Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2014.10.009
Brazilian Journal of Anesthesiology
Scientific Article

A randomised crossover trial comparing the Airtraq ® NT, McGrath ® MAC and Macintosh laryngoscopes for nasotracheal intubation of simulated easy and difficult airways in a manikin

Estudo cruzado e randômico comparando os laringoscópios Airtraq ® NT, McGrath ® MAC e Macintosh para intubação nasotraqueal em simulação de via aérea fácil e difícil em manequim

Manuel Ángel Gómez-Ríos; Stephan Pinegger; María de Carrillo Mantilla; Lucia Vizcaino; Purísima Barreto-Calvo; Michael J. Paech; David Gómez-Ríos; Beatriz López-Calviño

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Abstract

ABSTRACT OBJECTIVE: Several devices can aid nasotracheal intubation when managing difficult airways. The McGrath MAC and Airtraq NT were compared with a Macintosh laryngoscope when studying the performance of anaesthetists with different levels of experience, in a manikin model of easy or difficult airway scenarios. METHODS: Sixty-three anaesthetists were recruited into a randomised trial in which each performed nasotracheal intubation with all laryngoscopes, in both scenarios. The main endpoint was intubation time. Additional endpoints included laryngoscopic view, intubation success, number of optimisation manoeuvres, audible dental clicks and the force applied to the upper airway. RESULTS: Intubation time was significantly shorter using the McGrath MAC in both scenarios and using the Airtraq in the difficult scenario, when compared with the Macintosh laryngoscope. Both devices gave more Cormack and Lehane grade 1 or 2 views than the Macintosh in the difficult scenario (p < 0.001). The McGrath MAC had the best first-attempt success rate (98.4% vs. 96.8% and 95.8%, p < 0.001 for the Airtraq NT and Macintosh laryngoscopes respectively). The number of optimisation manoeuvres, audible dental clicks and subjective assessment of the degree of force applied were significantly lower for indirect laryngoscopes versus the Macintosh laryngoscope (p < 0.001). CONCLUSION: In a manikin, the Airtraq and the McGrath laryngoscopes appeared superior to the Macintosh laryngoscope when dealing with simulated airway scenarios. Both devices were associated with better views, intubation times and rates of success, especially in a simulated "difficult airway". Overall satisfaction was highest with the McGrath laryngoscope. Similar clinical studies are needed.

Keywords

Intubation, Laryngoscopes, Manikin, Randomised controlled trial

Resumo

RESUMO OBJETIVO: Vários dispositivos podem ajudar a intubação nasotraqueal no manejo de via aérea difícil. Os laringoscópios McGrath MAC e Airtraq NT foram comparados com um laringoscópio Macintosh em estudo do desempenho de anestesistas com diferentes níveis de experiência, em manequim com cenário de via aérea fácil ou difícil. MÉTODOS: Foram recrutados 63 anestesistas para um estudo randômico, no qual cada um fez intubação nasotraqueal com todos os laringoscópios, em ambos os cenários. O desfecho primário foi o tempo de intubação. Desfechos adicionais incluíram vista laringoscópica, sucesso na intubação, número de manobras de aprimoramento, cliques dentais audíveis e força aplicada nas vias aéreas superiores. RESULTADOS: O tempo de intubação foi significativamente menor com o uso do laringoscópio McGrath MAC em ambos os cenários e com o uso do Airtraq no cenário difícil, em comparação com o laringoscópio Macintosh. Ambos os dispositivos obtiveram mais grau 1 ou 2 de Cormack e Lehane para visualização do que o Macintosh em cenário difícil (p < 0,001). O McGrath MAC teve a melhor taxa de sucesso na primeira tentativa (98,4% vs. 96,8% e 95,8%, p < 0,001, para os laringoscópios Airtraq NT e Macintosh, respectivamente). O número de manobras de aprimoramento, os cliques dentais audíveis e a avaliação subjetiva do grau de força aplicada foram significativamente menores para os laringoscópios indiretos versus o laringoscópio Macintosh (p < 0,001). CONCLUSÃO: Em um manequim, os laringoscópios Airtraq e McGrath pareceram superiores ao laringoscópio Macintosh para lidar com cenários das vias aéreas simuladas. Ambos os dispositivos foram associados a melhores visibilidades, tempos de intubação e taxas de sucesso, especialmente em simulação de "via aérea difícil". A satisfação geral foi maior com o laringoscópio McGrath. Estudos clínicos similares são necessários.

Palavras-chave

Intubação, Laringoscópios, Manequim, Estudo randômico e controlado

References

Ayuso MA, Sala X, Luis M. Predicting difficult orotracheal intubation in pharyngo-laryngeal disease preliminary results of a composite index. Can J Anaesth. 2003;50:81-5.

Mayhew JF. Airway management for oral and maxillofacial surgery. Int Anesthesiol Clin. 2003;41:57-65.

Hall CE, Shutt LE. Nasotracheal intubation for head and neck surgery. Anaesthesia. 2003;58:249-56.

Gómez-Ríos MA, Serradilla LN. Use of the Airtraq® optical laryngoscope for nasotracheal intubation in predicted dif- ficult airway management in oral surgery. Can J Anaesth. 2010;57:1136-7.

Kristensen MS, Møller J. Airway management behaviour, expe- rience and knowledge among Danish anaesthesiologists - room for improvement. Acta Anaesthesiol Scand. 2001;45:1181-5.

