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Qamar, Kiran, Sheikh Ziarat Ali, Saba Naveed, Mehtab Tipu Chaudary, Fariha Aslam, and Nazia Rubab Maqbool. "Positive Predictive Value of Upper Lip Bite Test in Predicting Difficult Intubation." Pakistan Journal of Medical and Health Sciences 16, no. 4 (2022): 326–29. http://dx.doi.org/10.53350/pjmhs22164326.
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Objective: To determine the positive predictive value of upper lip bite test in predicting difficult intubation by taking Cormack and Lehane classification as gold standard. Design of the Study: Cross sectional study. Study Settings: This cross-sectional study was conducted at Department of Anesthesiology, Sir Ganga Ram Hospital, Lahore from 04/06/2021 to 03/12/2021. Materials and Methods: This study involved 313 patients of both genders, aged between 18-70 years undergoing general anesthesia on elective lists having positive upper lip bite test (Grade-III). On the basis of Cormack and Lehane Classification, the diagnosis was verified. Results of the ULBT were compared to the Cormack and Lehane grade-III and grade-IV diagnoses. Every patient's written informed permission was obtained. Results: In The mean age of the patients was 43.78±12.32 years. Majority (n=150, 47.9%) of the patients were aged between 36-52 years. There were 198 (63.3%) male and 115 (36.7%) female patients in the study group. Among the procedures, herniorrhaphy (32.9%) and cholecystectomy (26.8%) were the more frequent procedures followed by thyroidectomy (17.6%), tonsillectomy (13.1%) and mastectomy (9.6%). Majority (42.8%) of the patients belonged to ASA Class-I followed by ASA Class-II (29.7%) and ASA Class-III (27.5%). Difficult intubation was confirmed in 232 (74.1%) patients on Cormack and Lehane Classification (as per operational definition). Thus there were 232 true positive patients with 81 false positive patients. With the gold standard Cormack and Lehane Classification, the upper lip bite test yielded a positive predictive value of 74.1 percent in the prediction of difficult intubation. Conclusion: According to the gold standard of Cormack and Lehane Classification, an upper lip bite test (Grade-III) has a 74.1 percent positive predictive value for difficult intubation in patients undergoing general anaesthesia with endotracheal intubation on the elective list. Keywords: Difficult Intubation, Cormack and Lehane Classification, Upper Lip Bite Test
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Zulfiqar, Hassam, Hashaam Ghafoor, Muhammad Haroon Anwar, Jawad Zahir, Farzana Mazhar Bokhari, and Inam Ul Haq. "Comparison of Laryngoscopic Glottic Views Obtained via Macintosh vs Miller Blade in Adults Undergoing General Anesthesia with Endotracheal Intubation." Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 19, no. 3 (2023): 266–71. http://dx.doi.org/10.48036/apims.v19i3.830.
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Objective: To compare the glottic views obtained through Miller and Macintosh blade laryngoscopy in adults undergoing general anesthesia with endotracheal intubation. Methodology: This quasi-experimental study was conducted at Holy Family Hospital, Rawalpindi, from June 2022 to September 2022. Sixty patients scheduled for elective surgery under general anesthesia with endotracheal intubation were enrolled. Patients were randomly assigned to two groups: Miller blade group (n=30) and Macintosh blade group (n=30). The anesthesiologist conducting the intubation recorded the Cormack Lehane grade obtained. Data analysis utilized SPSS version 27.0, employing independent-sample t-tests, Mann-Whitney U tests, chi-square, or Fisher's exact tests as appropriate. A p-value <0.05 was considered statistically significant. Results: In the Miller blade group, comprising 30 patients, the mean age was 44.60+13.310 years, and 53.3% were male. Cormack-Lehane grades were distributed as follows: 76.7% grade I, 20.0% grade II, and 3.3% grade III. In the Macintosh blade group, with 30 patients, the mean age was 40.93+12.798 years, and 46.7% were male. Cormack-Lehane grades were distributed as follows: 30.0% grade I, 50.0% grade II, 13.3% grade III, and 6.7% grade IV. Conclusion: The study concluded that Miller blade laryngoscopy provides superior glottic views compared to Macintosh blade laryngoscopy. However, the ease of intubation and the time taken for intubation were not investigated, suggesting areas for exploration in future studies.
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Yin, Ning, Lei Fang, Li Zhang, et al. "Predictor of postoperative dyspnea for Pierre Robin Sequence infants." Open Medicine 15, no. 1 (2020): 915–20. http://dx.doi.org/10.1515/med-2020-0231.
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AbstractThe aim of this retrospective study is to determine the predictive factors of postoperative dyspnea in infants with Pierre Robin sequence (PRS). Forty children with PRS, who underwent general anesthesia, were retrospectively analyzed. The patient’s physiological status and anesthesiology data were collected accordingly, demographic characteristics including age, gender, height and weight at surgery, weight gain, preoperative airway status, tracheal intubation route, American Society of Anesthesiologists grading and airway Cormack–Lehane classification. Weight gain, dyspnea before the operation, Cormack–Lehane grade distribution showed a significant difference between patients with and without postoperative dyspnea (p = 0.0175, p = 0.0026, and p = 0.0038, respectively). Incompetent weight gain was identified as a predictor (p = 0.0371) of PRS postoperative dyspnea through the binary logistic regression model. In conclusion, this study established an early alerting model by monitoring the weight gain, dyspnea before the operation, Cormack–Lehane grade as potential combinations to predict the risk of postoperative dyspnea for PRS.
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Dhaka, Satyapal, Sunita Meena, Gopal Bansal, Bheru Dan Charan, Meenu Bagarhatta, and Vandana Mangal. "USE OF ULTRASOUND PARAMETERS FOR PREDICTION OF DIFFICULT INTUBATION AND ITS RELATION WITH THE CORMACK AND LEHANE GRADE OF LARYNGOSCOPY." International Journal of Advanced Research 9, no. 01 (2021): 606–11. http://dx.doi.org/10.21474/ijar01/12334.
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Background and AIMS: Airway ultrasound is novel,safe and noninvasive modality that help in predicting difficult airway.This study aimed todetermine the usefulness of airway ultrasound in order to predict difficult intubation. Method:- This was a hospital based prospective observational study on 100 patients aged 18-60 years of either sex undergoing elective surgery under general anaesthesia with endotracheal intubation.Preoperatively physical airway evaluation was performed byusing six parameters including Modified Mallampati class(MMC), thyromental distance(TMD), sternomental distance(SMD) , inter-incisor (IID)distance , hyomental distance(HMD)and neck circumference(NC). In preoperatively, Airway Ultrasoundwas performed andnoted the ratio of the depth of the pre‑epiglottic space (PES) to the distance from the epiglottis to the mid‑point of the distance between the vocal cords (E‑VC). CL grade was also noted during laryngoscopy. Compared ultrasound parameters with Cormack–Lehane grade. Specificity,Sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracywere calculated.Airway ultrasound measurements were compared with physical parametersin predicting Cormack –Lehane grade. Results: The incidence of difficult intubation was 7%. Sensitivity of PES/E-VC ratio was higher than NC, TMD, HMD, IID and SMD but less than Mallampati class. Specificity, PPV was lower than physical parameters.NPV was comparable. Conclusion: Percutaneous airway ultrasound is useful and promising technique for predicting Cormack and Lehane grading but a combination of all these is definitely helpful for better prediction.
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Thayyil, Baseema, Neetha Thattaparambil Chandran, Asish Karthik, and Maya Gomathy Amma. "Comparison of Upper Lip Bite Test and Ratio of Height to Thyromental Distance in Predicting Difficult Tracheal Intubation in South Indian Population – A Descriptive Study." Journal of Evidence Based Medicine and Healthcare 8, no. 27 (2021): 2412–16. http://dx.doi.org/10.18410/jebmh/2021/447.
