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Purpose Channelled blades have the advantage of avoiding stylet use and potential airway injury during videolaryngoscopic intubation. Nevertheless, the effectiveness of channelled Macintosh-type blades has not yet been fully established. We sought to assess the utility of channelled Macintosh-type blades for videolaryngoscopic intubation under cervical spine immobilization. Methods We conducted a randomized controlled noninferiority trial in neurosurgical patients with a difficult airway simulated by a cervical collar. Videolaryngoscopic intubation with a reinforced tracheal tube was performed using a channelled Macintosh-type blade without a stylet (channelled group, n  = 130) or a nonchannelled Macintosh-type blade with a stylet (nonchannelled group, n  = 131). The primary outcome was intubation success rate. Secondary outcomes included time to intubation and incidence or severity of intubation-related complications (subglottic, lingual, and dental injuries; bleeding; sore throat; and hoarseness). Results The initial intubation success rate was 98% and 99% in the channelled and nonchannelled groups, respectively, showing the noninferiority of the channelled group (difference in proportions −0.8%; 95% confidence interval [CI], −4.8% to 2.9%; predefined noninferiority margin, −5%; P  = 0.62). Fewer participants in the channelled group had subglottic injuries than in the nonchannelled group (32% [32/100] vs 57% [54/95]; difference in proportions, −25%; 95% CI, −39% to −11%; P  < 0.001). There were no significant differences between the two groups in the overall intubation success rate, time to intubation, and incidence or severity of other intubation-related complications. Conclusions For videolaryngoscopic intubation in patients with a cervical collar, channelled Macintosh-type blades are an alternative to nonchannelled Macintosh-type blades, with a noninferior initial intubation success rate and a lower incidence of subglottic injury. Study registration CRIS.nih.go.kr ( KCT0005186 ); first submitted 29 June 2020.

Although video laryngoscopy solves the problem of glottis exposure, it is difficult to deliver the tube to the glottic opening when the tracheal tube is unevenly shaped. This study aimed to compare the effects of different tube shapes on the first-pass success (FPS) rate in patients undergoing video laryngoscopy-assisted tracheal intubation. Three hundred patients above 18 years of age who underwent general anaesthesia and required endotracheal intubation were included in the study. The participants were randomly allocated to three groups with 100 participants in each group as follows: Group A, video laryngoscopes with a self-equipped stylet are used for tube preshaping; Group B: curvature of the video laryngoscope blade is modelled for tube preshaping; Group C: tube preshaping angle is consistent with the video laryngoscope blade, and the bending point is set 1 cm above the tracheal tube cuff. The primary outcome was FPS rates. The secondary outcomes included time to tracheal intubation, haemodynamic responses and adverse events. No significant differences in patient characteristics or airway assessments were noted ( P  > 0.05). Compared with Groups A, Group B and Group C exhibited a higher FPS rate (68% vs. 86% vs. 92%; P  < 0.001). However, there is no significant difference in FPS rate between Group B and Group C ( P  > 0.05). And the time to tracheal intubation in Group C was significantly less than that in Group A and Group B (22.21 ± 4.01 vs. 19.92 ± 4.11 vs. 17.71 ± 3.47; P  < 0.001). The straight-to-cuff stylet preshape angulation of curvature of the blade could provide a higher FPS rate and shorter time to tracheal intubation during video laryngoscopy-assisted endotracheal intubation. Trial registration: Chinese Clinical Trial Registry, ChiCTR1900026019.

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

Background Video laryngoscopes are widely used for tracheal intubation, particularly in challenging airway scenarios. The McGrath MAC, AIRWAY SCOPE ® , and AceScope ® are popular video laryngoscopes with different design features. This study aimed to compare the effectiveness and usability of these three devices in novice healthcare providers during simulated tracheal intubation scenarios employing a manikin. Methods Sixty novice healthcare providers, including nurses and pharmacists, were enrolled in this randomized crossover study. Participants performed tracheal intubation using the McGrath MAC, AIRWAY SCOPE, and AceScope in both normal airway and cervical spine immobilization models. Primary outcomes were intubation success rate and time to intubation. Secondary outcomes included user preferences, device ease of use, and the incidence of dental injuries. Results The AIRWAY SCOPE demonstrated the shortest intubation time in both normal airway and cervical spine immobilization models (14.90 ± 1.76 s and 23.80 ± 2.43 s, respectively), followed by the McGrath MAC and AceScope. All devices exhibited high success rates, and there were no significant differences in perceived difficulty among the three video laryngoscopes. The incidence of dental injuries was generally comparable among the devices. However, in the cervical spine immobilization model, the AceScope demonstrated a significantly higher rate of dental injuries compared to the McGrath MAC ( p  < 0.05), highlighting a potential concern for clinical practice. Conclusions The AIRWAY SCOPE was the most efficient video laryngoscope in terms of intubation time, followed by the McGrath MAC and AceScope. However, all devices showed high success rates and no significant differences in perceived difficulty. Further research is needed to validate these findings in clinical settings and investigate the impact of device-specific features on intubation outcomes and dental injury incidence. Trial registration Registration number: jRCT1030240598 ( https://jrct.niph.go.jp/re/reports/detail/91422 ) The registration date of the clinical trial is January 8, 2025.UMIN000050394.

