Comparison of face-to-face tracheal intubation and conventional head-end tracheal intubation using Airtraq™ video-laryngoscope in adults - A randomised study.

Background and Aims: Tracheal intubation can be difficult in certain scenarios where the head-end of the patient is not accessible as in entrapped casualties. A face-to-face technique using a video-laryngoscope can prove to be useful in such scenarios. However, the two positions of tracheal intubation namely, face-to-face and head-end, using video-laryngoscope have never been compared in patients. Material and Methods: Fifty patients of either sex, between 18 and 60 years, ASA class I/II, MPC I/II, scheduled to undergo surgical operations requiring general anesthesia with tracheal intubation were randomly allocated to either Group F (face-to-face intubation) or Group H (head-end intubation). Intubation was performed using Airtraq™ video-laryngoscope in both groups. Time taken for successful intubation, device insertion time, glottic view as per Cormack and Lehane (CL) grade, ease, attempts, the incidence of failed intubation, and hemodynamic parameters were noted. Results: The time taken for successful intubation in Group F was significantly longer than in Group H (38.09 ± 19.45 s vs. 19.32 ± 9.86 s, respectively; P < 0.001). Three cases of failed intubation were noted in Group F compared to none in Group H (P = 0.235). Glottic view, ease, attempts, and hemodynamic parameters were comparable among the groups (P > 0.05). Conclusion: The time taken for successful tracheal intubation was longer in face-to-face technique than in head-end technique in patients with the normal airway. However, both techniques were similar in terms of glottic view, ease of intubation and number of intubation attempts, the incidence of failed intubation, and hemodynamic changes. Therefore, face-to-face tracheal intubation is a good alternative to secure the airway when the head-end is not accessible.

Airtraq® versus GlideScope® for tracheal intubation in adults: a systematic review and meta-analysis with trial sequential analysis.

PURPOSE: In recent years, various types of indirect laryngoscopes have been developed. Nevertheless, no conclusions have been drawn about which type of indirect laryngoscope is most effective for tracheal intubation. We performed a systematic review and meta-analysis to determine whether the Airtraq® or the GlideScope® is more effective for tracheal intubation. METHODS: We extracted studies of adult prospective randomized trials comparing tracheal intubation between the Airtraq and GlideScope. An electronic database was used to extract the studies included in our meta-analysis. We extracted the following data from the identified studies: success rate, glottic visualization, and intubation time. Data from each trial were combined via a random-effects model for calculation of pooled relative risk (RR) or weighted mean difference (WMD) with a 95% confidence interval (CI). We also performed trial sequential analysis. RESULTS: We included eight trials comprising 571 patients for review. Compared with the GlideScope, Airtraq did not improve success rate, glottic visualization, or intubation time in tracheal intubation (success rate: RR, 0.98; 95% CI, 0.91 to 1.05; P = 0.58; I2 = 65%; glottic visualization: RR, 1.07; 95% CI, 0.88 to 1.29; P = 0.69; I2 = 64%; and intubation time: WMD, 1.4 seconds ; 95% CI, -6.2 to 9.1; P = 0.72; I2 = 96%). The quality of evidence was graded as "very low." Trial sequential analysis showed that total sample size did not reach the required information size for all parameters. CONCLUSION: In this meta-analysis, use of the Airtraq indirect laryngoscope did not result in improved success rate, glottic visualization, or intubation time in tracheal intubation compared with the GlideScope. Trial sequential analysis suggests that further studies are necessary to confirm these findings.