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BACKGROUND Failure in managing the airway is the most important cause of death in patients undergoing general anaesthesia (GA). For effectively preventing airway catastrophe it is essential to have a meticulous airway assessment pre-operatively. Many methods are in use to predict difficult airway like Mallampati, Wilson’s scoring, percentage of glottic opening (POGO) scoring, Cormack - Lehane classification, thyromental distance, mandibular hyoid distance, atlantooccipital joint extension etc. In this study, we compared between two popular methods of airway assessment, upper lip bite test (ULBT) and height to thyromental distance ratio (RHTMD) to predict the difficulty in tracheal intubation. METHODS This descriptive study was conducted at Government Medical college, Thrissur, over a period of one year , on 76 patients of American society of Anaesthesiologist (ASA) - PS l - lll, requiring general anaesthesia. ULBT and RHTMD were used to assess the patient’s airway. It was correlated with Cormack - Lehane classification during direct laryngoscopy. The data was analysed using Fisher exact test (P < 0.05) and Kappa statistics. RESULTS Out of the 76 patients, 41 (53.9%) were women 35 were men (46.1 %). ULBT predicted 89.6 % [25 + 43] belonging to class 1 and 2 as easy, while 10.5 % [8] of class 3 as difficult. RHTMD predicted 35 patients (46 %) as easy (grade 1) and 41 patients (54 %) as grade 2. Using ULBT, of the 8 patients predicted to have difficult intubation (Class 3), 2 were found practically difficult and 6 were easy. In remaining 68 patients, 23 patients had difficult view and 45 had easy view. According to Cormac and Lehane, among 41 patients who predicted difficult by RHTMD, 19 patients were practically difficult and 22 were easy. Of 35 patients, 6 patients were difficult and 29 were easy. CONCLUSIONS The RHTMD is more sensitive compared to ULBT in predicting difficult intubation. As assessed by Cormack - Lehane classification. KEYWORDS Difficult Intubation, Ratio of Height to Thyromental Distance, Upper Lip Bite Test
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Arulkumaran, Nishkantha, Charles S. McLaren, Kailash Arulkumaran, Barbara J. Philips, and Maurizio Cecconi. "An analysis of emergency tracheal intubations in critically ill patients by critical care trainees." Journal of the Intensive Care Society 19, no. 3 (2018): 180–87. http://dx.doi.org/10.1177/1751143717749686.
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Introduction We evaluated intensive care medicine trainees’ practice of emergency intubations in the United Kingdom. Methods Retrospective analysis of 881 in-hospital emergency intubations over a three-year period using an online trainee logbook. Results Emergency intubations out-of-hours were less frequent than in-hours, both on weekdays and weekends. Complications occurred in 9% of cases, with no association with time of day/day of week (p = 0.860). Complications were associated with higher Cormack and Lehane grades (p=0.004) and number of intubation attempts (p < 0.001), but not American Society of Anesthesiologist grade. Capnography usage was ≥99% in all locations except in wards (85%; p = 0.001). Ward patients were the oldest (p < 0.001), had higher American Society of Anesthesiologist grades (p < 0.001) and lowest Glasgow Coma Scale (p < 0.001). Conclusions Complications of intubations are associated with higher Cormack and Lehane grades and number of attempts, but not time of day/day of week. The uptake of capnography is reassuring, although there is scope for improvement on the ward.
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Acharya, Pragya, Anil Shrestha, Arjun Gurung, Megha Koirala, Gentle Sundar Shrestha, and Moda Nath Marhatta. "Effect of Head Elevation to Different Heights in Laryngeal Exposure with Direct Laryngoscopy." Journal of Nepal Health Research Council 17, no. 2 (2019): 168–72. http://dx.doi.org/10.33314/jnhrc.v0i0.1721.
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Background: The purpose of this study was to determine the optimal pillow height for the best laryngoscopic view in adult patients scheduled for elective surgery under general anaesthesia.Methods: 150 adult patients undergoing surgery under general anaesthesia with endotracheal intubation with no features suggestive of difficult airway were enrolled for the study. After induction of anaesthesia the assessment of direct laryngoscopic views was done at head positions without a pillow and with non-compressible pillows of heights 5cm and 10cm.Results: The laryngoscopic view with the 5cm pillow was significantly superior to other head position (p<0.01). The incidence of difficult laryngoscopy (Cormack and Lehane grade III) was 32.7% without a pillow which improved to (Cormack and Lehane grade III) 4% with 10cm pillow and there were no cases of difficult laryngoscopy with 5cm pillow.Conclusions: The use of 5cm pillow in the ‘sniffing’ position obtains the best laryngoscopic view during direct laryngoscopy.Keywords: Direct laryngoscopy; head elevation; laryngoscopicview; pillow height.
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Graham, Colin A., Angela J. Oglesby, Diana Beard, and Dermot W. McKeown. "Laryngoscopic views during rapid sequence intubation in the emergency department." CJEM 6, no. 06 (2004): 416–20. http://dx.doi.org/10.1017/s1481803500009416.
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ABSTRACT:Objectives:Our objective was to document and compare the views obtained at laryngoscopy during emergency department (ED) rapid sequence intubation (RSI) by anesthetists and emergency physicians of varying seniority and experience.Methods:Data were prospectively collected on every intubation attempt in 7 urban Scottish EDs for 2 calendar years, commencing Jan. 11, 1999. Data included patient’s age, gender, grade and specialty of intubator, laryngoscopic grade, and number of intubation attempts. Quality of laryngoscopic visualization was graded using the Cormack–Lehane scale, with grades I and II considered good visualization. A descriptive analysis was performed, and key statistical comparisons made.Results:During the study period, 735 patients underwent RSI, and grade of intubation was documented in 672 cases (91%). In total, 68.2%, 23.4%, 6.1% and 2.4% of the intubations were classified as Cormack–Lehane grade I, II, III and IV respectively. Overall, anesthetists and anesthesia trainees achieved good laryngoscopic visualization in 94.0% of cases (95% confidence interval [CI], 90.8%–96.4%) and emergency physicians and emergency medicine trainees did so in 89.2% of cases (95% CI, 85.5%–92.3%;p= 0.027). Specialist registrars and senior house officers in anesthesia were more likely to obtain good visualization than their emergency medicine counterparts (p= 0.034 and 0.035 respectively). Consultants in emergency medicine were more likely to obtain good views than their anesthesia counterparts, but this difference was not statistically significant.Conclusions:Anesthetic trainees obtain better laryngoscopic views than emergency medicine trainees, but these differences disappear with increasing emergency physician seniority, suggesting a training and experience effect. Emergency medicine trainees may benefit from additional focus on laryngoscopic visualization techniques early in their training period.
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Shah, Prerana N., and Kaveri Das. "McGrath Video Laryngoscope May Take a Longer Intubation Time Than Macintosh Laryngoscope." Journal of Anesthesiology 2015 (November 26, 2015): 1–4. http://dx.doi.org/10.1155/2015/901903.
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Background. Video laryngoscopes provide better view and can improve ease of intubation compared with standard laryngoscopes. Methods. A prospective randomized study was done on 60 patients, 18 to 65 years old, comparing McGrath video laryngoscope and Macintosh laryngoscope. The aim was to compare the ease, efficacy, and usability of them during routine airway management. The primary endpoint was duration of intubation and the secondary endpoints were Cormack and Lehane grade of laryngoscopic view, number of intubation attempts, and incidence of complications. Results. There was an increase in total duration of intubation with McGrath video laryngoscope with 42.9 ± 19.5 seconds compared to Macintosh laryngoscope with 17.9 ± 4.6 seconds. In Macintosh group, 73.3% had grade I, 20% had grade II, and 6.7% had grade III Cormack Lehane view, while in McGrath group, 83.3% had grade I, 13.3% had grade II, and 3.3% had grade III. In McGrath group, 6 patients (20%) required more than 120 seconds to get intubated and only 73.3% were intubated in 1 attempt, while patients in Macintosh group had 100% successful intubation in 1 attempt. Pharyngeal trauma was seen with McGrath videolaryngoscopy. Conclusion. Duration of laryngoscopy, intubation, and total duration of intubation were significantly higher in McGrath group than in Macintosh group. McGrath group required a higher number of intubation attempts.
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Hur, Min, Jong Yeop Kim, Sang Kee Min, Kyuheok Lee, Young Ju Won, and Ji Eun Kim. "Comparison of McGrath Videolaryngoscope and Macintosh Laryngoscope in Children with Torticollis: Randomized Controlled Trial." Children 8, no. 12 (2021): 1171. http://dx.doi.org/10.3390/children8121171.
