Top

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

19-01-2024 | Oropharyngeal Carcinoma | Reports of Original Investigations

A comparative evaluation of fibreoptic bronchoscopy versus C-MAC^® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients

Authors: Abhishek Kumar, DM, Nishkarsh Gupta, MD, Tanvi Bhargava, MD, Anju Gupta, MD, Vinod Kumar, MD, Sachidanand Jee Bharti, DM, Rakesh Garg, MD, Seema Mishra, MD, Sushma Bhatnagar, MD, Rajeev K. Malhotra, PhD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 4/2024

Abstract

Purpose

Nasotracheal intubation (NTI) is required for surgery in oropharyngeal (OP) carcinoma patients, but it may be challenging because of distorted anatomy, mucosal congestion, and increased risk of bleeding. Flexible bronchoscopy (FB)-guided NTI is preferred in these cases but has limitations. In this randomized controlled study, we sought to compare C-MAC^® D-BLADE-guided videolaryngoscopy (VL) (Karl Storz SE & Co. KG, Tuttlingen, Germany) with FB for NTI under general anesthesia in patients with OP carcinomas.

Methods

We randomized a total of 100 patients with OP carcinoma and El-Ganzouri’s risk index (EGRI) < 7 to undergo NTI under general anesthesia with FB (n = 50) or C-MAC D-BLADE-guided VL (n = 50). The primary outcome was the total intubation time. We also recorded the time to glottis view, nasal intubation difficulty scale (NIDS) score, best percentage of glottis opening score, and complications.

Results

The median [interquartile range (IQR)] total intubation time was shorter with VL than with FB (total intubation time, 38 [26–43] sec vs 60 [52–65] sec; difference, −20 sec [95% confidence interval (CI), −27 to −11]; P < 0.001). Similarly, the median [IQR] time to glottis view was shorter with VL compared to FB (8 [6–9] sec vs 22 [14–25] sec; difference, −13 sec [95% CI, −17 to −10]; P < 0.001). The median NIDS score was higher with VL (difference, 2 [95% CI, 2 to 3]; P < 0.001). The incidences of airway trauma (two cases with FB vs seven with VL; P = 0.30) and postoperative sore throat (ten cases in both groups; P = 0.56) were similar.

Conclusion

Compared to FB, C-MAC D-BLADE-based VL reduced the total time for nasal intubation oropharyngeal carcinoma patients, potentially representing an acceptable alternative in selected cases.

Trial registration

CTRI.nic.in (2018/11/0162830); first submitted 8 November 2018.

Available only for authorised users

Gormley M, Creaney G, Schache A, Ingarfield K, Conway DI. Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors. Br Dent J 2022; 233: 780–6. https://doi.org/10.1038/s41415-022-5166-xCrossRefPubMedPubMedCentral

Ahmed-Nusrath A. Anaesthesia for head and neck carcinoma surgery. BJA Educ 2017; 17: 383–9. https://doi.org/10.1093/bjaed/mkx028CrossRef

Ayuso MA, Sala X, Luis M, Carbó JM. Predicting difficult orotracheal intubation in pharyngolaryngeal disease: preliminary results of a composite index. Can J Anesth 2003; 50: 81–5. https://doi.org/10.1007/bf03020193CrossRefPubMed

Jepsen CH, Gätke MR, Thøgersen B, et al. Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios: a randomised controlled manikin study. Eur J Anaesthesiol 2014; 31: 131–6. https://doi.org/10.1097/eja.0b013e32836590a7CrossRefPubMed

Woodall NM, Harwood RJ, Barker GL. Complications of awake fibreoptic intubation without sedation in 200 healthy anaesthetists attending a training course. Br J Anaesth 2008; 100: 850–5. https://doi.org/10.1093/bja/aen076CrossRefPubMed

Nagarkar R, Kokane G, Wagh A, et al. Airway management techniques in head and neck cancer surgeries: a retrospective analysis. Oral Maxillofac Surg 2019; 23: 311–5. https://doi.org/10.1007/s10006-019-00782-1CrossRefPubMed

Dalal PG, Dalal GB, Pott L, Bezinover D, Prozesky J, Bosseau Murray W. Learning curves of novice anesthesiology residents performing simulated fibreoptic upper airway endoscopy. Can J Anesth 2011; 58: 802–9. https://doi.org/10.1007/s12630-011-9542-2CrossRefPubMed

Kramer A, Müller D, Pförtner R, Mohr C, Groeben H. Fibreoptic vs videolaryngoscopic (C-MAC® D-BLADE) nasal awake intubation under local anaesthesia. Anaesthesia 2015; 70: 400–6. https://doi.org/10.1111/anae.13016CrossRefPubMed

Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management: a topical review of the literature. Acta Anaesthesiol Scand 2010; 54: 1050–61. https://doi.org/10.1111/j.1399-6576.2010.02285.xCrossRefPubMed

10.

Roh GU, Kwak HJ, Lee KC, Lee SY, Kim JY. Randomized comparison of McGrath MAC videolaryngoscope, Pentax Airway Scope, and Macintosh direct laryngoscope for nasotracheal intubation in patients with manual in-line stabilization. Can J Anesth 2019; 66: 1213–20. https://doi.org/10.1007/s12630-019-01409-5CrossRefPubMed

11.

