Title: A Prospective Randomized Study to Compare the Ease of Tracheal Intubation using Truview, Airtraq and Macintosh Laryngoscopic Blades
Authors: Kaushik Prajwala S. MD, DNB, Oak Shrikanta P. DA, DNB, Yashod Shamala Dinkar MD
DOI: https://dx.doi.org/10.18535/jmscr/v9i10.32
Abstract
Introduction: Anaesthesiologists face several complications during tracheal intubation, inability to intubate being the most devastating. Macintosh has been the gold standard since times immemorial. Newer indirect laryngoscope blades have come into vogue which improve visualization of glottis. In our study we compare the ease of tracheal intubation between direct and indirect laryngoscopes.
Methods: Ninety consenting patients were included in this prospective randomized controlled trial to compare the ease of tracheal intubation using Truview(Group 1), Airtraq (Group 2) and MacIntosh (Group 3) laryngoscope blades. The time taken for intubation, intubation difficulty score, hemodynamic changes with intubation and complications were observed and compared.
Results: There was no statistically significant difference between the three blades with respect to duration of intubation (p =0.3), intubation difficulty score or complications. Statistically significant difference in pulse, mean arterial pressure at 1,3 and 5 minutes post intubation was found between the groups. Therise in pulse was found to be significantly lesser in Group 1(p value-0.001)
and Group 2(p value- 0.040) when compared to Group 3 at 3 minutes and significantly lesser in Group 1 when compared to Group 3(p value-0.041) at 5 minutes . Rise in mean arterial pressure (MAP) was significantly lesser in Group 2 when compared to Group 3 at 1 minute (p value- 0.038) and 3 minutes (p value- 0.026) after intubation.
Conclusion: Airtraq provides certain advantages over Truview and Macintosh in terms of ease of intubation and hemodynamic stability when used by experienced anesthesiologists in a normal airway.
Keywords: Truview; Macintosh; Airtraq; Intubation.
References
- Bag S K, Kumar V R H, Krishnaveni N, Ravishankar M, Velraj J, Aruloli M et all. A comparative study between Truview PCD laryngoscope and Macintosh laryngoscope in viewing glottic opening and ease of intubation: A crossover study. Anesth Essays Res. 2014. 8(3).372-76
- Bhandari G, Shahi K S, Asad M, and Bhakuni Rairtraqversus Macintosh laryngoscope: A comparative study in tracheal intubation .Anesth Essays Res. 2013 .7(2): 232–36.
- Cheney FW. The American Society of Anesthesiologists Closed Claims Project: What have we learned, how has it affected practice, and how will it affect practice in the future? Anesthesiology. 1999;91:552–6
- Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: A closed claims analysis. Anesthesiology. 2005; 103: 33–9.
- Maharaj CH, O’Croinin D, Curley G, Harte BH, Laffey JG. A comparison of tracheal intubation using the Airtraq® or the Macintosh laryngoscope in routine airway management: A randomised, controlled clinical trial. Anaesthesia. 2006;61(11):1093–9
- Liem EB, Bjoraker DG, Gravenstein D. New options for airway management: Intubating fibreoptic stylets. Vol. 91, British Journal of Anaesthesia. 2003. p. 408–18.
- Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL, Plaisance P LC. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesia. 1997;87(6):1290–7.
- Collins SR. Direct and Indirect Laryngoscopy: Equipment and Techniques. Respir Care [Internet]. 2014;59(6):850–64.
- Dwivedi Y, Shukla V, Srivastava U, Saxena A, Gupta A. Comparison of Airtraq and Trueview EVO2 with Macintosh Laryngoscope for Endotracheal Intubation by Experienced Anaesthesiologists: A Controlled Clinical Trial 2/6 Material & Methods. J Anesth Crit Care Open Access. 2015;3(4) :105-11
- Saxena A, Madan M, Shrivastava U, Mittal A, Dwivedi Y, Agrawal A, et al. Role of the truview EVO2 laryngoscope in the airway management of elective surgical patients: A comparison with the macintosh laryngoscope. Indian J Anaesth. 2013; 57(3): 276–281
- Hirabayashi Y, Hoshijima H, Kuratani N. Airtraq for difficult airways: A metaanalysis of randomized controlled trials. Japanese J Anesthesiol. 2013;62(7): 879–85
- Lu Y, Jiang H, Zhu YS. Airtraq laryngoscope versus conventional Macintosh laryngoscope: A systematic review and meta-analysis. Anaesthesia. 2011
- McElwain J, Malik MA, Harte BH, Flynn NM, Laffey JG. Comparison of the CMAC® videolaryngoscope with the Macintosh, Glidescope®, and Airtraq® laryngoscopes in easy and difficult laryngoscopy scenarios in manikins. Anaesthesia. 2010;
- Ertürk T, Deniz S, Şimşek F, Purtuloğlu T, Kurt E. Comparison of the Macintosh and Airtraq Laryngoscopes in Endotracheal Intubation Success .Turk J Anaesthesiol Reanim. 2015; 43(3): 181–187
- Timanaykar RT, Anand LK, Palta S. A randomized controlled study to evaluate and compare Truview blade with Macintosh blade for laryngoscopy and intubation under general anesthesia. J Anaesthesiol Clin Pharmacol. 2011;27(2):199–204
- Chalkeidis O, Kotsovolis G, Kalakonas A, Filippidou M, Triantafyllou C, Vaikos D, et al. A comparison between the Airtraq?? and macintosh laryngoscopes for routine airway management by experienced anesthesiologists: A randomized clinical trial. Acta Anaesthesiol Taiwanica. 2010;