RéSUMé: OBJECTIF: Ces dernières années, différents types de laryngoscopes indirects ont été mis au point. Néanmoins, aucune conclusion n'a été tirée sur le type de laryngoscope indirect le plus efficace pour l'intubation trachéale. Nous avons réalisé une revue systématique et une méta-analyse pour déterminer quel dispositif était le plus efficace pour l'intubation trachéale, soit l'Airtraq® ou le GlideScope®. MéTHODE: Nous avons extrait les études portant sur les essais randomisés prospectifs chez l'adulte comparant l'intubation trachéale avec l'Airtraq ou le GlideScope. Une base de données électronique a été utilisée pour extraire les études incluses dans notre méta-analyse. Nous avons extrait les données suivantes des études identifiées : taux de réussite, visualisation glottique et temps d'intubation. Les données de chaque étude ont été combinées au moyen d'un modèle à effets aléatoires pour le calcul du risque relatif (RR) groupé ou de la différence moyenne pondérée (DMP) avec un intervalle de confiance (IC) de 95 %. Nous avons également réalisé une analyse séquentielle des études. RéSULTATS: Nous avons inclus huit études portant sur 571 patients pour notre revue. Par rapport au GlideScope, l'Airtraq n'a pas amélioré le taux de réussite, la visualisation glottique ou le temps d'intubation pour l'intubation trachéale (taux de réussite : RR, 0,98; IC 95 %, 0,91 à 1,05; P = 0,58; I2 = 65 %; visualisation glottique : RR, 1.07; IC 95 %, 0,88 à 1,29; P = 0,69; I2 = 64 %; et temps d'intubation : DMP, 1,4 seconde; IC 95 %, -6,2 à 9,1; P = 0,72; I2 = 96 %). La qualité des données probantes a été classée comme « très faible ¼. L'analyse séquentielle des études a montré que la taille totale de l'échantillon n'atteignait pas la taille d'information requise pour tous les paramètres. CONCLUSION: Selon cette méta-analyse, l'utilisation du laryngoscope indirect Airtraq® n'entraîne pas d'amélioration du taux de réussite, de la visualisation glottique ou du temps d'intubation pour une intubation trachéale par rapport au GlideScope®. L'analyse séquentielle des études suggère que d'autres études sont nécessaires pour confirmer ces résultats.

Tracheal intubation using the Airtraq video laryngoscope vs. Macintosh laryngoscope in patients with anticipated difficult intubation.

Background: Various types of laryngoscopes have been invented to ameliorate the laryngoscopic view of the glottis, in normal and difficult airway, which helps anaesthesiologists to secure the airway during anaesthesia. In this prospective study, we aimed to compare the efficacy of the Airtraq video laryngoscope (AVL) and the Macintosh curved-blade laryngoscope (MBL), by using a common clinical assessment tool in patients with modified Mallampati class III and IV. Methods: A total of 60 patients [group A (AVL) and group M (MBL)] with modified Mallampati class III and IV listed for general anaesthesia were included. Each patient was intubated with either of the laryngoscope based on the group allotted. Time taken for tracheal intubation, grade of visualisation of glottis and need for manoeuvres to optimise the glottic view were compared. Results: The degree of the glottic view during successful intubation attempt was easily appreciated in group A (p < 0.0001). Difference in the requirement of manoeuvres for optimising the laryngeal view/assisting in intubation as assessed by manoeuvre score was easily appreciated in group A (p < 0.010). Rise in heart rate and mean arterial pressure 1 and 2 min after intubation was more in group M than in group A (p < 0.0001). No event of any airway trauma, as evidenced by visible trauma to lips or oral mucosa or blood on laryngoscope, was observed with either of the laryngoscope. Conclusion: The novel AVL provides better intubation conditions with greater ease of intubation, better glottic view and lesser haemodynamic alterations during laryngoscopy than MBL.

A comparative evaluation of Airtraq and Hansraj Video laryngoscopes in patients undergoing tracheal intubation with cervical spine immobilization - A randomized prospective study.

