tracheal tube placement. The patients were randomized to two groups, each receiving two laryngoscopies, n=25 direct-first and n=25 indirect-first. Results: All patients except for one were successfully intubated on the first attempt. The intubation time was 12.3±11.1 sec immediately following videolaryngoscopy (direct laryngoscopy first group) and 9.8±7.1 sec immediately following direct laryngoscopy (videolaryngoscopy first group), p=0.35. The first laryngoscopy time was 8.7±4.7 sec in the direct group and 13.3±10.7 sec in the indirect group, p=0.06. Twenty-percent of direct first cases compared to 0% of indirect first cases showed an improvement in airway view score by at least two classes on the second laryngoscopy, p=0.02. Backward-upward-rightward pressure was used in 36% of direct first and 12% of indirect first patients, p=0.047. Conclusions: This study corroborates previous results on the use of the C-MAC videolaryngoscopy system during endotracheal-assisted intubation. Although there was no difference in intubation time between direct laryngoscopy and videolaryngoscopy, the C-MAC system was found to improve laryngeal views and reduce the number of necessary laryngeal manipulations. A larger randomized study utilizing a similar model is necessary to definitively determine significant clinical results.

Videolaryngoscope Versus Traditional Laryngoscopy for Comparison of Ease of Intubation and Hemodynamic Changes – A Prospective Randomized Study

“…Further studies with larger sample size are required to validate the findings of the study. No significant difference in the total intubation time between the C-MAC and the Macintosh laryngoscope group was noted in our study which is in accordance with the findings of Cattano et al [12]. On the contrary, the time to intubate was significantly shorter in Group V as compared to Group M (24 s vs. 68 s) in study by Rajan et al [10 ].…”

A Randomised Control Study Comparing Hemodynamic Response to Laryngoscopy & Endotracheal Intubation with Macintosh Direct Laryngoscope & C-Mac Video Laryngoscope In Adult Patients

“…[24] According to Lee JH et al, 0 the increased number of attempts during tracheal intubation was found to be associated with increased risk of desaturations and tracheal intubation associated events (TIAEs) Our study was inconsistent with that of the Cattano et al, where no significant difference in the total intubation time was observed among the C-MAC and the Macintosh laryngoscope group. [25,26] studies by Shin et al, Kinicaslan et al,similar observations were obtained where the C-MAC was found to be associated with an improved laryngeal view as well as with a higher success rate of intubation compared to the Macintosh blade. [27,28] The percentage of glottis view among the patients intubated using the C-MAC video laryngoscope was found to be 80.67% whereas with conventional Macintosh laryngoscope it was found to be 61.33%.…”

Perbandingan Angka Keberhasilan dan Lama Intubasi antara Metode Laringoskopi Direk dan Videolaringoskopi pada Pasien Obesitas

“…Pada penelitian lain pun didapatkan hasil waktu intubasi yang sedikit lebih lama pada kelompok dengan metode videolaringoskopi dibanding dengan metode laringoskopi direk. 4, 28,29 Pada penelitian ini didapatkan manuver eksternal laring lebih sedikit dilakukan pada kelompok VL dibanding dengan kelompok direk.…”

“…16 Hasil ini sesuai dengan hasil penelitian-penelitian sebelumnya. 4, 28,29 Metode videolaringoskopi juga memiliki kelebihan lain, yaitu videolaringoskop secara signifikan meningkatkan jarak mulut ke mulut antara operator dan subjek serta menempatkan wajah operator di atas garis lurus aksis oral-faring-laring sehingga mengurangi risiko penularan mikrob akibat tindakan aerosol. 30 Penggunakan metode videolaringoskopi juga memiliki kelebihan dapat digunakan sebagai konfirmasi insersi ETT oleh personil lain di samping operator karena memiliki akses visualisasi melalui layar kamera.…”