Mason RA. Learning fibreoptic intubation fundamental prob- lems. Anaesthesia. 1992;47:729-31.

Niforopoulou P, Pantazopoulos I, Demestiha T. Video- laryngoscopes in the adult airway management a topical review of the literature. Acta Anaesthesiol Scand. 2010;54:1050-61.

Maassen R, Lee R, Hermans B. A comparison of three vide- olaryngoscopes the Macintosh laryngoscope blade reduces, but does not replace, routine stylet use for intubation in morbidly obese patients. Anesth Analg. 2009;109:1560-5.

Enomoto Y, Asai T, Arai T. Pentax- AWS, a new videolaryn- goscope, is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements a randomized comparative study. Br J Anaesth. 2008;100:544-8.

McElwain J, Malik MA, Harte BH. Comparison of the C-MAC videolaryngoscope with the Macintosh Glidescope, and Airtraq laryngoscopes in easy and difficult laryngoscopy scenarios in manikins. Anaesthesia. 2010;66:483-9.

Bamgbade OA, Onaolapo MH, Zuokumor PA. Nasotracheal intu- bation with the McGrath videolaryngoscope in patients with difficult airway. Eur J Anaesthesiol. 2011;28:673-4.

Ng I, Hill AL, Williams DL. Randomized controlled trial comparing the McGrath videolaryngoscope with the C-MAC videolaryngoscope in intubating adult patients with potential difficult airways. Br J Anaesth. 2012;109:439-43.

Ray DC, Billington C, Kearns PK. A comparison of McGrath and Macintosh laryngoscopes in novice users a manikin study. Anaesthesia. 2009;64:1207-10.

Savoldelli GL, Schiffer E, Abegg C. Comparison of the Glidescope, the McGrath, the Airtraq and the. Macin- tosh laryngoscopes in simulated difficult airways*. Anaesthesia. 2008;63:1358-64.

Hyuga S, Sekiguchi T, Ishida T. Successful tracheal intuba- tion with the McGrath® MAC video laryngoscope after failure with the Pentax- AWS(TM) in a patient with cervical spine immo- bilization. Can J Anaesth. 2012;59:1154-5.

Lu Y, Jiang H, Zhu YS. Airtraq laryngoscope versus con- ventional Macintosh laryngoscope a systematic review and meta-analysis. Anaesthesia. 2011;66:1160-7.

McElwain J, Laffey JG. Comparison of the C-MAC ® Airtraq® , and Macintosh laryngoscopes in patients undergoing tracheal intubation with cervical spine immobilization. Br J Anaesth. 2011;107:258-64.

Savoldelli GL, Schiffer E, Abegg C. Learning curves of the Glidescope, the McGrath and the Airtraq laryngoscopes a manikin study. Eur J Anaesthesiol. 2009;26:554-8.

Pott LM, Murray WB. Review of video laryngoscopy and rigid fiberoptic laryngoscopy. Curr Opin Anaesthesiol. 2008;21:750-8.

St Mont G, Biesler I, Pförtner R. Easy and difficult nasal intubation - a randomised comparison of Macintosh vs Airtraq® laryngoscopes. Anaesthesia. 2012;67:132-8.

Malik MA, Hassett P, Carney J. A comparison of the Glidescope Pentax AWS, and Macintosh laryngoscopes when used by novice personnel a manikin study. Can J Anaesth. 2009;56:802-11.

Liu L, Tanigawa K, Kusunoki S. Tracheal intubation of a difficult airway using Airway Scope Airtraq, and Macintosh laryngoscope a comparative manikin study of inexperienced personnel. Anesth Analg. 2010;110:1049-55.

Carassiti M, Zanzonico R, Cecchini S. Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways a manikin study. Br J Anaesth. 2012;108:146-51.

Maharaj CH, Higgins BD, Harte BH. Evaluation of intubation using the Airtraq or Macintosh laryngoscope by anaesthetists in easy and simulated difficult laryngoscopy - a manikin study. Anaesthesia. 2006;61:469-77.

El-Orbany M, Woehlck H, Salem MR. Head and neck position for direct laryngoscopy. Anesth Analg. 2011;113:103-9.

Maharaj CH, Costello JF, Higgins BD. Learning and performance of tracheal intubation by novice personnel a com- parison of the Airtraq and Macintosh laryngoscope. Anaesthesia. 2006;61:671-7.

Nicholas TA, Bernhagen MA, Boedeker BH. Nasotracheal intubation in a difficult airway using the Storz C-MAC Videolaryngoscope, the Boedeker Bougie endotracheal intro- ducer, and the Boedeker curved forceps. Stud Health Technol Inform. 2012;173:310-2.

Jones PM, Armstrong KP, Armstrong PM. A com- parison of glidescope videolaryngoscopy to direct laryn- goscopy for nasotracheal intubation. Anesth Analg. 2008;107:144-8.

Suzuki A, Onodera Y, Mitamura SM. Comparison of the Pentax- AWS Airway Scope with the Macintosh laryngoscope for nasotracheal intubation a randomized, prospective study. J Clin Anesth. 2012;24:561-5.

Puchner W, Drabauer L, Kern K. Indirect versus direct laryngoscopy for routine nasotracheal intubation. J Clin Anesth. 2011;23:280-5.

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