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We investigated the efficacy of the McGrath videolaryngoscope compared with the Macintosh laryngoscope in children with torticollis. Thirty children aged 1–10 years who underwent surgical release of torticollis were randomly assigned into the McGrath and Macintosh groups. Orotracheal intubation was performed by a skilled anesthesiologist. The primary outcome was the intubation time. The Cormack–Lehane grade, lifting force, intubation difficulty scale (IDS), difficulty level, and intubation failure rate were also assessed. The intubation time was significantly longer in the McGrath group than in the Macintosh group (31.4 ± 6.7 s vs. 26.1 ± 5.4 s, p = 0.025). Additionally, the Cormack–Lehane grades were comparable between the groups (p = 0.101). The lifting force and IDS were significantly lower in the McGrath group than in the Macintosh group (p < 0.001 and p = 0.022, respectively). No significant differences were observed with respect to endotracheal intubation difficulty and intubation success rate. Intubation-related complications were also not observed. In conclusion, compared with the Macintosh laryngoscope, the McGrath videolaryngoscope extended the intubation time and did not improve glottic visualization in children with torticollis, despite having a lesser lifting force, lower intubation difficulty scale, and similar success rate.
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Oh, Ji Youn, Ji Hye Lee, Yu Yil Kim, Seung Min Baek, Da Wa Jung, and Ji Hun Park. "A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods." Anesthesia and Pain Medicine 16, no. 2 (2021): 196–200. http://dx.doi.org/10.17085/apm.20073.
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Background: The direct entry of the camera under the epiglottis may provide a better view of the glottis than the indirect lifting of the epiglottis by placing the Macintosh blade tip on the vallecula when using the video laryngoscope. This study aimed to compare the efficiency of two different methods of lifting the epiglottis during the visualization of glottis using video laryngoscopy in the same patient.Methods: This prospective study enrolled 60 patients who underwent general anesthesia with tracheal intubation. In each patient, glottic views were obtained by directly (group DE) and indirectly lifting the epiglottis (group IE). These two methods were compared using the modified Cormack and Lehane grade and the percentage of glottis opening (POGO) score as assessment parameters.Results: Modified Cormack and Lehane grade showed a significant difference between the groups DE and IE (P = 0.004). The difference in the POGO score between the groups DE and IE was also statistically significant (87.5% and 64.4%, respectively; P < 0.001).Conclusions: Our results, therefore, revealed that the method of directly lifting epiglottis was better at exposing glottis than the method of indirectly lifting epiglottis using a video laryngoscope.
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Taboada, Manuel, Patricia Doldan, Andrea Calvo, et al. "Comparison of Tracheal Intubation Conditions in Operating Room and Intensive Care Unit." Anesthesiology 129, no. 2 (2018): 321–28. http://dx.doi.org/10.1097/aln.0000000000002269.
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Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Tracheal intubation is a common intervention in the operating room and in the intensive care unit. The authors hypothesized that tracheal intubation using direct laryngoscopy would be associated with worse intubation conditions and more complications in the intensive care unit compared with the operating room. Methods The authors prospectively evaluated during 33 months patients who were tracheally intubated with direct laryngoscopy in the operating room, and subsequently in the intensive care unit (within a 1-month time frame). The primary outcome was to compare the difference in glottic visualization using the modified Cormack-Lehane grade between intubations performed on the same patient in an intensive care unit and previously in an operating room. Secondary outcomes were to compare first-time success rate, technical difficulty (number of attempts, operator-reported difficulty, need for adjuncts), and the incidence of complications. Results A total of 208 patients met inclusion criteria. Tracheal intubations in the intensive care unit were associated with worse glottic visualization (Cormack-Lehane grade I/IIa/IIb/III/IV: 116/24/47/19/2) compared with the operating room (Cormack-Lehane grade I/IIa/IIb/III/IV: 159/21/16/12/0; P &lt; 0.001). First-time intubation success rate was lower in the intensive care unit (185/208; 89%) compared with the operating room (201/208; 97%; P = 0.002). Tracheal intubations in the intensive care unit had an increased incidence of moderate and difficult intubation (33/208 [16%] vs. 18/208 [9%]; P &lt; 0.001), and need for adjuncts to direct laryngoscopy (40/208 [19%] vs. 21/208 [10%]; P = 0.002), compared with the operating room. Complications were more common during tracheal intubations in the intensive care unit (76/208; 37%) compared with the operating room (13/208; 6%; P &lt; 0.001). Conclusions Compared with the operating room, tracheal intubations in the intensive care unit were associated with worse intubation conditions and an increase of complications.
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Nanjayya, Vinodh B., Christopher J. Hebel, Patrick J. Kelly, Jason McClure, and David Pilcher. "The knowledge of Cormack–Lehane intubation grade and intensive care unit outcome." Journal of the Intensive Care Society 21, no. 1 (2019): 48–56. http://dx.doi.org/10.1177/1751143719832178.
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Background For patients on invasive mechanical ventilation (MV), it is unclear if knowledge of intubation grade influences intensive care unit (ICU) outcome. We aimed to determine if there was an independent relationship between knowledge of intubation grade during ICU admission and in-hospital mortality. Methods We performed a retrospective cohort study of all patients receiving invasive MV at the Alfred ICU between December 2011 and February 2015. Demographics, details of admission, the severity of illness, chronic health status, airway detail (unknown or known Cormack–Lehane (CL) grade), MV duration and in-hospital mortality data were collected. Univariable and multivariable analyses were conducted to assess the relationship. The primary outcome was in-hospital mortality, and the secondary outcome was the duration of MV. Results Amongst 3556 patients studied, 611 (17.2%) had an unknown CL grade. Unadjusted mortality was higher in patients with unknown CL grade compared to known CL grade patients (21.6% vs. 9.9%). After adjusting for age, sex, severity of illness, type of ICU admission, cardiac arrest, limitations to treatment and diagnosis, having an unknown CL grade during invasive MV was independently associated with an increase in mortality (adjusted OR 1.5, 95% CI 1.14–1.98, p < 0.01). Conclusion Amongst ICU patients receiving MV, not knowing CL grade appears to be independently associated with increased mortality. This information should be communicated and documented in all patients receiving MV in ICU.
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Bukhari, Dr Sadaf, Dr Aaifa Khalid Niazi, and Dr Hajra Shuja. "ACCURACY OF UPPER LIP BITE TEST IN PREDICTING DIFFICULT AIRWAY." Professional Medical Journal 25, no. 12 (2018): 1966–71. http://dx.doi.org/10.29309/tpmj/18.496.
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INTRODUCTION: Various anatomical measurements and non‑invasive clinical tests can be performed to predict difficult intubation. Recently introduced “Upper lip bite test” (ULBT) is claimed to have a high predictability. However, limited data exists to support its high predictability both nationally and internationally.
 OBJECTIVE: To determine the diagnostic accuracy of upper lip bite test in the prediction of difficult airway.
 METHODOLOGY: This was a cross sectional study. A sample of 283 patients was calculated by using WHO sample size calculator and sampling was done by non-probability consecutive sampling. All the selected patients were assessed for upper lip bite test and Cormack and Lehane laryngoscopy grade separately. Data was collected on pre-designed proforma. Accuracy of ULBT was calculated based on the acquired data.
 RESULTS: The calculated accuracy of ULBT for predicting difficult airway was found to be 91.2%.
 CONCLUSION: ULBT is a reliable bedside technique with a high accuracy for predicting a difficult airway.
 KEY WORDS: Upper lip bite test, Cormack and Lehane scale, difficult airway.
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Vasilev, V. V. "EXPERIENCE OF VIDEO LARYNGOSCOPY DURING TRACHEAL INTUBATION FOR EMERGENCY INDICATIONS IN THE PRACTICE OF AN ANESTHESIOLOGIST AND RESUSCITATOR." EMERGENCY MEDICAL CARE 21, no. 3 (2020): 33–38. http://dx.doi.org/10.24884/2072-6716-2020-21-3-33-38.
