Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2026.844757
Brazilian Journal of Anesthesiology
Original Investigation

Comparative analysis of a 3D-printed videolaryngoscope versus the Macintosh model in adult airway management: a randomized clinical trial

Análise comparativa de um videolaringoscópio impresso em 3D versus o modelo Macintosh no manejo das vias aéreas em adultos: um ensaio clínico randomizado

Florentino Fernandes Mendes, Liége Caroline Immich, Thiago Fagundes Gross, Luis Fernando Marcelino Braga, Andreia Gomes Aires, Elizandra Braganhol, Ramon Magalhães Mendonça Vilela, Francine Ullrich Carrazzoni dos Reis, Gustavo Zordan Piva, Victor Hugo Reinoso Gomez, Vinicius Hofstätter Rodrigues, Afonso Reguly, Leandro de Freitas Spinelli, Simone Schneider Amaral, Gisele Orlandi Introíni

http://dx.doi.org/10.1016/j.bjane.2026.844757 Braz J Anesthesiol, vol.76, n4, 844757, 2026
PDF
Downloads: 0
Views: 13

Abstract

Background and objectives

Video Laryngoscopy (VL) provides enhanced glottic visualization in airway management, but its high cost limits adoption. Three-Dimensional (3D) printing offers a cost-effective alternative for producing VL devices. This randomized trial compared a 3D-printed Videolaryngoscope (VL3D) with the standard Macintosh Laryngoscope (MAC) during tracheal intubation in adults.

Methods

This was a randomized, controlled, and assessor-blinded clinical trial. The primary outcome was intubation difficulty, assessed using the Intubation Difficulty Scale (IDS). Secondary outcomes included glottic visualization (Cormack-Lehane grade) and Intubation Time (IT). The final analysis followed a modified intention-to-treat principle.

Results

This study included 52 patients scheduled to undergo general anesthesia with tracheal intubation. Baseline characteristics were comparable between groups. The analysis included 49 patients (VL3D, n = 26; MAC, n = 23). Categorical analysis of the primary outcome showed a higher incidence of moderate-to-severe intubation difficulty in the VL3D group (23.1% vs. 0%, p = 0.032), although median IDS scores were statistically similar. In relation to secondary outcomes, the VL3D provided significantly superior glottic visualization (Cormack-Lehane grade I: 72.0% in the VL3D group vs. 33.3% in the MAC group, p = 0.002). Conversely, the VL3D was associated with a significantly longer intubation time (median 70 seconds vs. 40 seconds, p = 0.005).

Conclusions

The VL3D demonstrated superior glottic visualization but correlated with significantly longer intubation duration and greater procedural difficulty. These findings suggest that additional specialized training or design optimization is necessary before widespread clinical implementation.

Keywords

3D Printing; Additive Manufacturing; Airway Management; Intratracheal; Intubation

Resumo

Contexto e objetivos

A videolaringoscopia (VL) proporciona melhor visualização da glote no manejo das vias aéreas, mas seu alto custo limita sua adoção. A impressão tridimensional (3D) oferece uma alternativa de baixo custo para a produção de dispositivos de VL. Este estudo randomizado comparou um videolaringoscópio impresso em 3D (VL3D) com o laringoscópio Macintosh (MAC) padrão durante a intubação traqueal em adultos.

Métodos

Este foi um ensaio clínico randomizado, controlado e com avaliação cega. O desfecho primário foi a dificuldade de intubação, avaliada pela Escala de Dificuldade de Intubação (IDS). Os desfechos secundários incluíram a visualização da glote (classificação de Cormack-Lehane) e o tempo de intubação (TI). A análise final seguiu o princípio da intenção de tratar modificado.

Resultados

Este estudo incluiu 52 pacientes agendados para anestesia geral com intubação traqueal. As características basais foram comparáveis ​​entre os grupos. A análise incluiu 49 pacientes (VL3D, n = 26; MAC, n = 23). A análise categórica do desfecho primário mostrou uma maior incidência de dificuldade de intubação moderada a grave no grupo VL3D (23,1% vs. 0%, p = 0,032), embora os escores medianos do IDS tenham sido estatisticamente semelhantes. Em relação aos desfechos secundários, o VL3D proporcionou visualização glótica significativamente superior (grau I de Cormack-Lehane: 72,0% no grupo VL3D vs. 33,3% no grupo MAC, p = 0,002). Por outro lado, o VL3D foi associado a um tempo de intubação significativamente maior (mediana de 70 segundos vs. 40 segundos, p = 0,005).

Conclusões

O VL3D demonstrou visualização glótica superior, mas correlacionou-se com duração de intubação significativamente maior e maior dificuldade do procedimento. Esses achados sugerem que treinamento especializado adicional ou otimização do projeto são necessários antes da implementação clínica generalizada.

Palavras-chave

Impressão 3D; Manufatura Aditiva; Manejo das Vias Aéreas; Intubação Intratraqueal

Referencias

1. Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev. 2022;4. CD011136.

2. Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: A Cochrane systematic review and metaanalysis update. Br J Anaesth. 2022;129:612−23.

3. Prekker ME, Driver BE, Trent SA, Resnick-Aultet D. DEVICE Investigators and the Pragmatic Critical Care Research Group. Video versus direct laryngoscopy for tracheal intubation of critically Ill adults. N Engl J Med. 2023;389:418−29.

4. Fonternel T, van Rooyen H, Joubert G, Turton E. Evaluating the usability of a 3D-printed video laryngoscope for tracheal intubation of a manikin. Med Devices. 2023;16:157−65.

5. Karippacheril JG, Cong ML. Videolaryngoscopy using an Android smartphone: A direct digital technique. Indian J Anaesth. 2016;60:143−5.

6. Mendes FF, Spinelli LF, Dutra PAS, de Braga ES, et al. Threedimensional printed laryngoscopes as allies against COVID-19. 3D Print Addit Manuf. 2023;10:930−40.

7. Seo SH, Lee JG, Yu SB, Kim DS, et al. Predictors of difficult intubation defined by the Intubation Difficulty Scale (IDS): predictive value of 7 airway assessment factors. Korean J Anesthesiol. 2012;63:491−7.

8. Adnet F, Borron SW, Racine SX, Clemessy JL, et al. The Intubation Difficulty Scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology. 1997;87:1290−7.

9. Borges RB, Mancuso ACB, Camey S, Leotti VD, et al. Power and Sample Size for Health Researchers: uma ferramenta para calculo de tamanho amostral e poder do teste voltado a pesquisadores da area da saúde. Clin Biomed Res. 2021;40.

10. Sakles JC, Rodgers R, Keim SM. Optical and video laryngoscopes for emergency airway management. Intern Emerg Med. 2008;3:139−43.

11. Martin LD, Mhyre JM, Shanks AM, Tremper KK. Kheterpal S. 3,423 emergency tracheal intubations at a university hospital: airway outcomes and complications. Anesthesiology. 2011;114: 42−8.

12. Paolini JB, Donati F, Drolet P. Review article: video-laryngoscopy: another tool for difficult intubation or a new paradigm in airway management? Can J Anaesth. 2013;60:184−91.

Submitted date:
26/08/2025

Accepted date:
05/04/2026

6a62208ba953953d07404bc7 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2026 Todos los derechos reservados sobre el contenido de este sitio web. Los artículos siguen sus propias licencias.

Braz J Anesthesiol

Share this page
Page Sections