BACKGROUND AND AIMS: Airway management is a key concern in trauma patients with cervical spine fracture. Application of manual inline axial stabilization (MIAS) has become the standard of care in these patients. Indirect laryngoscopy only requires alignment of the pharyngeal and laryngeal axis. Hence the primary objective of the study was to compare two indirect laryngoscopes, Airtraq (with adaptor) and Hansraj Video laryngoscopes based on its Intubation Difficulty Score. MATERIAL AND METHODS: Sixty anesthetized patients were divided into two groups using computer-based randomization, and tracheal intubation was performed using either Airtraq or Hansraj Videolaryngoscope with cervical spine immobilization. RESULTS: Both Airtraq and Hansraj groups were comparable in terms of percentage of glottic opening (POGO) scoring (92 ± 9.88% vs. 89.3 ± 10.4%.) and duration of intubation attempt (14.9 ± 4.36 sec vs. 16.97 ± 3.64 sec). Intubation difficulty scale (IDS) score was significantly shorter with Airtraq (1 ± 0.58 vs. 1.8 ± 0.805; P < 0.0001). The mean duration of time taken for laryngoscopy in Airtraq (12.9 ± 2.07 s vs. 19.06 ± 3.83 s; P < 0.0001)) was significantly shorter and also the duration of time taken to secure airway in Airtraq VL was significantly shorter (29.47 ± 4.75 s vs. 36.03 ± 5.80 sec; P < 0.0001). The heart rate and MABP changes were modest in both groups, but was significantly more in Hansraj VL as compared to Airtraq VL, post-intubation. CONCLUSION: Both Airtraq and Hansraj videolaryngoscope can be used as first-hand device in the scenario of cervical spine stabilization. Airtraq videolaryngoscope is better than Hansraj videolaryngoscope due to shorter IDS and lessor hemodynamic changes.

Does really selection of nostril affect performance of nasotracheal intubation with nasotracheal Airtraq®?

No abstract.

Which nostril should be used for nasotracheal intubation with Airtraq NT®: the right or left? A randomized clinical trial

Background/aim: Nasotracheal Airtraq is specifically designed to improve the glottis view and ease the nasotracheal intubation process in normal and difficult cases. Materials and methods: After Ethics committee approval, we decided to enroll 40 patients with an ASA physical status of I or II, between 18 and 70 years of age undergoing elective maxillofascial, oral, and double chin surgery to determine which nostril is more suitable for nasotracheal intubation with nasotracheal Airtraq. Patients were randomized into the right and left nostril groups. Results: Demographic and airway characteristics were similar among the groups. Nasotracheal intubation through the right nostril was shorter than that of the left nostril during nasotracheal intubation with the Airtraq NT (P < 0.001). 90° counterclockwise rotation of the tip of the tube was needed for directing the tube into the vocal cords in both right and left nostril groups (72% vs 88%). External laryngeal pressure and head flexion maneuvers can ease the intubation from the left nostril (P < 0.001 vs P = 0.03). Cuff inflation maneuver also can be helpful in some cases. We did not need any operator change or Magill forceps for any of the patients. Conclusion: Nasotracheal intubation via the right nostril can be safely and quickly performed with the Airtraq NT without the need of Magill forceps. We recommend the use of the 90° counterclockwise rotation, external laryngeal pressure, and head flexion maneuvers to direct the tube into the vocal cords first. On the other hand, cuff inflation maneuver must also be kept in mind.

A Comparison of 3 Videolaryngoscopes for Double-Lumen Tube Intubation in Humans by Users With Mixed Experience: A Randomized Controlled Study.