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Objectives. To assess the advantages and disadvantages of videolaryngoscopy as one of methods of tracheal intubation which is being widely used as an alternative to direct laryngoscopy in anesthesiologist’s practice.Material and methods. Over 100 of tracheal intubations were conducted with the use of videolaryngoscope, along with a routine use of the direct laryngoscopy. The results of 48 intubations are discussed. 4 clinical cases are presented in this article.Results. Cormack-Lehane grade I view was obtained in 39 cases (81,3%), Cormack-Lehane grade II - in 9 patients (18,8%). First attempt intubation was performed in 43 cases (89,6%), in 4 cases intubation was successful after second attempt (8,3%), failed intubation was in 1 case (2,1%). The mean duration of successful intubation was 36,9 sec. Certain difficulties occured during intubation related with the advancement of the endotracheal tube. Technical solutions are given for some of intraprocedural conditions.Conclusions. Videolaryngoscopy is a safe and effective method of tracheal intubation. Although this method is not lacking in disadvantages it has a number of advantages, main of which is the improved larynx visualization. In our opinion, this method can not completely replace direct laryngoscopy in anesthesiolodist’s practice, but may serve as an adjuvant in case of difficult intubation.
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Shin, Myungju, Sun Joon Bai, Ki-Young Lee, Ein Oh, and Hyun Joo Kim. "Comparing McGRATH® MAC, C-MAC®, and Macintosh Laryngoscopes Operated by Medical Students: A Randomized, Crossover, Manikin Study." BioMed Research International 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/8943931.
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We hypothesized that the McGRATH MAC would decrease the time of intubation compared to C-MAC for novices. Thirty-nine medical students who had used the Macintosh blade to intubate a manikin fewer than 3 times were recruited. The participants performed sequential intubations on the manikin in two simulated settings that included a normal airway and a difficult airway (tongue edema). The intubation time, success rate of intubation, Cormack-Lehane grade at laryngoscopy, and difficulty using the device were recorded. Each participant was asked to identify the device that was most useful. The intubation time decreased significantly and by a similar amount to the McGRATH MAC and C-MAC compared to the Macintosh blade (P<0.001andP=0.017, resp.). In the difficult airway, the intubation times were similar among the three devices. The McGRATH MAC and C-MAC significantly increased the success rate of intubation, improved the Cormack-Lehane grade, and decreased the difficulty score compared to the Macintosh blade in both airway settings. The majority of participants selected the McGRATH MAC as the most useful device. The McGRATH MAC and C-MAC may offer similar benefits for intubation compared to the Macintosh blade in normal and difficult airway situations.
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Agrawal, Anushri, Rashmi Pal, Deepali Valecha, and Manish Banjare. "Height to thyromental distance ratio and height to sternomental distance ratio comparison as difficult airway predictors: A cross-sectional study." Indian Journal of Clinical Anaesthesia 12, no. 1 (2025): 118–24. https://doi.org/10.18231/j.ijca.2025.018.
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: Difficult airway management is a critical concern in anesthesiology, contributing significantly to perioperative morbidity and mortality. Preoperative evaluation using predictive parameters like the Height-to-Thyromental Distance (RHTMD) ratio and the Height-to-Sternomental Distance (RHSMD) ratio aids in identifying patients at risk of difficult intubation. This study aimed to compare RHTMD and RHSMD as predictors of difficult airways in patients undergoing elective surgeries under general anesthesia.: A cross-sectional study was conducted involving 150 patients undergoing elective surgeries under general anesthesia. Airway assessments included measurements of Thyromental Distance (TMD), Sternomental Distance (SMD), RHTMD, RHSMD, weight, and height. Direct laryngoscopy was performed using a Macintosh blade by an anesthetist with over three years of experience, and the Cormack-Lehane grade was recorded. Institutional anesthesia protocols were uniformly applied. Using the Cormack-Lehane grade as the reference standard, RHTMD demonstrated a sensitivity of 88.9%, specificity of 97.7%, and accuracy of 96.67%. RHSMD showed a sensitivity of 83.3%, specificity of 95.5%, and accuracy of 94%.: The Height-to-Thyromental Distance ratio was found to be a more sensitive, specific, and accurate predictor of difficult airways compared to the Height-to-Sternomental Distance ratio. Combining both parameters further improved the predictive reliability, emphasizing the need for an integrated assessment approach in airway evaluation.
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Falak, Ara, Bashir Humaira, Ahmad Irshad, and Ah Mir Bashir. "Videolaryngoscopes are Becoming a New Breakthrough in Airway Management." International Journal of Pharmaceutical and Clinical Research 15, no. 10 (2023): 621–26. https://doi.org/10.5281/zenodo.11261579.
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<strong>Background: </strong>Difficulties in airway management increase the risk of hypoxia, which can also lead to devastating neurological outcome. <strong>Objectives: </strong>To compare Macintosh laryngoscope, Truview video laryngoscope and King Vision video laryngoscope with respect to time to intubation, Cormack- Lehane grading, number of attempts, optimisation manoeuvres required and the complications related to laryngoscopy and intubation. <strong>Methods: </strong>After obtaining approval from the Institutional Ethic Committee, the present, prospective, cross over randomized study “evaluating the efficacy of Kingvision, trueview and Macintosh video laryngoscope in patients requiring general anesthesia with endotracheal intubation.” was conducted in the Post-Graduate Department of Anaesthesiology and Intensive care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu over a period of one year. 120 patients undergoing elective surgery requiring tracheal intubation were randomly as-signed to undergo intubation using Kingvision, Truview or Macintosh laryngoscope, to compose equal groups of 40 each. <strong>Results: </strong>Majority of patients in all three groups had MPG I/II. Kingvision group (31; 77.5%), Truview group (35;87.5%) and Macintosh group (35;87.5%). 8 patients in Kingvision group and 5 patients each in Truview and Macintosh group had MPG III/IV indicating the difficulty in intubation. The three groups were comparable with relation to MPG distribution. (p>0.05). Cormack Lehane Grade I (full view of vocal cords) was seen in 40 (100%) patients of the Kingvision group, 37(92.5%) of the Truview group and 28(70%) of the Macintosh group. Grade II (partial view of vocal cords) was seen in no patient of Kingvision group, 6(15%) of Truview group and 10 (25%) of the Macintosh group. <strong>Conclusion:</strong> Both the video laryngoscopes were found to be significantly better than the Macintosh laryngoscope in terms of Cormack and Lehane grading; requirement of optimisation manoeuvres and need of second attempt for intubation.
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Ashokka, Balakrishnan, Krishnasamy Narendiran, Abhijit Bhattacharya, et al. "Inherent variability in airway characteristics of simulation manikins: is it time we standardised assessments of crisis management skills?" BMJ Simulation and Technology Enhanced Learning 2, no. 4 (2016): 103–7. http://dx.doi.org/10.1136/bmjstel-2016-000109.
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IntroductionLearning of simulation-based crisis management skills involves technologically advanced manikins and use of automated scenarios. Progressions in preprogrammed scenarios require finite task completion such as successful airway intubations for achieving optimal learning outcomes aligned to curricular goals. The study was set to explore the existing variability among various simulation manikins in use at our institute for undergraduate medical education.Methods56 final-year undergraduate students, who had received prior training in airway management skills, performed intubations on each of the 5 different manikins (56×5=280 intubations). The manikins used were the Human Patient Simulator (HPS), iStan & Emergency Care Simulator (ECS) from CAE Healthcare and Mega Code Kelly (MCK) and Airway Trainer (AWTR) from Laerdal. The students’ performances were compared for success rates, ease of intubation, grade of laryngeal visualisation and presence of tooth injury on the manikins, Data from the intubations were cross-tabulated and evaluated by general estimating equation analysis using the Poisson model.ResultsiStan had the higher rates of failure to intubate (64.3%). iStan (62.5%) and HPS (57.1%) had statistically significant teeth injury (p<0.0001) compared to other manikins. HPS and AWTR had the least difficult grades of laryngeal visualisation (Cormack Lehane grades 1 and 2), while the most difficult grade of visualisation (Cormack Lehane grades 3 and 4) was reported in ECS (44.6%).ConclusionsEach of the high-technology manikins used in automated scenarios for crisis management teaching and learning has heterogeneity in airway features. Since frequent airway management is a critical component of simulation scenarios, this can affect student performance when these manikins are used for formative and summative high-stakes assessments.
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Karczewska, Katarzyna, Szymon Bialka, Jacek Smereka, et al. "Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis." Journal of Clinical Medicine 10, no. 23 (2021): 5524. http://dx.doi.org/10.3390/jcm10235524.
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The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.
