The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults: a randomized controlled trial

Lianxiang Jiang, Shulin Qiu, Peng Zhang, Weidong Yao, Yan Chang, Zeping Dai, Lianxiang Jiang, Shulin Qiu, Peng Zhang, Weidong Yao, Yan Chang, Zeping Dai

Abstract

Background: Previous studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation.

Methods: Two hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups.

Results: Finally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments (P > 0.05). Compared with Group R, Group M had a better CLV (χ2 = 14.706, P = 0.001) and shorter times to glottis exposure (8.82 ± 2.04 vs 12.38 ± 1.81; t = 14.94; P < 0.001) and tracheal intubation (37.19 ± 5.01 vs 45.23 ± 4.81; t = 13.25; P < 0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 = 0.074; P = 0.446) and intubation procedure time (29.86 ± 2.56 vs 30.46 ± 2.97, t = 1.75, P = 0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference (P > 0.05).

Conclusion: Although the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation.

Trial registration: The study was registered on May 18, 2019 in the Chinese Clinical Trial Registry ( ChiCTR1900023252 ).

Keywords: Endotracheal intubation; Laryngoscopic approach; Video laryngosc.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow chart for patient recruitment and randomization
Fig. 2
Fig. 2
Effect of different laryngoscopic approaches on the systolic blood pressure (SBP)
Fig. 3
Fig. 3
Effect of different laryngoscopic approaches on the heart rate (HR)

References

    1. Mcnarry AF, Patel A. The evolution of airway management-new concepts and conflicts with traditional practice. Br J Anaesth. 2017;119:154–166. doi: 10.1093/bja/aex385.
    1. Mort TC, Braffett BH. Conventional versus video laryngoscopy for tracheal tube exchange: Glottic visualization, success rates, complications, and rescue alternatives in the high-risk difficult airway patient. Anesth Analg. 2015;121:440–448. doi: 10.1213/ANE.0000000000000825.
    1. Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane systematic review. Br J Anaesth. 2017;119:369–383. doi: 10.1093/bja/aex228.
    1. Wang JK. Endotracheal intubation and endobronchial intubation. In: Guo QL, Yao SL, editors. Clinical anesthesiology. Beijing: People's Medical Publishing House; 2017. pp. 41–70.
    1. Green-Hopkins I, Werner H, Monuteaux MC, Nagler J. Using Video-recorded Laryngoscopy to Evaluate Laryngoscopic Blade Approach and Adverse Events in Children. Acad Emerg Med. 2015;22:1283–1289. doi: 10.1111/acem.12799.
    1. Kerrey BT, Rinderknecht AS, Geis GL, Nigrovic LE, Mittiga MR. Rapid sequence intubation for pediatric emergency patients: higher frequency of failed attempts and adverse effects found by video review. Ann Emerg Med. 2012;60:259–251. doi: 10.1016/j.annemergmed.2012.02.013.
    1. Sakles JC, Chiu S, Mosier J, Walker C, Stolz U. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med. 2013;20:71–78. doi: 10.1111/acem.12055.
    1. Goto T, Gibo K, Hagiwara Y, Okubo M, Brown DF, Brown CA, 3rd, Hasegawa K. Factors Associated with First-Pass Success in Pediatric Intubation in the Emergency Department. West J Emerg Med. 2016;17:129–134. doi: 10.5811/westjem.2016.1.28685.
    1. Lascarrou JB, Boisrame-Helms J, Bailly A. Video laryngoscopy vs direct laryngoscopy on successful first-pass Orotracheal intubation among ICU patients: a randomized clinical trial. JAMA. 2017;317:483–493. doi: 10.1001/jama.2016.20603.
    1. Gao YX, Song YB, Gu ZJ, Zhang JS, Chen CF, Sun H, Lu Z. Video versus direct laryngoscopy on successful firstpass endotracheal intubation in ICU patients. World J Emerg Med. 2018;9:99–104. doi: 10.5847/wjem.j.1920-8642.2018.02.003.
    1. Sulser S, Ubmann D, Schlaepfer M, Brueesch M, Goliasch G, Seifert B, Spahn DR, Ruetzler K. C-MAC videolaryngoscope compared with direct laryngoscopy for rapid sequence intubation in an emergency department: a randomised clinical trial. Eur J Anaesthesiol. 2016;33:943–948. doi: 10.1097/EJA.0000000000000525.
    1. Yentis SM, Lee DJH. Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia. 1998;53:1041–1044. doi: 10.1046/j.1365-2044.1998.00605.x.
    1. Xue FS, Li HX, Liu YY, Yang GZ. Current evidence for the use of C-MAC videolaryngoscope in adult airway management: a review of the literature. Ther Clin Risk Manag. 2017;3:831–841. doi: 10.2147/TCRM.S136221.
    1. Aziz M, Brambrink A. The Storz C-MAC video laryngoscope: description of a new device, case report, and brief case series. J Clin Anesth. 2011;23:149–152. doi: 10.1016/j.jclinane.2010.01.006.
    1. Magill I. Technique in endotracheal anaesthesia. Br Med J. 1930;2:817–819. doi: 10.1136/bmj.2.3645.817.
    1. Bozdogan N, Sener M, Bilen A, Turkoz A, Donmez A, Arslan G. Does left molar approach to laryngoscopy make difficult intubation easier than the conventional midline approach? Eur J Anaesthesiol. 2008;25:681–684. doi: 10.1017/S0265021508004110.
    1. Cuvas O, Basar H, Gursoy N, Culhaoglu S, Demir A. Left-molar approach for direct laryngoscopy: is it easy? J Anesth. 2009;23:36–40. doi: 10.1007/s00540-008-0694-3.
    1. Carassiti M, Zanzonico R, Cecchini S, Silvestri S, Cataldo R, Agrò FE. Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways: a manikin study. Br J Anaesth. 2012;108:146–151. doi: 10.1093/bja/aer304.
    1. Cordovani D, Russell T, Wee W, Suen A, Cooper RM. Measurement of forces applied using a Macintosh direct laryngoscope compared with a Glidescope video laryngoscope in patients with predictors of difficult laryngoscopy: a randomised controlled trial. Eur J Anaesthesiol. 2018;35:1–6. doi: 10.1097/EJA.0000000000000737.
    1. Russell T, Khan S, Elman J, Katznelson R, Cooper RM. Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope (R) videolaryngoscopy. Anaesthesia. 2012;67:626–631. doi: 10.1111/j.1365-2044.2012.07087.x.
    1. Wetsch WA, Spelten O, Hellmich M, Carlitscheck M, Padosch SA, Lier H, Böttiger BW, Hinkelbein J. Comparison of different video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists: a randomized, controlled crossover trial. Resuscitation. 2012;83:740–745. doi: 10.1016/j.resuscitation.2011.11.024.
    1. Ruetzler K, Imach S, Weiss M, Haas T, Schmidt AR. Comparison of five video laryngoscopes and conventional direct laryngoscopy. Anaesthesist. 2015;64:513–519. doi: 10.1007/s00101-015-0051-5.

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