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Background and Objective: Anesthesiologists encounter difficulties during laryngoscopy and tracheal intubation of neonates with myelodysplasia. Tracheal intubation in lateral position in such cases deemed profitable but not easy because of the compromised laryngeal view. We compared GlideScope video laryngoscope (GVL) versus conventional Miller direct laryngoscope (DL) for tracheal intubation in laterally positioned neonates with myelodysplasia. Materials and Methods: Sixty neonates scheduled for elective surgical repair of meningeocele or meningeomyelocele under general anesthesia were allocated randomly for endotracheal intubation using GVL or DL. Percentage of glottis opening (POGO) scores, time to best glottis view (TBGV), endotracheal tube passage time (TPT), intubation time (IT), intubation attempts, and overall success rate of intubation were recorded. Results: TBGV was significantly shorter in GVL group (median = 6.8 s, range = 3.5-28.2 s) in comparison with DL group (median = 8.4 s, range = 4.8-32.7 s) (P = 0.01); however, TPT and IT were comparable. POGO scores were significantly higher with GVL group than DL group (median = 93.8, range = 45-100 and median = 82.4, range 10-100, respectively) (P = 0.001). Overall success of intubation was the same; however, three patients in GVL group required a second attempt for intubation in comparison with five patients in DL group. One patient in DL group required a third attempt. Conclusion: In laterally positioned neonates, GVL is easier than DL with a similar intubation time, comparable time required for tube passage, better views of the glottis, shorter times to obtain the best glottic view, and high success rate as compared with DL. GlideScope seems to be an effective approach for endotracheal intubation of laterally positioned neonates with myelodysplasia.

Background To verify a test prototype of a novel flexible video laryngoscope in a difficult airway management simulator and to compare the efficacy of the flexible video laryngoscope with that of a conventional video laryngoscope. Methods Fifteen clinical anesthesiologists performed endotracheal intubation with a flexible video laryngoscope and a conventional video laryngoscope in a difficult airway management simulator in the neutral position with intermediate and difficult mouth opening. The rate of intubation success, intubation time, and classification of glottic exposure were recorded. After endotracheal intubation, participants were asked to assess the difficulty of intubation of the two laryngoscopes. Results The success rate of endotracheal intubation with flexible video laryngoscope was significantly higher than that with video laryngoscope in neutral positions with both intermediate ( P  = 0.025) and difficult ( P  = 0.005) mouth opening. The Cormack Lehane score of the flexible video laryngoscope was significantly lower than that of the video laryngoscope in the neutral position with intermediate mouth opening ( P  < 0.001) and difficult mouth opening ( P  < 0.001). There was no significant difference in intubation time in the neutral position with intermediate mouth opening ( P  = 0.460) or difficult mouth opening ( P  = 0.078). The difficulty score of endotracheal intubations with the flexible video laryngoscope was also significantly lower than that of the video laryngoscope in the neutral position with intermediate mouth opening ( P  = 0.001) and difficult mouth opening ( P  = 0.001). Conclusions Compared with conventional video laryngoscopy, flexible video laryngoscopy can provide superior glottic exposure and improve the success rate of intubation in a difficult airway management simulator.

Introduction: Intubation in COVID patients is challenging. Various guidelines suggest the use of video-laryngoscope (VL) as the first device to aid intubation in a COVID patient. The best VL to facilitate intubation in such a setting especially by novices is not ascertained. We compared intubation characteristics by two VL's (McGrath-MAC and C-MAC) for intubation in a COVID simulated mannequin by novices. Methodology: This prospective randomized manikin-based crossover study was done in thirty medical professionals with no previous experience of intubation with VL. All participants were trained on Laerdel airway management trainer and were allowed 5 practice sessions with each scope with an intubation box while wearing face protective personal protective equipment (PPE). Participants were randomized into two groups of 15 each, one group performed the intubation first with McGrath and the other with C-MAC before crossing over. Results: The mean (S. D.) time to intubation was similar with both McGrath-VL and CMAC VL [31.33 (14.72) s vs 26.47 (8.5) s, P = (p-0.063)]. POGO score [mean (S. D.)] was better with CMAC [81.33 (16.24) vs 60.33 (14.73), p-0.00. The majority of the users preferred C-MAC VL for intubation (93.33%). The incidence of failed intubation and multiple attempts at intubating were similar with the two scopes. Conclusion: The time to intubation was similar with both VL's but the majority of novices preferred CMAC probably due to a bigger screen that helped them to have a better view of glottis in the COVID simulated mannequin.

