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Background and Objective: Postburn contracture (PBC) of the neck is commonly seen after acute burn in the face and neck region. Managing the airway is a challenge due to functional and anatomical deformities. We compared the ease of intubation using video and direct laryngoscopes. Material and Methods: Eighty patients, 18-60 years of age with ASA physical status I/II with Onah's types 1 and 2 contracture of the neck were randomized in this study. Group DL were intubated by direct laryngoscopy (DL) using Macintosh blade and Group VL by video laryngoscopy (VL) using King Vision. The outcome measures were ease of intubation (EOI), Cormack-Lehane (CL) grading, and associated complications if any. Results: EOI score was significantly lower in group VL (0.42 ± 0.84) as compared to group DL (0.85 ± 1.21) (P = 0.048) as was the use of external maneuvers (group VL: 17.5%; group DL: 42.5%; P = 0.015), and the use of stylet (group VL: 0%; group DL: 20%, P = 0.005). CL grading improved significantly in group VL (P < 0.001). Occurrence of complications was negligible in both the groups. A single failure in group DL needed rescue intubation. Conclusion: Intubation with a video laryngoscope was easier than with DL in patients with mild-to-moderate contracture neck with mouth opening >3 cm and MPG I/II.

Background Tracheal intubation is a core skill in airway management for anesthesiologists as well as for other medical professionals involved in advanced airway procedures. Traditionally, tracheal intubation in hospitals has been performed using a Macintosh blade for direct laryngoscopy (DL). However, recent literature increasingly supports the potential benefits of routine video laryngoscopy (VL). The aim of this study was to assess whether primary training in hyperangulated VL improves the first-pass success rate of tracheal intubation among first-year anesthesiology residents, compared to conventional DL training, in the operating room. Methods The JuniorDoc-VL Trial is a randomized, controlled, patient-blinded clinical trial of novice anesthesiology residents trained in DL and VL. Thirty residents will be randomly assigned to either the intervention group (VL group) or the control group (DL group) with a 1:1 allocation. The first-pass-success (FPS) rates (primary endpoint) and complication rates (secondary endpoint) will be compared between groups. Discussion We hypothesize that the primary use of hyperangulated video laryngoscopy (VL) in the experimental group will increase first-pass-success rates among inexperienced residents and reduce complication rates associated with advanced airway management in a mixed patient population. This study may provide an opportunity to develop strategies that allow physicians not routinely involved in anesthesia to effectively learn and maintain their skills in tracheal intubation. Trial registration ClinicalTrials.gov Registry (NCT06360328). Registered on 09.04.2024.

Intubation is frequently required for patients in the intensive care unit (ICU) but is associated with high morbidity and mortality mainly in emergency procedures and in the presence of severe organ failures. Improving the intubation procedure is a major goal for all ICU physicians worldwide, and videolaryngoscopy may play a relevant role. Videolaryngoscopes are a heterogeneous entity, including Macintosh blade-shaped optical laryngoscopes, anatomically shaped blade without a tube guide and anatomically shaped blade with a tube guide, which might have theoretical benefits and pitfalls. Videolaryngoscope/videolaryngoscopy improves glottis view and allows supervision by an expert during the intubation process; however, randomized controlled trials in the ICU suggest that the systematic use of videolaryngoscopes for every intubation cannot yet be recommended, especially in non-expert hands. Nevertheless, a videolaryngoscope should be available in all ICUs as a powerful tool to rescue difficult intubation or unsuccessful first-pass laryngoscopy, especially in expert hands. The use of associated devices such as bougie or stylet, glottis view needed (full vs incomplete) and patient position during intubation (ramped, sniffed position) should be further evaluated. Future trials will better define the role of videolaryngoscopy in ICU.

Background Direct laryngoscopy (DL) is widely recognized as the most commonly used method for tracheal intubation. However, growing evidence highlights the increasingly prominent role of video laryngoscopy (VL) in the management of difficult airways. This study aimed to determine the most effective medical education method to equip medical students with this critical skill. In addition to evaluating the contributions of an intubation training program utilizing direct laryngoscopy and video laryngoscopy to tracheal intubation success among inexperienced medical students, we also aimed to explore the potential benefits of combining these two techniques. Methods This mannequin-based study included 130 medical students. Before the study began, participants attended a 30-minute theoretical training session. Participants were randomly assigned to start with one of two scenarios. In each scenario, participants were given three attempts to perform intubation using each laryngoscope. The maximum allowable time for each intubation was set at 3 min. Students who successfully intubated within 3 min were recorded as successful, while those who failed to do so were recorded as unsuccessful. Results The study demonstrated that VL provided higher success rates and shorter intubation times, particularly during the first and second attempts. However, it is noteworthy that no significant difference in success rates was observed between VL and DL during the third attempt. Conclusion This study highlights the necessity of integrating both VL and DL methods in intubation training programs. The combination of both approaches allows students to achieve quick initial results while progressively developing proficiency for more complex scenarios over time. Clinical trial number Not applicable.

To compare three different video laryngoscope devices (VL) to standard direct laryngoscopy (DL) for tracheal intubation of obese patients undergoing bariatric surgery. Hypothesis: VL (vs DL) would reduce the time required to achieve successful tracheal intubation and improve the glottic view. Prospective, randomized and controlled. Preoperative/operating rooms and postanesthesia care unit. One hundred twenty-one obese patients (ASA physical status I-III), aged 18 to 80 years, body mass index (BMI) >30 kg/m2 undergoing elective bariatric surgery. Patients were prospectively randomized assigned to one of 4 different airway devices for tracheal intubation: standard Macintosh (Mac) blade (DL); Video-Mac VL; Glide Scope VL; or McGrath VL. After performing a preoperative airway evaluation, patients underwent a standardized induction sequence. The glottic view was graded using the Cormack Lehane and percentage of glottic opening (POGO) scoring systems at the time of tracheal intubation. Times from the blade entering the patient’s mouth to obtaining a glottic view, placement of the tracheal tube, and confirmation of an end-tidal CO2 waveform were recorded. In addition, intubation attempts, adjuvant airway devices, hemodynamic changes, adverse events, and any airway-related trauma were recorded. All three VL devices provided improved glottic views compared to standard DL (p < 0.05). Video-Mac VL and McGrath also significantly reduced the time required to obtain the glottic view. Video-Mac VL significantly reduced the time required for successful placement of the tracheal tube (vs DL and the others VL device groups). The Video-Mac and GlideScope required fewer intubation attempts (P< .05) and less frequent use of ancillary intubating devices compared to DL and the McGrath VL. Video-Mac and GlideScope required fewer intubation attempts than standard DL and the McGrath device. The Video-Mac also significantly reduced the time needed to secure the airway and improved the glottic view compared to standard DL. •Prospective and randomized study•Comparing 3 video laryngoscope devices to standard direct laryngoscopy•For tracheal intubation of obese patients undergoing elective bariatric surgery•The use of VL reduced the time required to achieve successful tracheal intubation and improved the glottic view of an obese surgical population

PurposeIn the preceding 20 years, many randomized-controlled trials and meta-analyses have compared direct Macintosh laryngoscopy with videolaryngoscopy. The videolaryngoscope blades have included both traditional Macintosh blades and hyperangulated blades. Macintosh and hyperangulated blades differ in their geometry and technique for tracheal intubation; certain patient populations may benefit from one blade type over another. The primary objective of this systematic review was to assess whether published meta-analyses comparing direct Macintosh laryngoscopy to videolaryngoscopy have accounted for the videolaryngoscope blade type. Secondary objectives evaluated heterogeneity among practitioner experience and specialty, clinical context, patient population, and original primary study outcomes.SourceA search was performed across Ovid Medline, Ovid Embase, ClinicalKey, PubMed, TRIP, AccessAnesthesiology, Google Scholar, and ANZCA discovery. A systematic review identified meta-analyses which compared direct Macintosh laryngoscopy to videolaryngoscopy. There were no patient age or clinical specialty restrictions. Exclusion criteria included non-English language, studies comparing non-Macintosh blade to videolaryngoscopy, and studies in awake patients.Principal findingsTwenty-one meta-analyses were identified that were published between 1 January 2000 and 7 May 2020. Macintosh and hyperangulated videolaryngoscope blades were combined in most studies (16/21; 76%). Heterogeneity was also present among practitioner experience (20/21; 95%), clinician specialty (15/21; 71%), and clinical locations (10/21; 48%). Adult and pediatric patients were combined or not defined in 5/21 studies (24%). The primary outcomes of the meta-analyses varied, with the most common (7/21; 33%) being first-pass tracheal intubation success.ConclusionsHeterogeneity across important clinical variables is common in meta-analyses comparing direct Macintosh laryngoscopy to videolaryngoscopy. To better inform patient care, future videolaryngoscopy research should differentiate blade type, clinical context, and patient-related primary outcomes.