OBJECTIVES: To test the hypothesis that laryngoscopy using the Airtraq (Prodol Limited, Viscaya, Spain) or King Vision laryngoscope (KVL) (Ambu A/S, Ballerup, Denmark) would result in a shorter time for successful double-lumen endobronchial tube (DLT) intubation by users with mixed experience than the time required using the Macintosh or GlideScope (Verathon Inc., Bothell, WA) laryngoscopes. DESIGN: A randomized, prospective, blind study. SETTING: A single university hospital. PARTICIPANTS: The study comprised 133 patients undergoing elective thoracic surgery. INTERVENTIONS: Patients were randomly allocated into the following 4 groups of DLTs: Macintosh (n = 32), GlideScope (n = 34), Airtraq (n = 35), or KVL (n = 32). MEASUREMENTS AND MAIN RESULTS: The following data were recorded: time required for achieving successful DLT intubation; glottis visualization; optimization maneuvers; first-pass success rate; intubation difficulty; failure to intubate, defined as an attempt taking >150 seconds to perform or if peripheral oxygen saturation <92% was noted; and postoperative sore throat and hoarseness were recorded. Compared with GlideScope, the Airtraq resulted in shorter times for achieving successful DLT intubation (median times: 21 s [95% confidence interval 23.9-70.8 s] v 57.5 s [95% confidence interval 46.2-89.1 s], respectively; p = 0.021); a lower score for difficult intubations (p = 0.023); and fewer optimization maneuvers. The 4 laryngoscopes were associated with comparable glottis visualization; first-pass success rate (100%, 100%, 94.4%, and 100%, respectively; p = 0.522); incidence of oropharyngeal trauma; postoperative sore throat; and hoarseness of voice. There were 2 (5.7%) endobronchial intubation failures using the Airtraq due to the inability to advance the DLT through the glottis opening. The experience of the anesthesiologists in using the 4 devices had a statistically significant negative correlation with the time to confirmation of endobronchial intubation (Spearman r -0.392; p < 0.001). CONCLUSION: When used by operators with mixed experience, the channeled Airtraq required less time for DLT intubation and was easier to use than the GlideScope, although failures did occur with the Airtraq, whereas they did not occur with the other systems.

A comparison of exposure of Glottis using the Airtraq or the Macintosh Laryngoscope in Potentially difficult airway management: A self-controlled clinical trial.

OBJECTIVE: To compare glottis exposure of the same patients with potentially difficult tracheal intubation (PDTI) subjected to Airtraq laryngoscopy and Macintosh laryngoscopy under consciousness and topical anesthesia. METHODS: A total of 147 PDTI patients with American Society of Anesthesiologists (ASA) I-III were subjected to Airtraq and Macintosh laryngoscopy performed by experienced anesthesiologists under consciousness and topical anesthesia. RESULTS: All patients were successfully intubated. Among them, three patients were intubated with fiberoptic bronchoscopy, 13 with Macintosh laryngoscopy and 131 with Airtraq laryngoscopy. Of the patients with Cormack and Lehance (C&L) Grade-I glottic view, 88 were subjected to Airtraq laryngoscopy and five to Macintosh laryngoscopy; Of the patients with C&L Grade-II glottic view, 56 were subjected to Airtraq laryngoscopy and 21 to Macintosh bronchoscopy; Of the patients with C&L Grade-III glottic view, three were subjected to Airtraq laryngoscopy and 112 to Macintosh bronchoscopy; Of the patients with C&L Grade-IV glottic view, none was subjected to Airtraq laryngoscopy and 9 to Macintosh laryngoscopy. CONCLUSIONS: Airtraq laryngoscopy could significantly improve the glottis exposure and reduce the difficulty of intubation for patients with potentially tracheal intubation compared to the traditional Macintosh laryngoscopy.

Comparison of laryngeal mask airway CTrach™ and Airtraq® videolaryngoscopes as conduits for endotracheal intubation in patients with simulated limitation of cervical spine movements by manual in-line stabilization.

BACKGROUND AND AIMS: Laryngeal mask airway (LMA) CTrach™ and Airtraq® videolaryngoscopes are useful for endotracheal intubation in patients with limited cervical spine movements and other predicted difficult airways. We aimed to compare LMA CTrach™ and Airtraq® videolaryngoscopes as conduits for endotracheal intubation in patients with simulated limitation of cervical spine movements by manual in-line stabilization (MILS). MATERIAL AND METHODS: This was a prospective, randomized study including 50 patients undergoing elective surgeries under general anesthesia. Patients were assigned to undergo intubation using Airtraq® (n = 25) or LMA CTrach™ (n = 25) by an experienced anesthesiologist, while MILS was provided. Laryngoscopy and intubation were compared in terms of time taken to obtain optimal laryngeal view, successful intubation, total time, percentage of glottis opening (POGO) score, maneuvers required for optimal laryngeal view and alignment of endotracheal tube, and number of attempts and complications. An integrated score was calculated to classify the attempt as good, restricted, or poor. RESULTS: Time taken to obtain optimal laryngeal view, successful intubation, and total time in both groups were comparable. POGO score >50% was seen in 25 and 21 patients in Groups A and C. Seventy-six percent and ninety-six percent in Groups A and C, respectively, had a good integrated score; 6% and 1% had restricted score; none had a poor score; and the difference between them was statistically significant (P = 0.042). CONCLUSIONS: LMA CTrach™ and Airtraq® are similar with respect to time taken for obtaining optimal laryngeal view, successful intubation, and total time when used for intubation in patients with simulated limitation of cervical spine movements.