Background Postoperative sore throat (POST) is a common problem following endotracheal (ET) intubation during general anesthesia. The objective was to compare the incidence and severity of POST during routine intubation with Glidescope (GL) and Macintosh laryngoscope (MCL). Methods One hundred forty adult patients ASA I and II with normal airway, scheduled to undergo elective surgery under GA requiring ET intubation were enrolled in this prospective randomized study and were randomly divided in two groups, GL and MCL. Incidence and severity of POST was evaluated at 0, 6, 12 and 24 h after surgery. Results At 0 h, the incidence of POST was more in MCL than GL ( n  = 41 v.s n  = 22, P  = 0.001), and also at 6 h after surgery ( n  = 37 v.s n  = 23, P  = 0.017). Severity of POST was more at 0, 6 and 12 h after surgery in MCL ( P  < 0.001, P  = 0.001, P  = 0.004 respectively). Conclusions Routine use of GL for ET tube placement results in reduction in the incidence and severity of POST compared to MCL. Trial regisration ClinicalTrials.gov NCT02848365 . Retrospectively Registered (Date of registration: July, 2016).

Morbid obesity is associated with a difficult management of the airway. There is no agreement on these patients being difficult to intubate, but if they are difficult to ventilate with facial mask, then the fast control of their airway becomes a priority. This study compares the quickness and success in tracheal intubation, glottic view, hemodynamic response, and complications from the use of the Macintosh and Airtraq laryngoscopes in morbidly obese patients for scheduled surgery. Prospective, observational, and randomized study. Operating room. Forty-six American Society of Anesthesiologists III patients. Patients were randomly assigned to undergo tracheal intubation using a Macintosh (n=23) or an Airtraq laryngoscope (n=23). The following were compared: intubation time, laryngeal vision, the necessity of additional maneuvers to carry out the tracheal intubation, the success of the maneuvers, complications, and hemodynamic response. The preoperative conditions of the studied patients were similar in both groups. The average time of the intubation was 17.27±16.1 seconds and 22.11±13.62 seconds in the Airtraq and Macintosh groups, respectively (P=.279). With the Airtraq device, 95.65% of patients presented a glottic view 1 and 2a (P=.006) and less optimizing maneuvers were needed to perform the tracheal intubation (P=.001). There were no cases of difficult intubation, failed intubation, or difficult ventilation. A statistically significant increase in the heart rate was detected with the use of the Macintosh laryngoscope. A patient with redundant epiglottis could not be intubated with the Airtraq laryngoscope. Both devices allow quick and safe management of the airway. The Airtraq laryngoscope improved the glottic view by the modified Cormack-Lehane classification, reduced the need for additional maneuvers for tracheal intubation, and also reduced the degree of sympathetic stimulus detected by a minor increase in heart rate after tracheal intubation. •Airway's management depends on 4 variables: patient, physician, time, and equipment.•In the design and development of the present study, all variables were controlled.•The “equipment” variable was assessed with none or minimum interference.•Both devices allow a quick and safe airway management in a morbidly obese patient.•The Airtraq laryngoscope improved the glottic view by the modified Cormack-Lehane.

The efficacy of devices for difficult intubation in paediatric patients, especially with a Cormack-Lehane grade 4 view, has yet to be established. We compared intubating parameters among three devices (the Airtraq®, McGrath®, and Macintosh laryngoscopes). This study is a randomised cross-over trial. Participants were 20 anaesthetists. Each device was tested three times using a paediatric manikin with a Cormack-Lehane grade 4 view. The order to use each device was randomised by a computer-generated random sequence. The primary endpoint was the rate of successful intubation. Secondary endpoints included the time taken to intubate, percentage of glottic opening score, and severity of potential dental trauma. The successful intubation rates of the Airtraq®, McGrath®, and Macintosh laryngoscopes were 100%, 72%, and 45%, respectively. The risk ratio of the success rates of Airtraq® compared with McGrath® and Macintosh laryngoscopes were 1.40 (95% CI; 1.19-1.64, P < 0.001) and 2.22 (95% CI; 1.68-2.94, P < 0.001), respectively. The modified Cormack-Lehane grade and percentage of the glottic opening score were better for the Airtraq® than for the other devices. The dental trauma score was lower for the Airtraq® than for the other devices. There were no significant differences in the intubation time among the groups. The Airtraq® had higher success rate, had better visibility, and was associated with less dental trauma than the other devices in a difficult paediatric intubation model with a Cormack-Lehane grade 4 view.