In severe trauma, it is estimated that approximately 2% of patients will sustain a spinal cord injury. The optimal method for advanced airway management that will minimize any associated cervical spine movement remains a topic of debate. Therefore, the aim of this study is to compare the effects of different tracheal intubation techniques in unstable injuries of the cervical spine. Tracheal intubation using conventional laryngoscopy (CL), video laryngoscopy (VL) or flexible bronchoscopic intubation (FO) was performed in six fresh human cadavers. Compression of the dural sac as well as angulation, distraction and intubation time were assessed by myelography in the presence of isolated atlanto-occipital dislocation (AOD) and of combined atlanto-occipital dislocation with atlanto-axial instability (AAI). In case of an isolated AOD, FO intubation resulted in significantly less compression of the dural sac at both levels compared to CL (− 0.46 mm vs. − 1.31 mm; p  < 0.001, r = .66) for C0/C1 and (− 0.09 mm vs. − 0.19 mm; p  =  < 0.05, r = .36) for C1/C2 and VL (− 0.46 mm vs. − 0.64 mm; p  =  < 0.05, r = .42 for C0/C1 and (− 0.09 mm vs. − 0.22 mm; p  =  < 0.01, r = .52) for C1/C2. Atlanto-axial Angulation in simultaneous AOD and AAI, the differences between CL and VL were significantly in favor of VL (4.1° vs. 3.2°; p  =  < 0.05, r = .39), and using FO resulted in less angulation than CL (2.5° vs. 4.1°; p  =  < 0.001, r = .60) and VL (2.5° vs. 3.2°; p  =  < 0.05). FO required longer in the case of combined AOD and AAI (FO 16.6 s vs. CL 9.8 s; p  =  < 0.001, r = .56), (FO 16.6 s vs. VL 9.7 s; p  =  < 0.001, r = .56). The study demonstrated that tracheal intubation using VL caused significant less compression of the dural sac than the CL. FO showed the lowest compression at all measuring points, but took almost twice as long. For elective or stable patients, where time to airway management is not a relevant factor, FO appears to be the safest method. However, FO is not available everywhere, and in urgent emergency situations, the longer duration may not be acceptable. In such cases, video laryngoscopy can represent a compromise between duration and patient safety, and most physicians have more clinical experience with VL than with FO.

Background Although Video laryngoscope (VL) can reduce the difficulty of endotracheal intubation and improve the glottic view, its use in critically ill patients is controversial. Methods Randomized controlled trials (RCTs) of VL and direct laryngoscopy (DL) for critically ill patients were searched on electronic databases, including Web of Science, PubMed, and Embase. Additional publications were identified by screening the reference lists of the identified articles and relevant previously published reviews. Results Overall, 25 RCTs involving 5836 critically ill patients were included in the analysis. There was no significant difference in the first intubation rate between the VL and DL groups (25 studies; RR, 1.03; 95% CI 0.96–1.11; n = 5836; p = 0.37; very low certainty). However, Multivariate meta-regression analysis identified two main sources of bias: whether intubation was performed in a hospital (p = 0.04) and operator proficiency with DL compared to VL (p < 0.001). Subgroup analysis showed that VL improved the first intubation rate in in-hospital intubation (19 studies; RR, 1.12; 95% CI 1.04–1.22; n = 4441; p < 0.01, very low certainty) and VL showed good potential to reduce the first-attempt intubation success rates, but not significantly (6 studies; RR, 0.75; 95% CI 0.56–1.00; n = 1395; p = 0.05, very low certainty). In subgroups with similar operator proficiency VL and DL, VL increased the success rate for first intubation (16 studies; RR, 1.14; 95% CI 1.06–1.23; n = 3,971; p < 0.01; very low certainty). However, VL decreased the first intubation rate (4 studies; RR, 0.65; 95% CI 0.49–0.88; n = 810; p < 0.01; very low certainty) in a subgroup where operator proficiency was higher for DL than for VL. Conclusion VL does not increase the first intubation rate. However, VL increases the first-attempt intubation success rate for in-hospital intubation and operators with similar proficiency in VL and DL. Graphical Abstract

Direct laryngoscopy is the most commonly used modality for endotracheal intubation in the emergency department. Video laryngoscopy may improve glottic view during laryngoscopy and intubation success rate in such patients. This meta-analysis has been designed to compare clinical efficacy of video laryngoscopy with direct laryngoscopy for endotracheal intubation in the emergency department. Meta-analysis of randomized controlled trial. Randomized controlled trials comparing video laryngoscopy and direct laryngoscopy for endotracheal intubation in adult patients in emergency department. PubMed (1946 to 20th October 2017) and The Cochrane Library databases (CENTRAL) were searched for potentially eligible trials on 20th October 2017. Adult patients presenting in the emergency department. Video laryngoscopy & direct laryngoscopy for intubation in emergency department. Primary outcome was ‘first intubation success rate’ and secondary outcomes were overall intubation success rate, in-hospital mortality and oesophageal intubation rate. Data of 1250 patients from 5 randomized controlled trials have been included in this study. Video laryngoscopy offers no advantage over direct laryngoscopy in terms of first intubation success rate (odds ratio 1.28, 95% CI 0.70, 2.36; p = 0.42), overall intubation success rate (OR 1.26, 95% CI 0.53, 3.01; p = 0.6) or in-hospital mortality (OR 1.25, 95% CI 0.8, 1.95; p = 0.32). However, oesophageal intubation rate is lower with the use of video laryngoscopy (OR 0.09, 95% CI 0.01, 0.7; p = 0.02). Use of video laryngoscopy for emergency endotracheal intubation in adult patients is associated with reduced oesophageal intubation over direct laryngoscopy. However, no benefit was found in terms of overall intubation success. •Video laryngoscopy improves glottic view during laryngoscopy for endotracheal intubation.•Observational studies have found that video laryngoscopy provide higher intubation success rate over direct laryngoscopy in the emergency department.•However, prospective randomized controlled trials questioned the utility of video laryngoscopy in emergency department in terms of intubation success rate.•First intubation success rate and over-all intubation success rate is similar between video-laryngoscopy and direct laryngoscopy in patient presenting in the emergency department.•Esophageal intubation rate is reduced with video laryngoscopy.

Intubating the trachea is a challenging task, especially for novice intubators. Successful intubation, in the shortest possible time, prevents hypoxia and hemodynamic disturbances. During the last few decades, video laryngoscopy has proven to be a helpful tool for intubating patients successfully, especially in difficult cases. However, novices must be proficient with a video laryngoscopy. It is not entirely clear which method, direct laryngoscopy or video laryngoscopy, is more successful for tracheal intubation in individuals who have recently started their airway management training. In this study, we aim to investigate this issue. 150 patients were randomly assigned to either direct laryngoscopy or video laryngoscopy by first-year anesthesia assistants. Intubation time, intubation success rate, Cormack-Lehane score, and instances of using the Optimal external laryngeal manipulation (OELM) maneuver, were recorded. The rate of successful intubation was higher in the direct laryngoscopy group, and the time taken was less. The direct laryngoscopy provided a better view of the glottis than the video laryngoscopy, although this difference was not statistically significant. Direct laryngoscopy resulted in a higher frequency of OELM. Based on our study, the success rate and speed of intubation in novices were higher with direct laryngoscopy compared to video laryngoscopy.