Comparison of VividTrac®, Airtraq®, King Vision®, Macintosh Laryngoscope and a Custom-Made Videolaryngoscope for difficult and normal airways in mannequins by novices.

BACKGROUND: Direct laryngoscopy remains the gold standard for endotracheal intubation and is preferred by experienced operators. However, an increasing number of reports currently support videolaryngoscopy, particularly for novice users. The widespread use of videolaryngoscopy may be limited due to financial limitations, especially in low-income countries. Therefore, affordable single-use scopes are now becoming increasingly popular. We sought to compare these new scopes with direct laryngoscopes and the previously tested videolaryngoscopes in mannequins by novices. METHODS: Fifty medical students were recruited to serve as novice users. Following brief, standardized training, students were asked to execute endotracheal intubation with each of the devices, including the Airtraq®, a custom-made videolaryngoscope, the King Vision®, the Macintosh laryngoscope and the VividTrac®, on an airway trainer (Laerdal Airway Management Trainer®) in normal and difficult airway scenarios. We evaluated the time to and the proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction. RESULTS: We observed no differences in esophageal intubation. However, intubation-related times, the view of the glottis and operator satisfaction were significantly better throughout the study with the commercial videolaryngoscopes. In comparison, the custom-made videolaryngoscope performance proved to be similar to that of the Macintosh laryngoscope. The VividTrac® performance was similar (P > 0.05) or significantly better than that of the King Vision® in both scenarios. CONCLUSIONS: Based upon our results, the Airtraq®, King Vision® and VividTrac® were superior to the Macintosh laryngscope in both normal and difficult airway scencarios for novice users. In particular, our study is the first to report that the VividTrac® shows promise for further clinical evaluation.

A comparative study of McGrath and Airtraq videolaryngoscopes for tracheal intubation.

BACKGROUND AND AIMS: Many cases of difficult tracheal intubation remain unrecognized until after induction of anesthesia. McGrath and Airtraq videolaryngoscopes are among the novel laryngoscopes that have an advantage over the conventional laryngoscopes in case of unanticipated difficult airway. Thus, we did a comparative study between McGrath and Airtraq videolaryngoscopes to evaluate their efficacy in routine anesthesia practice. MATERIAL AND METHODS: Sixty anesthetized patients were divided into two groups using computer-based randomization, and tracheal intubation was performed using either McGrath or Airtraq laryngoscope. The primary outcome measures were duration and incidence of successful tracheal intubation. Hemodynamic response, glottic view (percentage of glottic opening score [POGO]), ease of intubation, and airway complications were also measured. RESULTS: Both McGrath and Airtraq groups were comparable in terms of incidence of successful tracheal intubation (93.3% vs. 96.6%), ease of intubation (70% vs. 77%), and POGO scoring. Intubation time was significantly shorter with Airtraq (13.5 vs. 17.8 s; P < 0.001). There were statistically significant changes in the heart rate and blood pressure after tracheal intubation in both the groups (P < 0.001); however, these parameters reached baseline within 5 min of intubation in both the groups. The incidence of injury was 10% with McGrath videolaryngoscope and 13.3% with Airtraq and was comparable. CONCLUSION: Both Airtraq and McGrath videolaryngoscope have high success rates of intubation. Airtraq is better than McGrath laryngoscope due to shorter tracheal intubation time.

Comparison of polyvinyl chloride, curved reinforced, and straight reinforced endotracheal tubes for tracheal intubation through Airtraq™ laryngoscope in anesthetized patients.