This study aims to investigate the effect of McCoy, Macintosh laryngoscope, and C-MAC video-laryngoscopes on optic nerve sheath diameter (ONSD) and hemodynamic responses to laryngoscopy and intubation. This prospective randomized study was conducted in Zonguldak Bülent Ecevit University Hospital, Zonguldak, Turkey, between July 2019 and January 2020. Informed written consent was obtained from all patients. Patients with previous intracranial/ocular surgery or glaucoma were excluded from the study. The patients were randomized to use McCoy, Macintosh, and C-MAC (30 per group). Intubations were performed by the same person. Mean arterial pressure, heart rate (HR), and ONSD were recorded before the induction and repeated in 1, 3, 5, and 10 minutes after the intubation. The effects of laryngoscopy and intubation on hemodynamic responses and ONSD were similar between groups (p greater than 0.05). While the comparison within groups showed ONSD increase in McCoy group and HR and ONSD increase in the Macintosh group compared to baseline 1 min after the intubation, no change was observed in hemodynamic responses and ONSD measurements in the C-MAC® group (p greater than 0.05). In this study, there was no significant difference between the groups in terms of ONSD and hemodynamic responses to laryngoscopy and intubation. It was observed that there were no significant changes in ONSD values just in C-MAC® video-laryngoscope group. Therefore, intubations with C-MAC® video-laryngoscope are thought to be more appropriate for patients with an increase in intracranial pressure.

This study aimed to compare the utility of McGRATH MAC (McG) and Macintosh (McL) laryngoscopes for double-lumen endotracheal tube intubation in patients undergoing elective surgery. Randomized clinical trial. Operating room. Fifty adult patients scheduled for elective surgery under 1-lung ventilation with American Society of Anesthesiologists physical status 1 to 3. Double-lumen endotracheal tube intubation was performed with the McG (McG group; 25 patients) or conventional McL (McL group; 25 patients) laryngoscope by anesthesia residents. The number of attempts to successful intubation, intubation time, percentage of glottis opening score, and subjective difficulty of laryngoscopy and tube passage through the glottis were assessed. The total numbers of intubation attempts were 1 (McG group, 24 patients; McL group, 16 patients), 2 (McG group, 1 patient; McL group, 8 patients), and 3 (McG group, 0 patient; McL group, 1 patient), with significant differences between the two groups (P = .018). Intubation time was significantly shorter in the McG group compared with the McL group (McG: 17.1 ± 4.6 seconds vs McL: 20.8 ± 5.9 seconds, P = .026). The percentage of glottis opening score was significantly higher in the McG group compared with the McL group (McG: 88.4% ± 13.7% vs McL: 71.4% ± 20.4%, P = .004). The McG demonstrated a better intubation profile compared with the McL, possibly due to its ease of use for double-lumen endotracheal tube intubation. •The McGRATH MAC (McG) is a device that has been developed with a high-resolution video camera, providing both direct and indirect views of the glottis and reportedly useful in various airway management. However, the benefit of using McG for intubation with double-lumen endotracheal tubes remains unclear.•We investigated the hypothesis that videolaryngoscope McG is more useful than Macintosh laryngoscope (McL) for double-lumen endotracheal tube intubation performed by anesthesia residents.•The number of attempts for a successful intubation, intubation time, percentage of glottis opening score, and subjective difficulty of laryngoscopy and tube passage through the glottis were measured.•The total number of intubation attempts was significantly smaller in the McG group than in the McL group. Intubation time was significantly shorter in the McG group compared with the McL group. The percentage of glottis opening score was significantly higher in the McG group compared with the McL group. The McG demonstrated a better intubation profile compared with the McL, possibly due to its ease of use for double-lumen endotracheal tube intubation by anesthesia residents.

To compare the C-MAC video laryngoscope to the standard flexible fiberoptic scope (FFS) with an eye piece (but without a camera or a video screen) for intubation of patients undergoing cervical spine surgery with manual inline stabilization. The primary end point was the time to achieve successful tracheal intubation. Secondary end points included glottic view at intubation and number of intubation attempts. Prospective, randomized, single-blinded study. Cedars Sinai Medical Center in Los Angeles, CA. One hundred forty patients (American Society of Anaesthesiologists physical status I-III), aged 18 to 80years undergoing elective cervical spine surgery. Patients were prospectively randomized to undergo tracheal intubation using either an FFS (n=70) or the C-MAC video laryngoscope (n=70). After performing a preoperative airway evaluation, patients underwent a standardized induction sequence. The glottic view was assessed at the time of tracheal tube placement using the Cormack-Lehane and percentage of glottic opening scoring systems. In addition, the time required for successful insertion of the tracheal tube, number of intubation attempts to secure the airway, the need for adjuvant airway devices, hemodynamic changes, adverse events, and any airway-related trauma were recorded. The glottic view at the time of intubation did not differ significantly with the 2 devices; however, the C-MAC facilitated more rapid tracheal intubation compared with the FFS (P=.001). The peak heart rate response following insertion of the tracheal tube was also reduced (P=.004) in the C-MAC (vs FFS) group. The C-MAC may offer an advantage over the FFS with respect to the time required to obtain glottic view and successful placement of the tracheal tube in patients requiring cervical spine immobilization. •C-MAC video laryngoscope compared with the flexible fiberoptic scope (FFS)•Patients undergoing cervical spine surgery with manual inline stabilization•C-MAC required less time to obtain a clear glottic view and successful intubation.