Comparison of Tracheal Intubation Using the Storz's C-Mac D-blade(TM) Video-Laryngoscope Aided by Truflex(TM) Articulating Stylet and the Portex(TM) Intubating Stylet

Aida Al-Qasmi, Waffa Al-Alawi, Azharuddin Mohammed Malik, Rashid Manzoor Khan, Naresh Kaul, Aida Al-Qasmi, Waffa Al-Alawi, Azharuddin Mohammed Malik, Rashid Manzoor Khan, Naresh Kaul

Abstract

Background: Tracheal intubation using Storz's C-Mac D-blade(TM) videolaryngoscope is associated with difficult negotiation of the tracheal tube into the glottis due to steep angulation of its blade.

Objectives: In this study, we hypothesized that Truflex(TM) articulating stylet with its ability to dynamically tailor the ETT shape to patients' oropharyngeal anatomy would be better suited to the D-blade angulation and ease tracheal intubation compared to Portex(TM) intubation stylet.

Patients and methods: Following approval by the Ethical Issues Committee and informed consent, 218 ASA I and II patients of either sex were enrolled in this interventional, single-blind, randomized controlled trial. Tracheal intubation was performed following a uniform general anesthetic technique using the Storz's C-Mac D-blade(TM) videolaryngoscope aided by either Truflex(TM) articulating stylet or the Portex(TM) intubation stylet by an experienced anesthesiologist. The outcome measures included success or failure to intubate in the first attempt, total intubation time, hemodynamic disturbances, trauma if any and user satisfaction.

Results: The number of patients in whom intubation was successful in the first attempt was significantly higher by using Truflex™ articulating stylet (99.1%) compared to Portex(TM) intubation stylet (90.0%; P-Value = 0.003). User satisfaction grade was significantly better while using Truflex(TM) articulating stylet (8.5 ± 0.88) compared to the Portex(TM) intubation stylet (8.23 ± 0.99; P-Value = 0.035). We did not observe any significant difference in total intubation time, hemodynamic disturbances or trauma.

Conclusions: Storz's C-Mac D-blade(TM) videolaryngoscope provides grade I Cormack and Lehane's glottic view in 99.1% patients. First attempt successful tracheal intubation and user satisfaction significantly improved by Truflex(TM) articulating stylet compared to the Portex(TM) intubation stylet.

Keywords: C-Mac D-Blade; Endo Tracheal Intubation; Portex Intubating Stylet; Truflex Articulating Stylet; Video Laryngoscope.

Figures

Figure 1.. Truflex TM Articulating Stylet and…
Figure 1.. TruflexTM Articulating Stylet and the PortexTM Malleable Stylet

References

    1. Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth. 2005;52(2):191–8.
    1. Kaplan MB, Hagberg CA, Ward DS, Brambrink A, Chhibber AK, Heidegger T, et al. Comparison of direct and video-assisted views of the larynx during routine intubation. J Clin Anesth. 2006;18(5):357–62. doi: 10.1016/j.jclinane.2006.01.002.
    1. Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M. The GlideScope Video Laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth. 2005;94(3):381–4. doi: 10.1093/bja/aei041.
    1. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39(11):1105–11.
    1. Channa AB. Video laryngoscopes. Saudi J Anaesth. 2011;5(4):357–9. doi: 10.4103/1658-354X.87262.
    1. Piepho T, Fortmueller K, Heid FM, Schmidtmann I, Werner C, Noppens RR. Performance of the C-MAC video laryngoscope in patients after a limited glottic view using Macintosh laryngoscopy. Anaesthesia. 2011;66(12):1101–5. doi: 10.1111/j.1365-2044.2011.06872.x.
    1. Rai MR, Dering A, Verghese C. The Glidescope system: a clinical assessment of performance. Anaesthesia. 2005;60(1):60–4. doi: 10.1111/j.1365-2044.2004.04013.x.
    1. Behringer EC, Kristensen MS. Evidence for benefit vs novelty in new intubation equipment. Anaesthesia. 2011;66 Suppl 2:57–64. doi: 10.1111/j.1365-2044.2011.06935.x.
    1. Al-Qasmi A, Al-Alawi W, Malik AM, Khan RM, Kaul N. Assessment of Truflex articulating stylet versus conventional rigid Portex stylet as an intubation guide with the D-blade of C-Mac videolaryngoscope during elective tracheal intubation: study protocol for a randomized controlled trial. Trials. 2013;14:298. doi: 10.1186/1745-6215-14-298.
    1. Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL, Plaisance P, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology. 1997;87(6):1290–7.
    1. Cavus E, Neumann T, Doerges V, Moeller T, Scharf E, Wagner K, et al. First clinical evaluation of the C-MAC D-Blade videolaryngoscope during routine and difficult intubation. Anesth Analg. 2011;112(2):382–5. doi: 10.1213/ANE.0b013e31820553fb.
    1. Kilicaslan A, Topal A, Tavlan A, Erol A, Otelcioglu S. Effectiveness of the C-MAC video laryngoscope in the management of unexpected failed intubations. Braz J Anesthesiol. 2014;64(1):62–5. doi: 10.1016/j.bjane.2013.03.001.
    1. Serocki G, Neumann T, Scharf E, Dorges V, Cavus E. Indirect videolaryngoscopy with C-MAC D-Blade and GlideScope: a randomized, controlled comparison in patients with suspected difficult airways. Minerva Anestesiol. 2013;79(2):121–9.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever