Comparative assessment of intubating conditions in adult patients using C-MAC® Video laryngoscope and Macintosh direct laryngoscope in routine intubations

Background and Aims: Securing the airway with an endotracheal tube is considered the standard of care for surgeries requiring general anaesthesia. The Macintosh laryngoscope is the most commonly used device for directly visualising the structures of the larynx and facilitating tracheal intubation. Video laryngoscopes (VLS) which work on the principles of indirect laryngoscopy is found to improve the visualisation of larynx and increase success rate with laryngoscopy and intubation in manikin studies and difficult airway scenarios. Its usefulness in routine intubations in operative settings is yet to be evaluated. Material and Methods: After institutional ethical committee approval and patient consent, eighty ASA I/II patients, aged 18 to 60 years, with normal airway, who underwent elective surgeries under general anaesthesia were included in the study. Patients were randomly allocated into two groups of 40 each, to undergo laryngoscopy and oro-tracheal intubation using either Macintosh direct laryngoscope (group D) or C MAC® video Laryngoscope (Group V) following induction of general anaesthesia. Cormack Lehane laryngoscopy grading, number of attempts required for intubation, need for stylet, backwards upwards rightwards pressure (BURP) manoeuvre, duration of intubation, haemodynamics during laryngoscopy and intubation, and overall ease of intubation were compared. Results: Duration of intubation was more in group V in contrast to group D which was statistically significant (29.5±19.12 s Vs 12.22±9.25 s). There was also a significant increase in the usage of stylet in group V in comparison to group D (12 Vs 1). Combined usage of both BURP and Stylet was required in 8 patients of group V in contrast to one patient in group D. Conclusion: C-MAC® Video laryngoscope though improved the Cormack and Lehane grading, its use is associated with longer time for intubation, higher combined use of stylet and BURP manoeuvres to negotiate the endotracheal tube through the vocal cords in comparison with Macintosh laryngoscope in adult patients with normal airway.