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Published in: BMC Anesthesiology 1/2012

Open Access 01-12-2012 | Research article

Comparison of the glidescope, CMAC, storz DCI with the Macintosh laryngoscope during simulated difficult laryngoscopy: a manikin study

Authors: David W Healy, Paul Picton, Michelle Morris, Christopher Turner

Published in: BMC Anesthesiology | Issue 1/2012

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Abstract

Background

Videolaryngoscopy presents a new approach for the management of the difficult and rescue airway. There is little available evidence to compare the performance features of these devices in true difficult laryngoscopy.

Methods

A prospective randomized crossover study was performed comparing the performance features of the Macintosh Laryngoscope, Glidescope, Storz CMAC and Storz DCI videolaryngoscope. Thirty anesthesia providers attempted intubation with each of the 4 laryngoscopes in a high fidelity difficult laryngoscopy manikin. The time to successful intubation (TTSI) was recorded for each device, along with failure rate, and the best view of the glottis obtained.

Results

Use of the Glidescope, CMAC and Storz videolaryngoscopes improved the view of the glottis compared with use of the Macintosh blade (GEE, p = 0.000, p = 0.002, p = 0.000 respectively). Use of the CMAC resulted in an improved view compared with use of the Storz VL (Fishers, p = 0.05). Use of the Glidescope or Storz videolaryngoscope blade resulted in a longer TTSI compared with either the Macintosh (GLM, p = 0.000, p = 0.029 respectively) or CMAC blades (GLM, p = 0.000, p = 0.033 respectively).

Conclusions

Unsurprisingly, when used in a simulated difficult laryngoscopy, all the videolaryngoscopes resulted in a better view of the glottis than the Macintosh blade. However, interestingly the CMAC was found to provide a better laryngoscopic view that the Storz DCI Videolaryngoscope. Additionally, use of either the Glidescope or Storz DCI Videolaryngoscope resulted in a prolonged time to successful intubation compared with use of the CMAC or Macintosh blade. The use of the CMAC during manikin simulated difficult laryngoscopy combined the efficacy of attainment of laryngoscopic view with the expediency of successful intubation. Use of the Macintosh blade combined expedience with success, despite a limited laryngoscopic view. The limitations of a manikin model of difficult laryngoscopy limits the conclusions for extrapolation into clinical practice.
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Literature
1.
go back to reference Cormack RS, Lehane J: Difficult tracheal intubation in obstetrics. Anaesthesia. 1984, 39: 1105-1111. 10.1111/j.1365-2044.1984.tb08932.x.CrossRefPubMed Cormack RS, Lehane J: Difficult tracheal intubation in obstetrics. Anaesthesia. 1984, 39: 1105-1111. 10.1111/j.1365-2044.1984.tb08932.x.CrossRefPubMed
2.
go back to reference Lewis M, Keramati S, Benumof JL, Berry CC: What is the best way to determine oropharyngeal classification and mandibular space length to predict difficult laryngoscopy?. Anesthesiology. 1994, 81: 69-75. 10.1097/00000542-199407000-00011.CrossRefPubMed Lewis M, Keramati S, Benumof JL, Berry CC: What is the best way to determine oropharyngeal classification and mandibular space length to predict difficult laryngoscopy?. Anesthesiology. 1994, 81: 69-75. 10.1097/00000542-199407000-00011.CrossRefPubMed
3.
go back to reference Yentis SM, Lee DJ: Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia. 1998, 53: 1041-1044. 10.1046/j.1365-2044.1998.00605.x.CrossRefPubMed Yentis SM, Lee DJ: Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia. 1998, 53: 1041-1044. 10.1046/j.1365-2044.1998.00605.x.CrossRefPubMed
4.
go back to reference Mashour GA, Sandberg WS: Craniocervical extension improves the specificity and predictive value of the Mallampati airway evaluation. Anesth Analg. 2006, 103: 1256-1259. 10.1213/01.ane.0000237402.03329.3b.CrossRefPubMed Mashour GA, Sandberg WS: Craniocervical extension improves the specificity and predictive value of the Mallampati airway evaluation. Anesth Analg. 2006, 103: 1256-1259. 10.1213/01.ane.0000237402.03329.3b.CrossRefPubMed
5.
go back to reference You JS, Park S, Chung SP, Park YS, Park JW: The usefulness of the GlideScope video laryngoscope in the education of conventional tracheal intubation for the novice. Emerg Med J. 2009, 26: 109-111. 10.1136/emj.2008.059147.CrossRefPubMed You JS, Park S, Chung SP, Park YS, Park JW: The usefulness of the GlideScope video laryngoscope in the education of conventional tracheal intubation for the novice. Emerg Med J. 2009, 26: 109-111. 10.1136/emj.2008.059147.CrossRefPubMed
6.
go back to reference Low D, Healy D, Rasburn N: The use of the BERCI DCI Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation. Anaesthesia. 2008, 63: 195-201. 10.1111/j.1365-2044.2007.05323.x.CrossRefPubMed Low D, Healy D, Rasburn N: The use of the BERCI DCI Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation. Anaesthesia. 2008, 63: 195-201. 10.1111/j.1365-2044.2007.05323.x.CrossRefPubMed
7.
go back to reference Kaplan MB, Ward DS, Berci G: A new video laryngoscope-an aid to intubation and teaching. J Clin Anesth. 2002, 14: 620-626. 10.1016/S0952-8180(02)00457-9.CrossRefPubMed Kaplan MB, Ward DS, Berci G: A new video laryngoscope-an aid to intubation and teaching. J Clin Anesth. 2002, 14: 620-626. 10.1016/S0952-8180(02)00457-9.CrossRefPubMed
8.
go back to reference Marrel J, Blanc C, Frascarolo P, Magnusson L: Videolaryngoscopy improves intubation condition in morbidly obese patients. Eur J Anaesthesiol. 2007, 24: 1045-1049. 10.1017/S0265021507000889.CrossRefPubMed Marrel J, Blanc C, Frascarolo P, Magnusson L: Videolaryngoscopy improves intubation condition in morbidly obese patients. Eur J Anaesthesiol. 2007, 24: 1045-1049. 10.1017/S0265021507000889.CrossRefPubMed
9.
go back to reference Dhonneur G, Abdi W, Ndoko SK, Amathieu R, Risk N, El Housseini L, Polliand C, Champault G, Combes X, Tual L: Video-assisted versus conventional tracheal intubation in morbidly obese patients. Obes Surg. 2009, 19: 1096-1101. 10.1007/s11695-008-9719-0.CrossRefPubMed Dhonneur G, Abdi W, Ndoko SK, Amathieu R, Risk N, El Housseini L, Polliand C, Champault G, Combes X, Tual L: Video-assisted versus conventional tracheal intubation in morbidly obese patients. Obes Surg. 2009, 19: 1096-1101. 10.1007/s11695-008-9719-0.CrossRefPubMed
10.
go back to reference Ndoko SK, Amathieu R, Tual L, Polliand C, Kamoun W, El Housseini L, Champault G, Dhonneur G: Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq laryngoscopes. Br J Anaesth. 2008, 100: 263-268.CrossRefPubMed Ndoko SK, Amathieu R, Tual L, Polliand C, Kamoun W, El Housseini L, Champault G, Dhonneur G: Tracheal intubation of morbidly obese patients: a randomized trial comparing performance of Macintosh and Airtraq laryngoscopes. Br J Anaesth. 2008, 100: 263-268.CrossRefPubMed
11.
go back to reference Dhonneur G, Ndoko SK, Yavchitz A, Foucrier A, Fessenmeyer C, Pollian C, Combes X, Tual L: Tracheal intubation of morbidly obese patients: LMA CTrach vs direct laryngoscopy. Br J Anaesth. 2006, 97: 742-745. 10.1093/bja/ael219.CrossRefPubMed Dhonneur G, Ndoko SK, Yavchitz A, Foucrier A, Fessenmeyer C, Pollian C, Combes X, Tual L: Tracheal intubation of morbidly obese patients: LMA CTrach vs direct laryngoscopy. Br J Anaesth. 2006, 97: 742-745. 10.1093/bja/ael219.CrossRefPubMed
12.
