• RohGo UnGUDepartment of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Bundang CHA General Hospital, Seongnam, Korea., Hyun Jeong Kwak, Kyung Cheon Lee, Sun Young Lee, and Jong Yeop Kim.
• Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Bundang CHA General Hospital, Seongnam, Korea.
• Can J Anaesth. 2019 Oct 1; 66 (10): 1213-1220.

BackgroundThe objective of this study was to determine the clinical usefulness of videolaryngoscopes (VLs) by comparing the time to intubation (TTI) and the ease of intubation of McGrath MAC VL (MVL), Pentax Airway Scope VL (PVL), and Macintosh direct laryngoscope (DL) during nasotracheal intubation using manual in-line stabilization to simulate difficult airways.MethodsOne hundred and twenty patients were randomly assigned to the MVL group (n = 40), the PVL group (n = 40), and the DL group (n = 40). Nasotracheal intubation was performed using MVL, PVL, or DL, according to group assignments. The primary outcome was TTI and secondary outcomes were glottic view, ease of intubation, and bleeding.ResultsThe TTI was significantly shorter in the MVL group than in the DL group (45 sec vs 57 sec; difference in means: - 12; 95% confidence interval [CI], - 21 to - 3; P = 0.01). The percentage of glottic opening and Cormack Lehane grade were significantly superior in the MVL and the PVL groups compared with the DL group (both P < 0.001). The intubation difficulty scale and numeric rating scale regarding ease of intubation were also significantly lower in the MVL and PVL groups than in the DL group (all P < 0.007). The incidence of bleeding was significantly lower in the MVL group than in the DL group (3 vs 15, relative risk 0.2; 95% CI, 0.06 to 0.64; P = 0.001).ConclusionThis study showed that both MVL and PVL provided better visualization of the glottis and easier intubation, with less additional manipulation than DL during nasotracheal intubation in simulated difficult airways. Additionally, use of the MVL significantly shortened the TTI compared with the DL.Trial Registrationwww.clinicaltrials.gov (NCT02647606); registered 6 January, 2016.

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