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Pearce, A. C., L. V. Duggan, and K. El‐Boghdadly. "Making the grade: has Cormack and Lehane grading stood the test of time?" Anaesthesia 76, no. 5 (2021): 705–9. http://dx.doi.org/10.1111/anae.15446.
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Watase, Taketo, Olesya Baker, Andrew Latimer, Medley Gatewood, and Calvin Brown. "Association of Cormack Lehane grade and first-pass success with hyper-angulated videolaryngoscopes." Trends in Anaesthesia and Critical Care 30 (February 2020): e146-e147. http://dx.doi.org/10.1016/j.tacc.2019.12.358.
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Koyanagi, Yuko, Eiko Yokota, Marina Iwata, Ritsuko Shimazaki, Toru Misaki, and Yoshiyuki Oi. "A Case of Successful Tracheal Tube Exchange With McGrath MAC for Tube Damage During Oral Surgery." Anesthesia Progress 67, no. 3 (2020): 174–76. http://dx.doi.org/10.2344/anpr-67-02-01.
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A patient undergoing a bilateral sagittal split and LeFort 1 maxillary osteotomy performed under general anesthesia required emergent intraoperative exchange of a potentially damaged nasotracheal tube. This exchange was smoothly performed under constant indirect visualization using the McGrath MAC video laryngoscopy system. After the exchange, ventilation of the patient dramatically improved. The removed endotracheal tube was torn 19 cm from the distal tip. The McGrath MAC was useful for visualizing the glottis and confirming the entire course of the tube exchange despite the patient's having a difficult airway (Cormack-Lehane grade 3).
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Parveen, Sania, Syed Moied Ahmed, and Mohd Najmul Aqib Khan. "Randomized Controlled Study: Comparing the Effectiveness of iSCOPE 3 and AirTraq Video Laryngoscope Examinations in Patients Undergoing Tracheal Intubation." Indonesian Journal of Anesthesiology and Reanimation 6, no. 2 (2024): 80–88. http://dx.doi.org/10.20473/ijar.v6i22024.80-88.
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Introduction: Nowadays, indirect laryngoscopy is a commonly used technique for teaching airway control skills. Incorporating small, less expensive, and yet more reliable video cameras into laryngoscopes has given the process of laryngoscopy and intubation, a big leap. The AirTraq has shown promise in several settings, while the iSCOPE 3 video laryngoscope is a newly launched device, and no literature is available to our understanding. Objective: To compare the effectiveness of the iSCOPE 3 video laryngoscope with the AirTraq optical laryngoscope. Material and Method: It was a randomized controlled study conducted among sixty patients after approval from the Board of Study and ethical clearance, divided into two groups. In Group AT, patients were intubated with AirTraq, and in Group IS, patients were intubated with iSCOPE 3 as per the protocol. The primary outcome metric was the duration of tracheal intubation. Secondary outcomes were measured by the quantity of tries and intubation ease, glottic view or percentage of the glottic opening score (POGO), and Cormack & Lehane grade. Results: In the iSCOPE 3 and AirTraq groups, comparable mean intubation times were observed. (19.50 s vs. 19.16 s). The ease of intubation was significantly better with iSCOPE 3 (p< 0.05), single attempt was needed to intubate 96.7% of patients in the iSCOPE 3 group compared to 70% of patients in the AirTraq group (p< 0.05). POGO score and Cormack & Lehane grade were also significantly better with iSCOPE 3 (p <0.05). Conclusion: Pogo and CL grade were better with iSCOPE 3 than AirTraq, and hence the success rate of intubation, number of attempts, and ease of intubation were significantly better with iSCOPE 3.
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Khalid, Atif, Farah Nasreen, and Manazir Athar. "A prospective randomised study to compare the efficacy of Medicam pediatric video Laryngoscope and Macintosh Laryngoscope as an intubating device in pediatric patients: Videolaryngoscopy in pediatric airway." Serbian Journal of Anesthesia and Intensive Therapy 46, no. 1-2 (2024): 23–28. http://dx.doi.org/10.5937/sjait2402023k.
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Introduction: Airway management in paediatric patients is always a challenging task due to limited functional reserve. Recently, many airway devices have been utilized with varied success rates. The Medicam Paediatric Video Laryngoscope (MPVL) is a recent addition that may significantly impact paediatric airway outcomes. Hence, the present study was designed to assess the efficacy of MPVL and the Macintosh direct laryngoscope in terms of intubation characteristics. Methods: Following ethical approval and informed consent, this prospective, randomized study included sixty ASA I and II patients of either sex aged between 2 and 10 years of age. Patients were randomly allocated into two groups: Medicam Paediatric Video Laryngocope and Direct Laringocopy (n = 30 each), to be intubated with the Medicam Paediatric video laryngoscope and Macintosh direct laryngoscope, respectively. The primary outcome was intubation time, while the secondary outcome was first attempt success rate, Cormack Lehane grade, and ease of intubation. Results: The mean time to intubation in group MPVL was 16.0 ± 2.88 seconds, and in group DL was 12.33 ± 2.72 seconds (p-value < 0.05). Cormack-Lehane grade 1 was significantly higher in Group MPVL than Group DL (p = 0.04). The two devices were comparable in terms of first-attempt success rate and ease of intubation. No complications were observed except in one patient in the DL group. Conclusion: MPVL provides better glottis visualization and a trend towards a higher first attempt success rate at the expense of prolonged intubation time. However, the time difference regarding intubation was not clinically significant.
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Kotwani, Manish, Netraj Namdev Kawale, Pranav Balu Nam, and Deepti Kotwani. "Modified Mallampati Test in Supine versus Sitting Position as a Predictor for Difficult Intubation – An Observational Study." Airway 7, no. 2 (2024): 64–70. http://dx.doi.org/10.4103/arwy.arwy_9_24.
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Abstract Background: The modified Mallampati test (MMT) is routinely employed to predict difficult laryngoscopy and tracheal intubation. This test, as a standard, when conducted with a patient in a sitting position, exhibits limited practicality due to its relatively low sensitivity and specificity in predicting difficult tracheal intubation (DTI). It is hypothesised that MMT, when performed with a patient lying supine, may improve its efficacy as a predictor of DTI. Methods: This single-centre prospective observational study was conducted involving 455 adult patients requiring general endotracheal anaesthesia. During preanaesthetic evaluation, MMT was performed in the sitting position as a standard (sitting MMT). Subsequently, independent observers recorded the MMT in the supine position (supine MMT) before administering general anaesthesia. The sitting and supine MMT were correlated with Cormack and Lehane grades using the Chi-square test. Diagnostic performance metrics, including the area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive predictive values (PPV) and negative predictive values, were employed to assess the predictive capabilities of MMT in both positions. Results: Out of 455 patients, 72 (15.8%) experienced difficult intubation (defined as Cormack–Lehane Grade III and above). Both MMT in the sitting and supine positions demonstrated strong predictive capabilities for DTI, with areas under the ROC of 0.799 and 0.779, respectively. While sitting in the MMT position exhibited higher sensitivity (55.6% vs. 28.8%), supine MMT demonstrated a superior PPV (86.1% vs. 55.6%). Conclusion: MMT, when conducted with a patient in a supine position emerges as an alternative and a reliable predictor for predicting DTI.
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Mookambika, R., RV Hemanth Kumar, Archana Areti, and V. Jaya. "Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial." Indian Journal of Anaesthesia 68, no. 6 (2024): 547–52. http://dx.doi.org/10.4103/ija.ija_1130_23.
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Background and Aims: The head-elevated laryngoscopy position (HELP) and a 25° backup have been proposed to enhance glottic visualisation, yet concerns about ergonomic discomfort hinder their widespread adoption. This study compares the comfort and posture adopted by anaesthesiologists while performing laryngoscopy and tracheal intubation with patients in HELP while in a supine position or with 25° backup. Methods: The study included 48 patients aged 18–60 years with normal airways and 12 experienced anaesthesiologists. Patients were randomised into two groups using permuted block randomisation. Anaesthesiologists performed laryngoscopy and intubation in supine HELP and 25° backup HELP positions. Anaesthesiologist’s posture was determined by measuring the angles of neck, wrist, elbow, back and knee joints, which were compared using Student’s t-test, and subjective comfort assessed on a Likert scale was compared using the Chi-square test. As mentioned by the anaesthesiologist, Cormack- Lehane grading was also noted and compared using a Chi-square test between groups, taking a P value <0.05 as significant. Results: Both positions demonstrated comparable anaesthesiologist posture (P = 0.919) and comfort (P = 0.644). However, the 25° backup HELP positions significantly improved Cormack–Lehane grades, with 68% achieving grade 1 compared to 31% in the supine HELP group (P = 0.012). Haemodynamic stability and tracheal intubation time showed no significant differences between the groups (P = 0.475 and 0.117, respectively), and no complications were reported in either group. Conclusion: Anaesthesiologists’ posture and comfort during laryngoscopy and tracheal intubation are similar between supine and 25° backup in patients with easy airways.