go back to reference Maharaj CH, Buckley E, Harte BH, Laffey JG: Endotracheal intubation in patients with cervical spine immobilization: a comparison of macintosh and airtraq laryngoscopes. Anesthesiology. 2007, 107: 53-59. 10.1097/01.anes.0000267529.71756.f0.CrossRefPubMed Maharaj CH, Buckley E, Harte BH, Laffey JG: Endotracheal intubation in patients with cervical spine immobilization: a comparison of macintosh and airtraq laryngoscopes. Anesthesiology. 2007, 107: 53-59. 10.1097/01.anes.0000267529.71756.f0.CrossRefPubMed
13.
go back to reference Komatsu R, Kamata K, Hoshi I, Sessler DI, Ozaki M: Airway scope and gum elastic bougie with Macintosh laryngoscope for tracheal intubation in patients with simulated restricted neck mobility. Br J Anaesth. 2008, 101: 863-869. 10.1093/bja/aen288.CrossRefPubMed Komatsu R, Kamata K, Hoshi I, Sessler DI, Ozaki M: Airway scope and gum elastic bougie with Macintosh laryngoscope for tracheal intubation in patients with simulated restricted neck mobility. Br J Anaesth. 2008, 101: 863-869. 10.1093/bja/aen288.CrossRefPubMed
14.
go back to reference Komatsu R, Kamata K, Hamada K, Sessler DI, Ozaki M: Airway scope and StyletScope for tracheal intubation in a simulated difficult airway. Anesth Analg. 2009, 108: 273-279. 10.1213/ane.0b013e31818a4398.CrossRefPubMed Komatsu R, Kamata K, Hamada K, Sessler DI, Ozaki M: Airway scope and StyletScope for tracheal intubation in a simulated difficult airway. Anesth Analg. 2009, 108: 273-279. 10.1213/ane.0b013e31818a4398.CrossRefPubMed
15.
go back to reference Malik MA, Subramaniam R, Churasia S, Maharaj CH, Harte BH, Laffey JG: Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes. Br J Anaesth. 2009, 102: 654-661. 10.1093/bja/aep056.CrossRefPubMed Malik MA, Subramaniam R, Churasia S, Maharaj CH, Harte BH, Laffey JG: Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes. Br J Anaesth. 2009, 102: 654-661. 10.1093/bja/aep056.CrossRefPubMed
16.
go back to reference Malik MA, Maharaj CH, Harte BH, Laffey JG: Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth. 2008, 101: 723-730. 10.1093/bja/aen231.CrossRefPubMed Malik MA, Maharaj CH, Harte BH, Laffey JG: Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth. 2008, 101: 723-730. 10.1093/bja/aen231.CrossRefPubMed
17.
go back to reference Liu EH, Goy RW, Tan BH, Asai T: Tracheal intubation with videolaryngoscopes in patients with cervical spine immobilization: a randomized trial of the Airway Scope(R) and the GlideScope(R). Br J Anaesth. 2009, 103: 446-451. 10.1093/bja/aep164.CrossRefPubMed Liu EH, Goy RW, Tan BH, Asai T: Tracheal intubation with videolaryngoscopes in patients with cervical spine immobilization: a randomized trial of the Airway Scope(R) and the GlideScope(R). Br J Anaesth. 2009, 103: 446-451. 10.1093/bja/aep164.CrossRefPubMed
18.
go back to reference Arslan ZI, Yildiz T, Baykara ZN, Solak M, Toker K: Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA CTrach devices*. Anaesthesia. 2009, 64: 1332-1336. 10.1111/j.1365-2044.2009.06053.x.CrossRefPubMed Arslan ZI, Yildiz T, Baykara ZN, Solak M, Toker K: Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA CTrach devices*. Anaesthesia. 2009, 64: 1332-1336. 10.1111/j.1365-2044.2009.06053.x.CrossRefPubMed
19.
go back to reference Nileshwar A, Thudamaladinne A: Comparison of intubating laryngeal mask airway and Bullard laryngoscope for oro-tracheal intubation in adult patients with simulated limitation of cervical movements. Br J Anaesth. 2007, 99: 292-296. 10.1093/bja/aem127.CrossRefPubMed Nileshwar A, Thudamaladinne A: Comparison of intubating laryngeal mask airway and Bullard laryngoscope for oro-tracheal intubation in adult patients with simulated limitation of cervical movements. Br J Anaesth. 2007, 99: 292-296. 10.1093/bja/aem127.CrossRefPubMed
20.
go back to reference 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. Anesth Analg. 2009, 109: 1560-1565. 10.1213/ANE.0b013e3181b7303a.CrossRefPubMed 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. Anesth Analg. 2009, 109: 1560-1565. 10.1213/ANE.0b013e3181b7303a.CrossRefPubMed
21.
go back to reference Van Zundert A, Maassen R, Lee R, Willems R, Timmerman M, Siemonsma M, Buise M, Wiepking M: A Macintosh laryngoscope blade for videolaryngoscopy reduces stylet use in patients with normal airways. Anesth Analg. 2009, 109: 825-831. 10.1213/ane.0b013e3181ae39db.CrossRefPubMed Van Zundert A, Maassen R, Lee R, Willems R, Timmerman M, Siemonsma M, Buise M, Wiepking M: A Macintosh laryngoscope blade for videolaryngoscopy reduces stylet use in patients with normal airways. Anesth Analg. 2009, 109: 825-831. 10.1213/ane.0b013e3181ae39db.CrossRefPubMed
22.
go back to reference Cavus E, Kieckhaefer J, Doerges V, Moeller T, Thee C, Wagner K: The C-MAC Videolaryngoscope: First Experiences with a New Device for Videolaryngoscopy-Guided Intubation. Anesth Analg. 2010, 110: 473-477. 10.1213/ANE.0b013e3181c5bce5.CrossRefPubMed Cavus E, Kieckhaefer J, Doerges V, Moeller T, Thee C, Wagner K: The C-MAC Videolaryngoscope: First Experiences with a New Device for Videolaryngoscopy-Guided Intubation. Anesth Analg. 2010, 110: 473-477. 10.1213/ANE.0b013e3181c5bce5.CrossRefPubMed
23.
go back to reference Littell RC, Henry PR, Ammerman CB: Statistical analysis of repeated measures data using SAS procedures. J Anim Sci. 1998, 76: 1216-1231.PubMed Littell RC, Henry PR, Ammerman CB: Statistical analysis of repeated measures data using SAS procedures. J Anim Sci. 1998, 76: 1216-1231.PubMed
Metadata
Title
Comparison of the glidescope, CMAC, storz DCI with the Macintosh laryngoscope during simulated difficult laryngoscopy: a manikin study
Authors
David W Healy
Paul Picton
Michelle Morris
Christopher Turner
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2012
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-12-11

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