Jiang J, Ma DX, Li B, Wu AS, Xue FS. Videolaryngoscopy versus direct laryngoscopy for nasotracheal intubation: a systematic review and meta-analysis of randomised controlled trials. J Clin Anesth 2019; 52: 6–16. https://doi.org/10.1016/j.jclinane.2018.08.029CrossRefPubMed

12.

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. Br J Anaesth 2012; 109: 439–43. https://doi.org/10.1093/bja/aes145CrossRefPubMed

13.

Law JA, Thana A, Milne AD. The incidence of awake tracheal intubation in anesthetic practice is decreasing: a historical cohort study of the years 2014–2020 at a single tertiary care institution. Can J Anesth 2023; 70: 69–78. https://doi.org/10.1007/s12630-022-02344-8CrossRefPubMed

14.

El-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996; 82: 1197–204. https://doi.org/10.1097/00000539-199606000-00017CrossRefPubMed

15.

Lee MC, Tseng KY, Shen YC, et al. Nasotracheal intubation in patients with limited mouth opening: a comparison between fibreoptic intubation and the Trachway®. Anaesthesia 2016; 71: 31–8. https://doi.org/10.1111/anae.13232CrossRefPubMed

16.

Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for the management of unanticipated difficult intubation in adults. Br J Anaesth 2015; 115: 827–48. https://doi.org/10.1093/bja/aev371CrossRefPubMedPubMedCentral

17.

Cortellazzi P, Minati L, Falcone C, Lamperti M, Caldiroli D. Predictive value of the El-Ganzouri multivariate risk index for difficult tracheal intubation: a comparison of Glidescope® videolaryngoscopy and conventional Macintosh laryngoscopy. Br J Anaesth 2007; 99: 906–11. https://doi.org/10.1093/bja/aem297CrossRefPubMed

18.

Schnack DT, Kristensen MS, Rasmussen LS. Patients’ experience of awake versus anaesthetised orotracheal intubation: a controlled study. Eur J Anaesthesiol 2011; 28: 438–42. https://doi.org/10.1097/eja.0b013e328343222dCrossRefPubMed

19.

Prasanna D, Bhat S. Nasotracheal intubation: an overview. J Maxillofac Oral Surg 2014; 13: 366–72. https://doi.org/10.1007/s12663-013-0516-5CrossRefPubMed

20.

Yumul R, Elvir-Lazo OL, White PF, et al. Comparison of the C-MAC video laryngoscope to a flexible fiberoptic scope for intubation with cervical spine immobilization. J Clin Anesth 2016; 31: 46–52. https://doi.org/10.1016/j.jclinane.2015.12.045CrossRefPubMed

21.

Durga VK, Millns JP, Smith JE. Manoeuvres used to clear the airway during fibreoptic intubation. Br J Anaesth 2001; 87: 207–11. https://doi.org/10.1093/bja/87.2.207CrossRefPubMed

22.

Xue FS, Li HX, Liu YY, Yang GZ. Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature. Ther Clin Risk Manag 2017; 13: 831–41. https://doi.org/10.2147/tcrm.s136221CrossRefPubMedPubMedCentral

23.

Seo KH, Kim KM, John H, Jun JH, Han M, Kim S. Comparison of C-MAC D-blade videolaryngoscope and McCoy laryngoscope efficacy for nasotracheal intubation in simulated cervical spinal injury: a prospective randomized comparative study. BMC Anesthesiol 2020; 20: 114. https://doi.org/10.1186/s12871-020-01021-xCrossRefPubMedPubMedCentral

24.

Kim YC, Lee SH, Noh GJ, et al. Thermosoftening treatment of the nasotracheal tube before intubation can reduce epistaxis and nasal damage. Anesth Analg 2000; 91: 698–701. https://doi.org/10.1097/00000539-200009000-00038CrossRefPubMed

Title: A comparative evaluation of fibreoptic bronchoscopy versus C-MAC® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients
Authors: Abhishek Kumar, DM
Nishkarsh Gupta, MD
Tanvi Bhargava, MD
Anju Gupta, MD
Vinod Kumar, MD
Sachidanand Jee Bharti, DM
Rakesh Garg, MD
Seema Mishra, MD
Sushma Bhatnagar, MD
Rajeev K. Malhotra, PhD
Publication date: 19-01-2024
Publisher: Springer International Publishing
Keywords: Oropharyngeal Carcinoma
Bronchoscopy
General Anesthesia
Difficult Airway
Sore Throat
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 4/2024
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-023-02687-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A comparative evaluation of fibreoptic bronchoscopy versus C-MAC^® D-BLADE-guided videolaryngoscopy for nasotracheal intubation under general anesthesia in oropharyngeal carcinoma surgery patients

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 4/2024

Canadian tertiary care pediatric massive hemorrhage protocols: a survey and comprehensive national review

Subcutaneous emphysema potentially caused by tracheostomy tubes with subglottic suction devices

Inhaled iloprost in off-pump coronary artery bypass surgery: a randomized controlled trial

Landiolol for the prevention of postoperative atrial fibrillation: a trial sequential analysis

Comment on “In reply: Comment on ‘Strategies for intraoperative glucose management: a scoping review’”

Clinician responses to disruptive intraoperative behaviour: patterns and norms identified from a multinational survey