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Tawfic, Qutaiba A., and Jyoti Burad. "The GlideScope for tracheal intubation in patients with grade IV modified Cormack and Lehane." European Journal of Anaesthesiology 27, no. 7 (2010): 668–70. http://dx.doi.org/10.1097/eja.0b013e3283357075.
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International, Journal of Medical Science and Innovative Research (IJMSIR). "Airway Assessment by Comparing Clinical Parameters and Usg Parameters in Correlation With Cormack-Lehane Grade: A Prospective Observational Study." International Journal of Medical Science and Innovative Research (IJMSIR) 9, no. 5 (2024): 57–65. https://doi.org/10.5281/zenodo.15430413.
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<strong>Introduction</strong>: Airway assessment before surgery is important for anesthesiologist's to predict difficult intubation. This assessment helps to identify a difficult airway, allowing time for adequate preparation, such as selecting the right equipment and technique. Incapability to sustain a patent airway results in insufficient ventilation and oxygenation leading to hypoxic brain damage and death. Recently Ultra sonogram (USG) gained importance in accurate prediction of difficult airway and has potential to become 1st line non- invasive airway assessment tool in future. <strong>Aim</strong>: To compare the clinical parameters and USG parameters of airway assessment in predicting Cormack –Lehane grading in patients undergoing elective surgery under general anaesthesia.
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Sakkas, Andreas, Christel Weiß, Wolfgang Zink, et al. "Airway Management of Orofacial Infections Originating in the Mandible." Journal of Personalized Medicine 13, no. 6 (2023): 950. http://dx.doi.org/10.3390/jpm13060950.
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The primary aim of this study was to assess the incidence of a difficult airway and emergency tracheostomy in patients with orofacial infections originating in the mandible, and a secondary aim was to determine the potential predictors of difficult intubation. This retrospective single-center study included all patients who were referred between 2015 and 2022 with an orofacial infection originating in the mandible and who were surgically drained under intubation anesthesia. The incidence of a difficult airway regarding ventilation, laryngoscopy, and intubation was analyzed descriptively. Associations between potential influencing factors and difficult intubation were examined via multivariable analysis. A total of 361 patients (mean age: 47.7 years) were included in the analysis. A difficult airway was present in 121/361 (33.5%) patients. Difficult intubation was most common in patients with infections of the massetericomandibular space (42.6%), followed by infections of the mouth floor (40%) and pterygomandibular space (23.5%). Dyspnea and stridor were not associated with the localization of infection (p = 0.6486/p = 0.4418). Multivariable analysis revealed increased age, restricted mouth opening, higher Mallampati scores, and higher Cormack–Lehane classification grades as significant predictors of difficult intubation. Higher BMI, dysphagia, dyspnea, stridor and a non-palpable mandibular rim did not influence the airway management. Patients with a difficult airway were more likely to be admitted to the ICU after surgery than patients with regular airway were (p = 0.0001). To conclude, the incidence of a difficult airway was high in patients with orofacial infections originating in the mandible. Older age, limited mouth opening, a higher Mallampati score, and a higher Cormack–Lehane grade were reliable predictors of difficult intubation.
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Sakshi Jain, Jayendra Arya, Arvind Rathiya, and Sudhakar Dwivedi. "Correlation between upper airway ultrasound and Cormack–Lehane grading during laryngoscopy – A prospective study." Asian Journal of Medical Sciences 14, no. 1 (2023): 117–23. http://dx.doi.org/10.3126/ajms.v14i1.48306.
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Background: Securing airway and adequate ventilation after induction of anesthesia is the utmost priority of anesthesiologists, failure of that can lead to hypoxic brain injury and death in a few minutes. Aims and Objectives: The aims of this study were to ascertain the role of ultrasonography in predicting difficult intubation by comparing different ultrasonographic parameters. Materials and Methods: One hundred patients posted for elective surgery under general anesthesia were studied. The study was carried out in two phases. The first phase – during the pre-anesthetic checkup, ultrasonographic measurements of Anterior neck soft-tissue thickness at the level of hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of vocal cords (ANS-VC), pre-epiglottic space (Pre-E), distance from the epiglottis to the mid-point of the distance between the vocal cords (EVL), and the ratio of both (PES/EVL) was also done. In the second phase, Cormack–Lehane (CL) grade was noted during intubation. A Chi-square test was applied to correlate ultrasonographic parameters and CL grade. Sensitivity, specificity, an area under the receiver operating characteristic (ROC) curve, negative predictive value, and positive predictive value were calculated for various parameters. Results: In this study among the studied parameter, only ANS–VC was statistically significant in predicting difficult intubation (P<0.0001). ANS-VC >0.32 cm was 93.3% sensitive and 84.7% specific and had Area under the ROC curve of 85% in predicting CL grade 3 and 4 (difficult intubation). Conclusion: USG is a useful tool in predicting difficult intubation. ANS-VC >0.32 cm is a highly sensitive and specific predictor of difficult intubation, while other USG parameters are not indicative of difficult intubation.
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S, Ajanth, Vinayak Sirsat, S. Chauhan, and Deepak M. Kokane. "Comparative Study of Upper Lip Bite Test and Modified Mallampatti Classification in Predicting Difficult Endotracheal Intubation." Indian Journal of Anesthesia and Analgesia 8, no. 6 (2021): 563–69. http://dx.doi.org/10.21088/ijaa.2349.8471.8621.82.
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Objective: To compare sensitivity, specificity, positive and negative predictive values of upper lip bite test and modified mallampatti test to predict difficulty in endotracheal intubation in patients between 16 to 55 years of age. Methods: One hundred ASA1/2 patients admitted for elective surgical procedure requiring endotracheal intubation were prospectively studied to predict difficult intubation in age group 16-55 years of age after obtaining an informed consent. Preoperative Airway assessment was done with modified mallampatti test and upper lip bite test. Results: In our study, eighty four had Upper lip bite test (ULBT) class I and II and sixteen patients had class III. Of these two ofthe ULBT class Iand II and five of the ULBTclassIII had Cormack Lehane grade III . There were one hundred patients predicted to be easy for intubation by MMT (i.e. patients who had ULBT class I and II) out of whom however, we encountered difficult intubation in 6 patients. One in MMT class III also had difficult intubation. None of the patients had class IV MMT.Of the entire one hundred patients, a total of seven patients had difficult intubation, all of whom had Cormack Lehane class III on laryngoscopy. Conclusion: Upper Lip Bite Test (ULBT)is a better test at predicting difficult endotracheal intubation when compared toModified Mallampati Test (MMT). Upper lip bite test and modified mallampatti classification are good predictors of easy intubation rather than difficult intubation. Upper lip bite test should be used in combination with other airway assessment methods viz. Thyromental distance, hyomental distance, inter incisor distance to predict difficult intubation.
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Chaudhry, Shahid Adalat, Muhammad Nadeem Khan, and Mubashar Iqbal. "A Comparative Study of Glottic Visualization and Ease of Intubation with McCoy and Macintosh Laryngoscopes." Pakistan Journal of Medical and Health Sciences 16, no. 1 (2022): 598–600. http://dx.doi.org/10.53350/pjmhs22161598.