BACKGROUND AND AIMS: The Airtraq™ video laryngoscope facilitates tracheal intubations in patients with difficult airway or cervical spine immobilization. However, curved reinforced tracheal tube and straight reinforced tracheal tubes are useful where neck of the patient is likely to be moved or flexed or if patient is in prone position, wherein nonreinforced endotracheal tube (ETT) might get kinked and/or compressed. We compared intubation success rate of curved and straight reinforced tracheal tubes with polyvinyl chloride (PVC) tracheal tube using Airtaq™ laryngoscope in paralyzed and anesthetized patients. MATERIAL AND METHODS: Totally, 120 patients underwent random allocation to one of the three groups using computer-generated randomization table. Patients were intubated with appropriate size and type of ETT using Airtraq™ after obtaining optimal glottis view. Experienced anesthesiologist performed endotracheal intubation and unblinded observer noted down success and ease of intubation. RESULTS: Patients intubated with PVC tube (100%) had higher rates of successful intubation and shorter intubation time (4 s), in comparison to intubation with curved reinforced (92.5%) and straight reinforced tubes (SRTs) (85%) using Airtraq™ laryngoscope (AL). However, there was no statistical difference in the incidence of airway trauma among all the three groups. CONCLUSIONS: PVC tracheal tube is significantly superior to both curved and SRTs for intubation using AL.

An observational study of feasibility of tracheal intubation using Airtraq in pediatric population.

BACKGROUND AND AIM: There is a paucity of observational studies for the use of Airtraq (AT) in children, especially infants. We undertook a prospective observational study to compare ease of use of infant (size 0), pediatric (size 1), and small (size 2) AT. MATERIAL AND METHODS: AT was used for endotracheal intubation in healthy pediatric patients of 3 months to 18 years age. The primary outcome was success of intubation which was noted as number (%) and analyzed using Fisher's exact test. The secondary outcomes were percentage of glottis opening (POGO) score, visual analog scale (VAS) for field of view, time to best view (TTBV), time to intubation (TTI), and VAS for ease of use and were presented as median (interquartile range) in each subgroup of sizes and analyzed using Kruskal-Wallis test. RESULTS: Overall POGO score was 100 (100, 100 [50-100]) %, VAS field of view was 10 (10, 10 [5-10]), and TTBV was 6 (4, 10 [1.5-24]) s. There was no statistically significant difference in any of the subgroups. The success rate of intubation with AT was 100% with AT size 1 and 2, whereas 45% with AT 0, P < 0.001. VAS for ease of use was 5 (4, 10 [3-10]) with AT 0 compared to 10 (10, 10 [9-10]) with AT 1 and 10 (10, 10 [6-10]) with AT 2 (P < 0.001). TTI was 28 (20, 36 [11.8-59]) s in those who could be successfully intubated. CONCLUSIONS: All sizes of AT provide quick, easy, and excellent glottic visualization. However, failure rate for intubation with infant (size 0) is high compared to nil with pediatric (size 1) and small (size 2).

Evaluation of a smartphone camera system to enable visualization and image transmission to aid tracheal intubation with the Airtraq(®) laryngoscope.

Using three-dimensional printing, we produced adaptors to attach a smartphone with camera to the eyepiece of the Airtraq(®) laryngoscope. This low-cost system enabled a team to simultaneously view the laryngoscopy process on the smartphone screen, and also enabled image transmission. We compared the Airtraq(®) with the smartphone Airtraq(®) system in a crossover study of trainee anesthesiologists performing tracheal intubation in a manikin. We also evaluated the smartphone Airtraq(®) system for laryngoscopy and tracheal intubation in 30 patients, including image transmission to and communication with a remote instructor. In the manikin study, the smartphone Airtraq(®) system enabled instruction where both trainee and instructor could view the larynx simultaneously, and did not substantially increase the time required for intubation. In the patient study, we were able to view the larynx in all 30 patients, and the remote instructor was able to receive the images and to respond on correctness of laryngoscopy and tracheal tube placement. Tracheal intubation was successful within 90s in 19 (63 %) patients. In conclusion, use of a smartphone with the Airtraq(®) may facilitate instruction and communication of laryngoscopy with the Airtraq(®), overcoming some of its limitations.

