Videolaryngoscopes for placement of double lumen tubes: Is it time to say goodbye to direct view?

El-Tahan, Mohamed R.

doi:10.4103/1658-354x.168804

Cited by 18 publications

(9 citation statements)

References 41 publications

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“…The glottic view was significantly better and the need of external laryngeal manipulation significantly lower with the McGrath ® MAC VL as seen in the other studies. [1617] There was no significant difference between either of the laryngoscopes for the number of attempts taken to successfully intubate the trachea with a DLT with only one case in each group requiring two attempts at intubation.…”

Section: Discussionmentioning

confidence: 98%

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

2019

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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.

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Section: Discussionmentioning

confidence: 98%

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

2019

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“…Although prior studies showed that videolaryngoscopes might provide an improvement in the intubation condition with a high success rate [9], there were many indicators for evaluating devices for DLT intubation, and it was challenging to identify the best device in the absence of a review study to distinguish these devices in terms of applicability in these special circumstances. We conducted network meta-analysis, in which multiple treatments are being compared, to assess the effectiveness, with regard to factors such as success rate of the first attempt of intubation, intubation time, and adverse event rates of intubating devices (Mc, SV, CV, and stylet V) as a strategy for selecting the right device for DLT intubation.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Double-lumen tube is commonly used in thoracic surgeries that need one-lung ventilation, but its big size and stiff structure make it harder to perform intubation than a conventional tracheal intubation tube. Objectives To investigate the effectiveness and safety of videoscopes for double-lumen tube insertion. The primary outcome was the success rate of first attempt intubation. Secondary outcomes were intubation time, malposition, oral mucosal damage, sore throat, and external manipulation. Design Systematic review and network meta-analysis Data sources Databases (Pubmed, Embase, Cochrane, Kmbase, Web of science, Scopus) up to June 23, 2020 were searched. Eligibility Randomized controlled trials comparing different videoscopes for double-lumen tube intubation were included in this study. Methods We classified and lumped the videoscope devices into the following groups: standard (nonchanneled) videolaryngoscope, channeled videolaryngoscope, videostylet, and direct laryngoscope. After assessing the quality of evidence, we statistically analyzed and chose the

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“…This observation was similar to El Thahan et al . [ 11 ] and could be due to the steeper learning curve to learn DLT insertion with video laryngoscope.…”

Section: Discussionmentioning

confidence: 99%

A randomized control led study comparing CMAC video laryngoscope and Macintosh laryngoscope for insertion of double lumen tube in patients undergoing elective thoracotomy

Mathew

Chandy

Punnoose

et al. 2021

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Double lumen tube (DLT) insertion for isolation of lung during thoracic surgery is challenging and is associated with considerable airway trauma. The advent of video laryngoscopy has revolutionized the management of difficult airway. Use of video laryngoscopy may reduce the time to intubate for DLTs even in patients with normal airway. Material and Methods: A total of 87 ASA 1–3 adults, scheduled to undergo elective thoracotomy, requiring a DLT were randomly allocated to videolaryngoscope (CMAC) arm or Macintosh laryngoscope arm. It was on open label study, and only the patient was blinded. The primary objective of this study was to compare the mean time taken for DLT intubation with CMAC (Mac 3) and Macintosh laryngoscope blade and the secondary objectives included the hemodynamic response to intubation, the level of difficulty using the intubation difficulty scale (IDS), and complications associated with intubation. Data was analysed using the statistical software SPSS (version 18.0). Results: The time taken for intubation was not significantly different (42.8 ± 14.8 s for CMAC and 42.5 ± 11.5 s for Macintosh laryngoscope P -0.908). The CMAC video laryngoscope was associated with an improved laryngoscopy grade (Grade I in 81.8% with CMAC and in 46.5% with Macintosh), less pressure applied on the tongue, and less external laryngeal pressure required. Hemodynamic responses to intubation were similar in both groups. Conclusion: Macintosh blade is as good as CMAC (mac 3) blade to facilitate DLT intubation in adult patients with no anticipated airway difficulty, however CMAC was superior as it offers better laryngoscopic view, needed less force, and fewer external laryngeal manipulations.

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Videolaryngoscopes for placement of double lumen tubes: Is it time to say goodbye to direct view?

Cited by 18 publications

References 41 publications

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

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

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

A randomized control led study comparing CMAC video laryngoscope and Macintosh laryngoscope for insertion of double lumen tube in patients undergoing elective thoracotomy

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