Comparison of the Laryngeal Mask Airway (CTrachTM) and Direct Coupled Interface-Video Laryngoscope for Endotracheal Intubation: a Prospective, Randomized, Clinical Study

Abstract

Objective: Video laryngoscopy was developed to facilitate tracheal intubation of difficult airways. We aimed to compare the efficacy of CTrach™ (CT) and Direct Coupled Interface-Videolaryngoscope (DCI-VL) in patients with normal airways. Material and Methods: Sixty ASA I–II (American Society of Anesthesiologists) adult patients admitted for elective surgery were enrolled in this prospective study. The patients were randomly assigned to two groups, where intubation was performed via CT or DCI-VL. Time to obtain a good glottic view, total intubation time, success rates and the number of patients who required maneuvers for a good glottic view were recorded. Results: The mean time to obtaining a good glottic view was significantly longer with CT than with DCI-VL (29.4±20.3 seconds vs. 12.8±1.9 seconds, respectively; p=0.01). Intubation was achieved on the first attempt in 28 patients in the CT group (93.3%) and in 24 in the DCI-VL group (80%) (p=0.77). The total intubation time for CT was significantly longer compared to DCI-VL (99.9±36.0 seconds vs. 39.2±21.4 seconds, respectively; p=0.01). Optimization maneuvers were required in eight and two patients in the CT and DCI-VL groups, respectively (p=0.03). Conclusion: Although the normal airway endotracheal intubation success rates were similar in both groups, the time to obtain a good glottic view and the total intubation time were significantly shorter with DCI-VL. Turkish Anahtar Kelimeler: CTrach, video laringoskop, havayolu yönetimi Amaç: Video laringoskopi zor hava yolunda trakeal entubasyonu kolaylaştırmak amacıyla geliştirilmiştir. Bu çalışmada CTrach™ (CT) ve Direct Coupled Interface-Videolariyngoskopun (DCI-VL) normal hava yoluna sahip hastalarda etkinliklerinin karşılaştırılması amaçlanmıştır. Materyal metod: Bu çalışmaya elektif cerrahi planlanan, 60 ASA (American Society of Anesthesiologists) I-II yetişkin hasta dahil edildi. Hastalar rastgele, entübasyonun CT veya DCI-VL aracılığıyla yapılacaklar olmak üzere iki gruba ayrıldı. İyi glottik görüntü elde etme süresi, total entübasyon süresi, entübasyon başarı oranları ve iyi glottik görüntü elde etmek için manevraya ihtiyaç duyulan hastalar kaydedildi. Bulgular: CT ile iyi glottik görüntü elde etmek için gereken süre DCI-VL' tan anlamlı olarak uzundu (29.4±20.3 saniye, 12.8±1.9 saniye; p=0.01). İlk denemede entübasyon, CT grubunda 28 hastada (%93.3), DCI –VL grubunda 24 hastada (%80) gerçekleşti (p=0.77). Total entübasyon süresi CT de, DCI- VL ile karşılaştırıldığında anlamlı olarak daha uzundu (99.9±36.0 saniye, 39.2±21.4 saniye, p=0.01). CT grubunda 8, DCI- VL grubunda ise 2 hastada optimizasyon manevraları gerekti (p=0.03). Sonuç: Normal hava yolu olan hastalarda endotrakeal entubasyon başarı oranları her iki grupta da benzer olmasına rağmen, iyi glottik görüntü elde etme süresi ve total entübasyon süresi DCI-VL de anlamlı olarak kısadır.

Keywords

• CTrach, video laryngoscope, airway management

Comparison of the Laryngeal Mask Airway (CTrachTM) and Direct Coupled Interface-Video Laryngoscope for Endotracheal Intubation: a Prospective, Randomized, Clinical Study

Öz

References

1. Tse JC, Rimm EB, Hussain A. Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study. Anesth Analg 1995;81: 254-8. [CrossRef]
2. Combes X, Le Roux B, Suen P, Dumerat M, Motamed C, Sauvat S, et al. Unanticipated difficult airway in anesthetized patients: prospective validation of a management algorithm. Anesthesiology 2004;100:1146-50. [CrossRef]
3. Crosby ET, Cooper RM, Douglas MJ, Doyle DJ, Hung OR, Labrecque P, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth 1998;45:757-76. [CrossRef]
4. Stroumpoulis K, Pagoulatou A, Violari M, Ikonomou I, Kalantzi N, Kastrinaki K, et al. Videolaryngoscopy in the management of the difficult airway: a comparison with the Macintosh blade. Eur J Anaesthesiol 2009;26:218-22. [CrossRef]
5. Liu EH, Goy RW, Chen FG. The LMA CTrach, a new laryngeal mask airway for endotracheal intubation under vision: evaluation in 100 patients. Br J Anaesth 2006;96:396-400.[CrossRef]
6. Timmermann A, Russo S, Graf BM. Evaluation of the CTrach--an intubating LMA with integrated fibreoptic system. Br J Anaesth 2006;96:516-21. [CrossRef]
7. Liu EH, Wender R, Goldman AJ. The LMA CTrach in patients with difficult airways. Anesthesiology 2009;110:941-3. [CrossRef]
8. 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. [CrossRef]

9. Cavus E, Thee C, Moeller T, Kieckhaefer J, Doerges V, Wagner K. A randomised, controlled crossover comparison of the C-MAC videolaryngoscope with direct laryngoscopy in 150 patients during routine induction of anaesthesia. BMC Anesthesiol 2011;11:6. [CrossRef]
10. Van Zundert A, Maassen R, Lee R, Willems R, Timmerman M, Siemonsma M, et al. A Macintosh laryngoscope blade for videolaryngoscopy reduces stylet use in patients with normal airways. Anesth Analg 2009;109:825-31. [CrossRef]
11. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003;98:1269-77. [CrossRef]
12. Liu EH, Goy RW, Chen FG. An evaluation of poor LMA CTrach views with a fibreoptic laryngoscope and the effectiveness of corrective measures. Br J Anaesth 2006;97:878-82. [CrossRef]
13. Kaplan MB, Ward DS, Berci G. A new video laryngoscope-an aid to intubation and teaching. J Clin Anesth 2002;14:620-6. [CrossRef]
14. 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. [CrossRef]
15. 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;110:473-7. [CrossRef]
16. Vincent RD Jr, Wimberly MP, Brockwell RC, Magnuson JS. Soft palate perforation during orotracheal intubation facilitated by the GlideScope videolaryngoscope. J Clin Anesth 2007;19:619-21. [CrossRef]
17. Cuchillo JV, Rodriguez MA. Considerations aimed at facilitating the use of the new GlideScope videolaryngoscope. Can J Anaesth 2005;52:661-2. [CrossRef]
18. 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;109:1560-65. [CrossRef]