Background King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the performance of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators. Methods Ninety nine ASA I or II adult patients, scheduled for oral maxillofacial surgeries with El-Ganzouri risk index 1–7 were enrolled. Patients were randomly allocated to intubate with one of three laryngoscopes (non-channeled King Vision, McGrath MAC and Macintosh). The intubators were experienced with more than 100 successful nasotracheal intubations using each device. The primary outcome was intubation time. The secondary outcomes included first success rate, time required for viewing the glottis, Cormack-Lehane grade of glottis view, the number of assist maneuvers, hemodynamic responses, the subjective evaluating of sensations of performances and associated complications. Results The intubation time of King Vision and McGrath group was comparable (37.6 ± 7.3 s vs. 35.4 ± 8.8 s) and both were shorter than Macintosh group (46.8 ± 10.4 s, p  < 0.001). Both King Vision and McGrath groups had a 100% first attempt success rate, significantly higher than Macintosh group (85%, p  < 0.05). The laryngoscopy time was comparable between King Vision and McGrath group (16.7 ± 5.5 s vs. 15.6 ± 6.3 s) and was shorter than Macintosh group (22.8 ± 7.2 s, p  < 0.05) also. Compared with Macintosh laryngoscope, Glottis view was obviously improved when exposed with either non-channeled King Vision or McGrath MAC VL ( p  < 0.001), and assist maneuvers required were reduced ( p  < 0.001). The maximum fluctuations of MAP were significantly attenuated in VL groups (47.7 ± 12.5 mmHg and 45.1 ± 10.3 mmHg vs. 54.9 ± 10.2 mmHg, p  < 0.05 and p  < 0.01). Most device insertions were graded as excellent in McGrath group, followed by Macintosh and King Vision group ( p  = 0.0014). The tube advancements were easier in VLs compared with the Macintosh laryngoscope ( p  < 0.001). Sore throat was found more frequent in Macintosh group compared with King Vision group ( p  < 0.05). Conclusions Non-channeled King Vision and McGrath MAC VLs were comparable and both devices facilitated nasotracheal intubation in managing predicted difficult intubations compared with Macintosh laryngoscope. Trial registration ClinicalTrials registration number NCT03126344 . Registered on April 24, 2017.

Background and Aims: Role of video laryngoscopes (VLs) in the management of difficult airway with single-lumen tubes (SLTs) is established. VLs provide improved glottis view but are associated with longer time to intubate (TTI). We aimed to compare the TTI for double-lumen tube (DLT) insertion using the McGrath® MAC VL versus direct Macintosh laryngoscope (DL). Methods: Eleven senior anaesthesiologists experienced in SLT insertion, but not DLT insertion with VL participated. Seventy-four adults belonging to American Society of Anesthesiologists physical status I-II posted for elective surgery needing lung isolation were randomised to both intubator and laryngoscope (VL/DL). Primary endpoint was TTI; secondary endpoints included glottic view assessed by the Cormack and Lehane (CL) grade, need for external laryngeal manipulation, ease of intubation [scored using Numeric Rating Scale (1 - easiest, 10 - most difficult)] and associated complications. TTI was compared using Student's t-test. Results: No difference was found in TTI with DL and VL [(56.6 ± 14) s vs (64.4 ± 24) s, P = 0.104] as well as ease of use of laryngoscope [median score of 2 (1-3) in both]. Use of VL resulted in more patients with CL I glottic view - 86.0% versus 58.0% (P = 0.007). Fewer patients required external laryngeal manipulations (19% vs 47%, P = 0.013), and complications were fewer in the VL group (5% vs 24%, P = 0.023). Conclusion: TTI for DLT insertion was similar with VL and DL. However, VL was associated with better glottis visualisation, reduced need of external laryngeal manipulation and fewer complications.

Objectives: The aim of the study was to compare time to intubation and glottic visualization between Macintosh, McCoy, and Glidescope video laryngoscope (GVL) in morbidly obese patients. Methodology: Forty-five American Society of Anesthesiologists I-III morbidly obese patients were randomized into three groups of 15 each and time to intubation, Cormack-Lehane grading, and Intubation Difficulty Score (IDS) were compared. Results: GVL took more time to intubate (TTI) compared to Macintosh and McCoy laryngoscope (P = 0.0001). Overall IDS were similar between the groups. Conclusion: To conclude, GVL takes longer TTI with no added advantage in IDS and hemodynamic response to intubation in morbidly obese patients. McCoy is only as effective as Macintosh and hence Macintosh laryngoscope should be laryngoscope of choice due to its widespread availability and familiarity.

