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      Comparison of McGrath, Pentax, and Macintosh laryngoscope in normal and cervical immobilized manikin by novices: a randomized crossover trial

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          Abstract

          Background

          The aim of this study was to compare tracheal intubation performance regarding the time to intubation, glottic view, difficulty, and dental click, by novices using McGrath videolaryngoscope (VL), Pentax Airway Scope (AWS) and Macintosh laryngoscope in normal and cervical immobilized manikin models.

          Methods

          Thirty-five anesthesia nurses without previous intubation experience were recruited. Participants performed endotracheal intubation in a manikin model at two simulated neck positions (normal and fixed neck via cervical immobilization), using three different devices three times each. Performance parameters included intubation time, success rate of intubation, Cormack Lehane laryngoscope grading, dental click, and subjective difficulty score.

          Results

          Intubation time and success rate during first attempt were not significantly different between the 3 groups in normal airway manikin. In the cervical immobilized manikin, the intubation time was shorter ( p = 0.012), and the success rate with the first attempt was significantly higher ( p < 0.001) when using McGrath VL and Pentax AWS compared with Macintosh laryngoscope. Both VLs showed less difficulty score ( p < 0.001) and more Cormack Lehane grade I ( p < 0.001) in both scenarios. The incidence of dental clicks was higher with Macintosh laryngoscope compared with McGrath VL in cervical immobilized airway ( p < 0.001).

          Conclusions

          McGrath VL and Pentax AWS did not show clinically significant decrease in intubation time, however, they achieved higher first attempt success rate, easier intubation and better glottis view compared with Macintosh laryngoscope by novices in a cervical immobilized manikin model. McGrath VL may reduce the risk of dental injury compared with Macintosh laryngoscope in cervical immobilized scenario.

          Trial registration: ClinicalTrials.gov (NCT03161730), May 22, 2017

          https://clinicaltrials.gov/ct2/hom

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          Most cited references24

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          Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance.

          T Inoue, Atsuhiro Sakamoto, Zen'ichiro Wajima … (2005)
          The objective of this study was to systematically determine the diagnostic accuracy of bedside tests for predicting difficult intubation in patients with no airway pathology. Thirty-five studies (50,760 patients) were selected from electronic databases. The overall incidence of difficult intubation was 5.8% (95% confidence interval, 4.5-7.5%). Screening tests included the Mallampati oropharyngeal classification, thyromental distance, sternomental distance, mouth opening, and Wilson risk score. Each test yielded poor to moderate sensitivity (20-62%) and moderate to fair specificity (82-97%). The most useful bedside test for prediction was found to be a combination of the Mallampati classification and thyromental distance (positive likelihood ratio, 9.9; 95% confidence interval, 3.1-31.9). Currently available screening tests for difficult intubation have only poor to moderate discriminative power when used alone. Combinations of tests add some incremental diagnostic value in comparison to the value of each test alone. The clinical value of bedside screening tests for predicting difficult intubation remains limited.
          Article 0 comments Cited 176 times – based on 0 reviews     Review now
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            Adverse respiratory events in anesthesia: a closed claims analysis.

            Frederick Cheney, Lawrence Ward, K Posner … (1990)
            Adverse outcomes associated with respiratory events constitute the single largest class of injury in the American Society of Anesthesiology Closed Claims Study (522 of 1541 cases; 34%). Death or brain damage occurred in 85% of cases. The median cost of settlement or jury award was +200,000. Most outcomes (72%) were considered preventable with better monitoring. Three mechanisms of injury accounted for three-fourths of the adverse respiratory events: inadequate ventilation (196; 38%), esophageal intubation (94; 18%), and difficult tracheal intubation (87; 17%). Inadequate ventilation was used to describe claims in which it was evident that insufficient gas exchange had produced the adverse outcome, but it was not possible to identify the exact cause. This group was characterized by the highest proportion of cases in which care was considered substandard (90%). The esophageal intubation group was notable for a recurring diagnostic failure: in 48% of cases where auscultation of breath sounds was performed and documented, this test led to the erroneous conclusion that the endotracheal tube was correctly located in the trachea. Claims for difficult tracheal intubation were distinguished by a comparatively small proportion of cases (36%) in which the outcome was considered preventable with better monitoring. A better understanding of respiratory risks may require investigative protocols that initiate data collection immediately upon the recognition of a critical incident or adverse outcome.
            Article 0 comments Cited 119 times – based on 0 reviews     Review now
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              Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization.

              M. Malik, C Maharaj, B Harte … (2008)
              The purpose of this study was to evaluate the effectiveness of the Pentax AWS, Glidescope, and the Truview EVO2, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization. One hundred and twenty consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n=30), Glidescope (n=30), Truview EVO2 (n=30), or AWS (n=30) laryngoscope. All patients were intubated by one of the three anaesthetists experienced in the use of each laryngoscope. The Glidescope, AWS, and Truview EVO2 each reduced the intubation difficulty score (IDS), improved the Cormack and Lehane glottic view, and reduced the need for optimization manoeuvres, compared with the Macintosh. The mean IDS was significantly lower with the Glidescope and AWS compared with the Truview EVO2 device, and the IDS was lowest with the AWS. The duration of tracheal intubation attempts was significantly shorter with the Macintosh compared with the other devices. There were no differences in success rates between the devices tested. The AWS produced the least haemodynamic stimulation. The Glidescope and AWS laryngoscopes required more time but reduced intubation difficulty and improved glottic view over the Macintosh laryngoscope more than the Truview EVO2 laryngoscope when used in patients undergoing cervical spine immobilization.
              Article 0 comments Cited 60 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                In Kyong Yi: lyrin01@gmail.com
                Hyun Jeong Kwak: hyun615@gilhospital.com
                Kyung Cheon Lee: leekc@gilhospital.com
                Ji Hyea Lee: potato624@aumc.ac.kr
                Sang Kee Min: anesmin@nate.com
                Jong Yeop Kim:
                ORCID: http://orcid.org/0000-0003-3402-365X
                kjyeop@ajou.ac.kr
                Journal
                Journal ID (nlm-ta): Eur J Med Res
                Journal ID (iso-abbrev): Eur. J. Med. Res
                Title: European Journal of Medical Research
                Publisher: BioMed Central (London )
                ISSN (Print): 0949-2321
                ISSN (Electronic): 2047-783X
                Publication date (Electronic): 20 August 2020
                Publication date PMC-release: 20 August 2020
                Publication date Collection: 2020
                Volume: 25
                Electronic Location Identifier: 35
                Affiliations
                [1 ]GRID grid.251916.8, ISNI 0000 0004 0532 3933, Department of Anesthesiology and Pain Medicine, , Ajou University School of Medicine, ; 164, World cup-ro, Yeongtong-gu, Suwon, 16499 Korea
                [2 ]GRID grid.411653.4, ISNI 0000 0004 0647 2885, Department of Anesthesiology and Pain Medicine, , Gachon University, Gil Medical Center, ; 24, Namdong-Daero 774beon-gil, Namdong-gu, Incheon, 21565 Korea
                Author information
                http://orcid.org/0000-0003-3402-365X
                Article
                Publisher ID: 435
                DOI: 10.1186/s40001-020-00435-0
                PMC ID: 7441605
                PubMed ID: 32819444
                SO-VID: 03e81c6c-58a1-4c3d-ace7-c4f81dfa05c6
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 26 February 2019
                Date accepted : 12 August 2020
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Medicine
                Keywords: laryngoscopy,intubation,videolaryngoscope,cervical immobilization,novice
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: laryngoscopy, intubation, videolaryngoscope, cervical immobilization, novice

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