Face-to-face tracheal intubation in adult patients: a comparison of the Airtraq™, Glidescope™ and Fastrach™ devices.

PURPOSE: Airway management in emergency settings can be difficult due to limited access to the patient. The use of video laryngoscopes along with the Fastrach™ device improves tracheal intubation; however, the use of such devices in a face-to-face intubation model has not been evaluated in adult patients. METHODS: After obtaining official approval from the Local Research Ethics Committee and written informed consent from the patients, 120 patients were enrolled in this prospective randomized study. The patients were ASA I and ASA II according to the American Society of Anesthesiologists Physical Status Classification System. Rocuronium was administered for neuromuscular blockade following standard anesthesia monitoring and induction. The patients were divided into three groups (40 patients per group) and their tracheas were intubated via a face-to-face approach with the Airtraq™, Glidescope™ or Fastrach™ devices. RESULTS: The intubation success rates of the Airtraq™, Glidescope™ and Fastrach™ devices were similar (100, 98 and 90 %; p = 0.07). The insertion time for the Airtraq™ [8.5 (6-11) s] was the shortest followed by the Glidescope™ [11 (7-19) s] and the Fastrach™ [16.5 (14.3-21.8) s; p < 0.001]. The intubation time for the Airtraq™ [14 (10.3-18.8) s] was shorter than the Glidescope™ [25 (18-45) s], and Fastrach™ devices [46.5 (40-65) s; p < 0.001]. The Glidescope™ device required a greater number of optimization maneuvers (p = 0.009) and intubation attempts than the Airtraq™ (p = 0.004). Esophageal intubation (p = 0.001) and mucosal damage were more common in the Fastrach™ group (p = 0.03). CONCLUSIONS: The Airtraq™ device provided faster insertion and intubation times and enabled better Cormack-Lehane grades. Additionally, the Airtraq™ device required the minimum number of optimization maneuvers and was associated with fewer complications and fewer intubation attempts than the Glidescope™ and Fastrach™ devices during face-to-face tracheal intubation.

Comparison of haemodynamic response to tracheal intubation with two different videolaryngoscopes: A randomized clinical trial.

BACKGROUND: Endotracheal intubation (ETI), which is the gold standard in coronary artery bypass grafting (CABG), may cause myocardial ischaemia by disturbing the balance between haemodynamic changes and oxygen supply and consumption of the myocardium as a result of sympathetic stimulation. In this study, we aimed to compare two different videolaryngoscopes (C-MAC and Airtraq) in the hemodynamic response to ETI. METHODS: Fifty ASA II...III CABG surgery patients were randomly assigned to C-MAC or Airtraq. The hemodynamic data included arterial blood pressure [systolic (SAP), diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at six different points in time: before laryngoscopy-T1, during laryngoscopy-T2, immediately after intubation-T3, and 3 (T4), 5 (T5) and 10 (T6) minutes after intubation. Intraoperative complications were recorded. Patients were questioned about postoperative complications 2 and 24...hours following extubation. RESULTS: The hemodynamic response to ETI was significantly greater with C-MAC. The increase in HR started with the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started immediately after ETI (p...=...0.024; p...=...0.012; p...=...0.030; p...=...0.009, respectively). In group analyses, T1...T2, T2...T3 and T1...T3 comparisons did not show any significant differences in HR with Airtraq. However, with C-MAC, HR after intubation increased significantly compared to the pre-laryngoscopy values (T1...T3) (p...=...0.004). The duration of laryngoscopy was significantly reduced with C-MAC (p...<...0.001), but the duration of intubation and total intubation were similar (p...=...0.36; p...=...0.79). CONCLUSIONS: Compared to C-MAC, the hemodynamic response to ETI was less with Airtraq. Thus, Airtraq may be preferred in CABG patients for ETI.