Background and Aims: C-MAC® video laryngoscope (VL) with Macintosh blade has been found to improve Cormack-Lehane (C-L) laryngoscopic view as well as intubating conditions for orotracheal intubation. However, studies done on the performance of C-MAC® VL for nasotracheal intubation (NTI) are very few in number. Hence, we compared laryngoscopy and intubating conditions between Macintosh direct laryngoscope and C-MAC® VL for NTI. Methods: Sixty American Society of Anesthesiologists Physical Status I, II patients, aged 8-18 years, posted for tonsillectomy surgeries under general anaesthesia with NTI were randomised, into two groups. Patients in group 1 were intubated using Macintosh direct laryngoscope and group 2 with C-MAC® VL. C-L grading, time required for intubation, need for additional manoeuvres and haemodynamic changes during and after intubation were compared between the groups. Results: C-L grade 1 views were obtained in 26 and 29 patients in group 1 and group 2, respectively (86.7% vs. 96.7%). Remaining patients were having C-L grade 2 (13.3% vs. 3.3%). Duration of intubation was less than a minute in group 2 (93.3%). Need for additional manoeuvres (M1-M5) were more in group 1 (97% vs. 77%). M1 (external manipulation) was needed more in group 2 compared to group 1 (53.3% vs. 30%). Magill's forceps alone (M4) and M4 with additional external manipulation (M5) were needed more in group 1 compared to group 2 (60% vs. 16%). Conclusion: The overall performance of C-MAC® VL was better when compared to conventional direct Macintosh laryngoscope during NTI in terms of glottis visualisation, intubation time and need for additional manoeuvres.

Background: Tracheal intubation using the 2nd-generation video laryngoscope sometimes cannot be performed easily because there is no functional endotracheal tube (ETT) guide. Therefore, a rigid stylet is often required during tracheal intubation. The Endotrol® tracheal tube (Endotrol) is a single use ETT that whole tube can be bent and slide easily into the trachea. We studied the intubation ease of a combination of an Endtrol and the McGrath® video laryngoscope (McGrath), which is one of the 2nd-generation video laryngoscopes. Methods: Sixty adult patients under general anesthesia were randomized into three groups: Group A: McGrath with Endotrol, B: McGrath with a rigid stylet attached ETT, and C: Direct laryngoscope with an ETT. The primary outcome measure was intubation time. Secondary outcomes were the number of insertion attempts required and the number of patients who complained of a sore throat after the procedure. The level of significance for each test was set at P < 0.05. Results: Intubation time (median [range] in seconds) was shorter in Group A (32 [27-54]) than Group B (37 [27-49]) and C (37 [27-50]) (P = 0.01 for both comparison). There was no significant difference among groups for the number of insertion attempts required. The number of patients with a sore throat was lower in Group A (0) than Group B (5) and C (6) (P = 0.02 and 0.01, respectively). Conclusion: A combination of an Endtrol and a McGrath is effective for shortening intubation time and avoiding sore throats.

Parapharyngeal tumors are rare head and neck tumors which can present as an intraoral mass and can pose great challenge to anesthesiologists. The primary concern is the difficult airway due to gross anatomical distortion of the upper airway. Securing the airway in an awake state should be the primary goal of anesthesiologists to avoid catastrophic complications. Herewith, we report the successful use of C-MAC ® video laryngoscope with the acute-angle D-BLADE™ in combination with Frova introducer for awake intubation in a patient with parapharyngeal mass after multiple attempts of failed fiber-optic intubation.

Robotic thyroidectomy (RT) is a new gasless, scarless technique which utilises the da Vinci™ surgical robot to excise thyroid tumours. Anaesthetic management must be modified according to the patient position and robotic surgery equipment. Anaesthesiologists need to be geared up to face the new challenges posed by advancements in surgical techniques in order to maintain patient safety. Another vital aspect of this surgery is documenting possible recurrent laryngeal nerve palsy, for which a C-Mac D-Blade™ video laryngoscope serves as a valuable tool. Post-operative pain management in RT also merits special attention.