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Introduction: The anaesthetist should protect the airways during induction, recovery and maintenance during anaesthesia. The Macintosh blade is the utmost prevalent blades with a slightly back curved that extends all the way to the tip. The McCoy blade is grounded on a normal Macintosh blade with a hinged tip and is functioned by a lever mechanism located at the handle back. Objective: This study attempts to compare McCoy and Macintosh blades to facilitate intubation for glottis imaging. Place and Duration: In the Department of Anesthesia, Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six months duration from June 2021 to November 2021. Method: The study included 70 Grade I and II ASA adults of both sexes (20 to 60 years) who endured planned surgery under GA necessitating intubation by endotracheal tube. Using a computer-generated randomization table, individuals were assigned randomly to any of the 2 groups contingent on the type of laryngoscope blades used while doing intubation. After anaesthesia induction, ‘laryngoscopy’ was done and the intubation of trachea was done. McCoy Laryngoscope Blade was used in In Group A while Macintosh Laryngoscope Blade in Group B. The number of trials, Cormack Lehane classification, the necessity for external laryngeal manipulation and degree of intubation difficulty were evaluated. Results: Both groups were comparable for sex, weight, age, height, MPC grading, ASA status and among the two groups; no statistically significant alteration was noted (p-value> 0.05). In Group A and B Cormack Lehane classification in Grade-I scored 82.9% and 60%, correspondingly, while Grade-II scoring in Group A and B were 17% and 25.8%, correspondingly. The Grade-I Intubation Difficulty score (IDS) in Groups A and Group B were 88.6% and 80%, respectively, while Grade-II IDS in Groups A and B were 11.4% and 14.2%. 8.5% of patients in group A and 5.7% of patients in group B required two intubation attempts. Conclusion: There are no significant fluctuations to the glottis visualization with Macintosh and McCoy laryngoscopes, but in terms of external manipulation of larynx, the McCoy laryngoscope is superior to the Macintosh laryngoscope in terms of comfort of intubation. Keyword: endotracheal tube, Macintosh blades, Macintosh and McCoy laryngoscopes.
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Agrawal, Neha, Alks Shah, Balraj Joshi, and Pinal Vasani. "Evaluation of the True View PCD Video Laryngoscope for Oral Endotracheal Intubation." Academia Anesthesiologica International 5, no. 2 (2020): 57–61. http://dx.doi.org/10.21276/aan.2020.5.2.12.
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Background: Truview PCD video laryngoscope is particularly planned to assist in locating the endotracheal tube in addition to observe the admission of the tube into the glottis. The present study was performed to assess the outlook of glottic opening and relief of intubation between the Truview PCD laryngoscope and Macintosh laryngoscope in patients undergoes general anaesthesia. Subjects and Methods: Ninety patients of ASA grade 1 and 2 aged 18-60 years, posted for elective surgery under general anaesthesia needing endotracheal intubation were arbitrarily allocated into group 1 (Truview PCD laryngoscope n=45) and group 2 (Macintosh laryngoscope n=45). The two groups were compared for demographic data, intubation difficulty score, Cormack-Lehane grade, time to intubate, number of intubation attempts and hemodynamic parameters. Conclusion: Truview PCD can be measured as an alternate intubation device, especially in difficult intubation conditions.
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Jain, Sakshi. "Abstract No. : ABS1378: Correlation between upper airway ultrasound and Cormack- Lehane grading during laryngoscopy-A prospective study." Indian Journal of Anaesthesia 66, Suppl 1 (2022): S54. http://dx.doi.org/10.4103/0019-5049.340717.
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Background & Aims: Difficult and failed tracheal intubation after direct laryngoscopy is a dreaded complication of general anaesthesia. Preoperative prediction of the Cormack-Lehane (CL) grade with ultrasonographic measurements of ANS-Hyoid, ANS-VC, PES&EVL can help in better airway management during general anaesthesia. Methods: We studied 100 patients undergoing elective surgery under general anaesthesia. Study was carried out in two phases. Firstly, during preanaesthetic checkup, Mallam pati grade (MPG), Sternomental distance (SMD), Thyromental distance (TMD) and ultrasound measurements of the anterior neck soft tissue thickness at the level of the hyoid (ANS-Hyoid), at the level of the vocal cords (ANS-VC) and ratio of the depth of the pre-epiglottic space (Pre-E) to the distance from the epiglottis to the mid-point between the vocal cords (E-VC) were obtained, CL grade was noted during laryngoscopy. Chi-square test wasapplied to predict any statistically correlation between measurement of ultrasonographic parameters and CL grade. Results: The incidence of difficult intubation was 15%. An ANS-VC>0.32 had sensitivity of 100% in predicting a CL grade of 3 and4, which was higher than ANS-hyoid, PES/EVL, MPG, SMD, TMD, while specificity and PPV were lower. JOURNAL/ijana/04.03/01762628-202203001-00082/inline-graphic1/v/2022-09-30T091728Z/r/image-tiff Conclusion: Ultrasound is a useful test in airway assessment. ANS-VC>0.32 is a potential predictor of difficult intubation. ANS-hyoid, PES/EVL are not indicative of difficult intubation.
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Keshav, Swapnil, Jitendra Kumar, Nidhi Arun, and V. K. Verma. "Co-Relation Between USG- Guided Methods and Conventional Methods for the Assessment of Airway and Cormack Lehane Grading in Adult Patients - A Randomized, Double Blinded Prospective Observational Study." International Journal of Medical and Biomedical Studies 9, no. 2 (2025): 77–86. https://doi.org/10.32553/ijmbs.v9i2.3031.
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Background: A comprehensive examination of the airway is essential for secure anesthetic administration. Conventional clinical evaluations, like the Mallampati classification and thyromental distance, are commonly employed although frequently lack reliability in predicting challenging airway situations. The introduction of point-of-care ultrasonography (POCUS) has established non-invasive imaging as a valuable supplement in preoperative airway assessment. This study examines the efficacy of ultrasound-guided measurements relative to traditional methods in forecasting Cormack-Lehane (CL) grades during laryngoscopy. Objective: To evaluate the predicted accuracy of ultrasound-guided assessment compared to conventional methods in identifying difficult laryngoscopy, as indicated by CL grading, and to ascertain whether their combination improves overall predictive performance. Method: A randomized, double-blind, prospective observational study was performed at the Indira Gandhi Institute of Medical Sciences in Patna over the course of one year. One hundred twenty adult patients scheduled for elective procedures under general anesthesia were enrolled. Airway evaluations were conducted utilizing conventional methods (Mallampati classification, thyromental distance, etc.) and ultrasound-assisted metrics (skin-to-epiglottis distance [SED], hyomental distance ratio [HMDR], etc.). The anesthesiologist conducting the intubation was unaware of the evaluations. The link with CL grades was examined by Pearson correlation, logistic regression, and ROC curves. Result: Ultrasound-guided metrics exhibited enhanced prediction precision relative to traditional techniques. SED ?2.54 cm and HMDR ?1.2 were substantially correlated with challenging laryngoscopy (CL Grade III–IV), with sensitivities of 78.5% and 83.3%, respectively. Conversely, conventional procedures like Mallampati class III–IV and thyromental distance <6.5 cm exhibited diminished sensitivities (47.6% and 59.4%). The integration of two modalities resulted in the highest prediction accuracy, achieving an AUC of 0.93. Conclusion: Ultrasound-guided airway assessment is a dependable, objective, and reproducible method that improves the prediction of challenging intubation. When combined with traditional clinical methods, it markedly enhances the sensitivity and specificity of airway assessment. Integrating POCUS into conventional preoperative screening techniques may improve patient safety and diminish airway-related problems. Keywords: Airway examination, ultrasonography, Cormack-Lehane classification, endotracheal intubation, point-of-care ultrasound, preoperative assessment
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Kim, Hyunjee, Hoon Jung, Seong Min Hwang, and Woo Seok Yang. "Preoperative rigid laryngoscopic examination and modified jaw thrust manoeuver during fibreoptic-assisted tracheal intubation for general anaesthesia." BMJ Case Reports 14, no. 5 (2021): e232826. http://dx.doi.org/10.1136/bcr-2019-232826.
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Preoperative laryngoscopic examination of the airway informs general anaesthesia management and planning. However, the same glottic opening view cannot always be obtained during direct laryngoscopy of anaesthetised patients. In this case report, a patient underwent preoperative rigid laryngoscopy due to medical history, and no problems were anticipated in performing tracheal intubation; however, the direct laryngoscopic view was a Grade 4 on the Cormack-Lehane Scale after anaesthesia induction. A jaw thrust manoeuvre to facilitate fibreoptic-assisted nasotracheal intubation was not feasible. In order to compensate, a modified method of jaw thrust was implemented, where both thumbs were placed on the floor of the patient’s mouth, leading to a successful result. Safe airway management should be implemented with proper planning based on a careful preoperative evaluation.
