Comparison of direct laryngoscope and McGrath videolaryngoscope in terms of glottic view and hemodynamics in bariatric surgery

Background/aim: In the recent years, videolaryngoscopes VL have emerged as alternative devices to direct laryngoscopes DL in difficult intubation situations. Therefore, we aimed to compare the Macintosh DL and McGrath VL in terms of the glottic image quality, intubation success, intubation time, hemodynamic response after intubation, and complications in bariatric surgery patients.Material and methods: After obtaining approval by the ethics committee and receiving informed consent, we recorded the demographic and physical data of patients undergoing bariatric surgery. Patients were divided into 2 groups: Group M was intubated with the Macintosh DL, and Group V was intubated with the McGrath VL. After intubation, we noted the Cormack-Lehane score, the duration of intubation, the number of intubation interventions, and the hemodynamic data of patients. Results: A total of 62 patients ASA II, body mass index of >35 kg/m2 were included in the study. All patients except 1 patient were intubated on the first attempt. Although there was a decrease in heart rate and blood pressure with induction, similar hemodynamic data were obtained between groups during the operation. In group V, we obtained a better glottic image P = 0.011 , but intubation success was similar between the study groups. We also measured the intubation time in group M as 45.9 ± 19.1 s and group V as 57.1 ± 15.8 s P = 0.015 .Discussion: Although we measured longer intubation times with the McGrath VL compared with the Macintosh DL, we obtained a better glottic image without causing hemodynamic changes. However, these findings did not make any difference in terms of intubation success.

Keywords:

McGrath videolaryngoscope, bariatric surgery, airway management glottic view, hemodynamics,

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1. Catenacci VA, Hill JO, Wyatt HR. The obesity epidemic. Clinics in Chest Medicine 2009; 30 (3): 415-444. doi: 10.1016/j. ccm.2009.05.001
2. Ezri T, Gewurtz G, Sessler DI, Medalion B, Szmuk P et al. Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia 2003; 58 (11): 1111-1114.
3. Ng I, Hill AL, Williams DL, Lee K, Segal R. Randomized controlled trial comparing the McGrath videolaryngoscope with the C-MAC videolaryngoscope in intubating adult patients with potential difficult airways. British Journal of Anaesthesia 2012; 109 (3): 439-443. doi: 10.1093/bja/aes145
4. Murphy C, Wong DT. Airway management and oxygenation in obese patients. Canadian Journal of Anaesthesia = Journal Canadien D’anesthesie 2013; 60 (9): 929-945. doi: 10.1007/ s12630-013-9991-x
5. Neligan PJ, Porter S, Max B, Malhotra G, Greenblatt EP et al. Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients. Anesthesia and Analgesia 2009; 109 (4): 1182-1186. doi: 10.1213/ane.0b013e3181b12a0c
6. Marrel J, Blanc C, Frascarolo P, Magnusson L. Videolaryngoscopy improves intubation condition in morbidly obese patients. European Journal of Anaesthesiology 2007; 24 (12): 1045-1049. doi: 10.1017/S0265021507000889
7. Su YC, Chen CC, Lee YK, Lee JY, Lin KJ. Comparison of video laryngoscopes with direct laryngoscopy for tracheal intubation: a meta-analysis of randomised trials. European Journal of Anaesthesiology 2011; 28 (11): 788-795. doi: 10.1097/ EJA.0b013e32834a34f3
8. Merli G. Videolaryngoscopy: is it only a change of view? Minerva Anestesiologica 2010; 76 (8): 569-571.
9. Pazur I, Maldini B, Hostic V, Ozegic O, Obraz M. Comparison of Cormack Lehane grading system and intubation difficulty score in patients intubated by D-Blade video and direct Macintosh laryngoscope: A randomized controlled study. Acta Clinica Croatica 2016; 55 (4): 560-564. doi: 10.20471/acc.2016.55.04.05
10. Hoshijima H, Mihara T, Maruyama K, Denawa Y, Takahashi M et al. McGrath videolaryngoscope versus Macintosh laryngoscope for tracheal intubation: A systematic review and meta-analysis with trial sequential analysis. Journal of Clinical Anesthesia 2018; 46: 25-32. doi: 10.1016/j.jclinane.2017.12.030
11. Arici S, Karaman S, Dogru S, Karaman T, Tapar H et al. The McGrath Series 5 video laryngoscope versus the Macintosh laryngoscope: a randomized trial in obstetric patients. Turkish Journal of Medical Sciences 2014; 44 (3): 387-392.
12. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39 (11): 1105-1111.
13. Aceto P, Perilli V, Modesti C, Ciocchetti P, Vitale F et al. Airway management in obese patients. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery 2013; 9 (5): 809-815. doi: 10.1016/j.soard.2013.04.013
14. Yumul R, Elvir-Lazo OL, White PF, Sloninsky A, Kaplan M et al. Comparison of three video laryngoscopy devices to direct laryngoscopy for intubating obese patients: a randomized controlled trial. Journal of Clinical Anesthesia 2016; 31: 71-77. doi: 10.1016/j.jclinane.2015.12.042
15. Hoshijima H, Denawa Y, Tominaga A, Nakamura C, Shiga T et al. Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis. Journal of Clinical Anesthesia 2018; 44: 69- 75. doi: 10.1016/j.jclinane.2017.11.008
16. Combes X, Dhonneur G. Difficult tracheal intubation. British Journal of Anaesthesia 2010; 104 (2): 260; author reply 261. doi: 10.1093/bja/aep384
17. Maassen R, Lee R, Hermans B, Marcus M, van Zundert A. A comparison of three videolaryngoscopes: the Macintosh laryngoscope blade reduces, but does not replace, routine stylet use for intubation in morbidly obese patients. Anesthesia and Analgesia 2009; 109 (5): 1560-1565. doi: 10.1213/ ANE.0b013e3181b7303a
18. Sharma DJ, Weightman WM, Travis A. Comparison of the Pentax Airway Scope and McGrath Videolaryngoscope with the Macintosh laryngoscope in tracheal intubation by anaesthetists unfamiliar with videolaryngoscopes: a manikin study. Anaesthesia and Intensive Care 2010; 38 (1): 39-42. doi: 10.1177/0310057X1003800108
19. Altun D, Ali A, Camci E, Ozonur A, Seyhan TO. Haemodynamic response to four different laryngoscopes. Turkish Journal of Anaesthesiology and Reanimation 2018; 46 (6): 434-440. doi: 10.5152/TJAR.2018.59265
20. Xue FS, Zhang GH, Li XY, Sun HT, Li P et al. Comparison of hemodynamic responses to orotracheal intubation with the GlideScope videolaryngoscope and the Macintosh direct laryngoscope. Journal of Clinical Anesthesia 2007; 19 (4): 245- 250. doi: 10.1016/j.jclinane.2006.11.004
21. Nishikawa K, Matsuoka H, Saito S. Tracheal intubation with the PENTAX-AWS (airway scope) reduces changes of hemodynamic responses and bispectral index scores compared with the Macintosh laryngoscope. Journal of Neurosurgical Anesthesiology 2009; 21 (4): 292-296. doi: 10.1097/ ANA.0b013e3181a9c6dc
22. Williams D, Ball DR. Palatal perforation associated with McGrath videolaryngoscope. Anaesthesia 2009; 64 (10): 1144- 1145. doi: 10.1111/j.1365-2044.2009.06091.x
23. Lascarrou JB, Boisrame-Helms J, Bailly A, Le Thuaut A, Kamel T et al. Video Laryngoscopy vs Direct Laryngoscopy on successful first-pass orotracheal intubation among ICU patients: A randomized clinical trial. Jama 2017; 317 (5): 483- 493. doi: 10.1001/jama.2016.20603
24. Taylor AM, Peck M, Launcelott S, Hung OR, Law JA et al. The McGrath(R) Series 5 videolaryngoscope vs the Macintosh laryngoscope: a randomised, controlled trial in patients with a simulated difficult airway. Anaesthesia 2013; 68 (2): 142-147. doi: 10.1111/anae.12075
25. Barak M, Philipchuck P, Abecassis P, Katz Y. A comparison of the Truview blade with the Macintosh blade in adult patients. Anaesthesia 2007; 62 (8): 827-831. doi: 10.1111/j.1365- 2044.2007.05143.x