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K P, Madhu, Sneha Rajur, and Yathish . "Role of Acromioaxillosuprasternal Notch Index (AASI) as a New Predictor of Difficult Visualization of Larynx in Comparison with Modified Mallampati Test." Indian Journal of Anesthesia and Analgesia 8, no. 3 (2021): 397–402. http://dx.doi.org/10.21088/ijaa.2349.8471.8321.56.
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Background: Pre-operative airway assessment should be able to predict potential difficult airway, allowing management plan to be developed ahead of time. Hence this study was aimed to compare Acromio-AxilloSuprasternal Notch Index (AASI), a new simple bedside test with Modified Mallampati Test (MMP) in predicting difficult visualization of larynx. Materials and Methods: After ethical committee clearance and informed written consent, 320 patients of ASA I and II posted for elective surgery under general anaesthesia were included in this study. AASI and MMP were noted during preanaesthetic airway assessment. After induction of anaesthesia, a blinded and experienced anaesthetist did laryngoscopy, intubated the patient and noted Cormack-Lehane(CL) grading of laryngeal view. The data observed was analysed using Receiver operating characteristic curve(ROC) analysis to compare AASI and MMP. A P value less than 0.05 was considered statistically significant. Results: Incidence of Difficult Visualization of Larynx(DVL) in our study was 8.4%. AASI had better Sensitivity(88.89% v/s 22.22%), Specificity(98.63% v/s 95.22%),Positive predictive value (85.71% v/s 26.32%), Negative predictive value (98.97% v/s 93%) and Diagnostic accuracy(97.81% v/s 89.03%) in comparison with MMP respectively (P <0.001) when cut off reference value of 0.56 AASI was taken. Conclusion: AASI is a better predictor of difficult laryngoscopy with a higher sensitivity and positive predictive value in comparison with MMP. Hence AASI can be used as a simple bedside test to predict difficult airway during pre-anaesthetic airway assessment. Keywords: Acromioaxillosuprasternal notch index (AASI); Modified Mallampati test (MMP); Cormack-Lehane (CL) grade; Difficult visualization of larynx (DVL); Airway assessment.
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Saravanan, Balachandar, Gayatri Mishra, Vaibhav Pandey, Antony John Charles, and V. R. Hemanth Kumar. "Comparison of ease of intubation and glottic visualisation using Miller (paraglossal approach) and Macintosh laryngoscope in adults: A randomised crossover study." Indian Journal of Clinical Anaesthesia 11, no. 4 (2024): 518–23. http://dx.doi.org/10.18231/j.ijca.2024.094.
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Previous randomised controlled trials have produced inconclusive results about the initial success rates of intubation when comparing the adult Miller and Macintosh blades. A prospective randomised crossover study involving 200 adult ASA I or II patients scheduled for elective surgery under general anaesthesia. This study aimed to evaluate the efficacy of intubation with the adult Miller blade using a paraglossal approach compared to the Macintosh blade in adult patients. Tocompare the ease of orotracheal intubation and glottic visualisation using the adult Miller and Macintosh blades. After obtaining approval from the ethical committee, 200 adult patients satisfying inclusion criteria were enrolled. Group allocation was determined by the order of blade usage during laryngoscopy, with randomisation conducted via computer-generated random numbers. Patients were divided into two groups: Group MAC (where the initial laryngoscopy was performed using the Miller blade, followed by intubation with the Macintosh blade) or Group MIL (where the initial laryngoscopy was performed using the Macintosh blade, followed by intubation with the Miller blade). Following standard anaesthesia protocols, the first laryngoscopy was carried out with the randomly assigned blade, accompanied by the administration of a 10% Lignocaine spray. After one minute of mask ventilation, the second laryngoscopy was performed with the alternate blade, and intubation was completed. Parameters were documented, including the first attempt intubation success rate, Cormack-Lehane grade, intubation duration, utilisation of ancillary devices for intubation, and hemodynamic measures. The first attempt success rate was 92% and 95% in Group MIL and Group MAC, respectively (P=0.081). Cormack-Lehane grade I was seen in 73% of cases in Group MIL and 68% of in Group MAC (P=0.022). The average intubation time was 16.42±1.60 seconds in Group MIL and 16.68±1.38 seconds in Group MAC (P=0.221). Utilizing the Miller laryngoscope and paraglossal technique for adult intubation demonstrates comparable first-attempt intubation success rates to the Macintosh blade while providing superior glottic visualisation.
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Rachel Sharon Ambrose, Selvakumaran Pannirselvam, and Thirumaaran U. "Measurement of Neck Circumference, Tongue thickness and Skin to Epiglottis Distance as Predictors of Difficult Intubation: A Prospective Study." Journal of Pharmaceutical Negative Results 13, no. 4 (2022): 1181–85. http://dx.doi.org/10.47750/pnr.2022.13.04.166.
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Airway Assessment is essential in pre anesthetic assessment. Anticipating and preparing for difficulty in airway management is crucial to avoid airway catastrophes. Routine pre operative airway examination usually includes mouth opening and dentition, Mallampati classification, thyromental distance and neck movements. Neck circumference is a quick bedside test to determine difficult laryngoscopy. Increased tongue thickness and skin to epiglottis distance affects performance of laryngoscopy and tracheal intubation increasing the risk of difficult airway. Presently there is a search for non-invasive and accurate tools to overcome limitations of clinical airway assessment tests. Ultrasonography has been evolving as a useful device for airway assessment especially soft tissue structures in anterior surface of neck. Here we studied the measurement of neck circumference and ultrasound measurement of tonguethickness and skin to epiglottis distance as predictors for difficult intubation. The Aim of the study is to predict difficulty in intubation by measuring neck circumference, thickness of tongue and thickness of skin to epiglottis. Prospective observational study, 120 patients posted for surgery under general anesthesia, Department of anesthesia, Meenakshi medical college, Kanchipuram. After institutional Human ethical committee clearance, 120 Patients were screened during preoperative assessment for undergoing procedures under general anaesthesia. Neck circumference and other airway parameters were measured with measuring tape and distance between Skin to epiglottis and tongue thickness were measured with ultrasound linear probe. Patients were grouped into Group E( Easy Intubation) whose Cormack-lehane grade was 1 and 2 and Group D ( Difficult intubation) whose Cormack-lehane grade was 3 and 4. SPSS version 16 was used for statistical analysis. There was no statistical significance seen between age, sex, height among easy and difficult intubation but significance was seen with weight (p <0.05), Thyromental distance(p<0.05) and Sterno-mental distance(p<0.05). High significance was seen in Distance between skin to epiglottis distance(p<0.001), Tongue thickness(p<0.001) and Neck Circumference(p<0.001) in difficult intubation cases. Neck circumference and ultrasonographic measurement of tongue thickness and skin to epiglottis can avoid unanticipated difficult intubation.
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Firdaus, Riyadh, Aries Perdana, and Rinal Effendi. "Difficult Intubation Predictor: Comparison Between Ratio Of Height To Thyromental Distance, Mallampati Score And Thyromental Distance." Journal Of The Indonesian Medical Association 73, no. 1 (2023): 35–38. http://dx.doi.org/10.47830/jinma-vol.73.1-2023-813.
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Introduction: The Mallampati score and thyromental distance (TMD) are frequently used to identify challenging laryngoscopies, but their reliability in predicting difficulty is uncertain. This study aims to assess the effectiveness of using the ratio of height to thyromental distance (RHTMD) in predicting difficult visualization of the larynx (DVL) when compared to the Mallampati score and TMD.Method: To achieve this goal, 277 patients who received general anesthesia during elective surgery were evaluated using the Mallampati score, TMD, and RHTMD. The Cormack and Lehane (CL) classification was used to grade the laryngeal view, with CL grade 3 and 4 indicating difficult visualization. The study then determined and compared the area under the curve (AUC), sensitivity, and specificity for each airway predictor.Results: The AUC of RHTMD (85.5%) was better than TMD (82.7%) and significantly better than the Mallampati score (61.4%).Conclusion: RHTMD is more accurate in predicting difficult laryngoscopy than both the Mallampati score and TMD.
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Rohit, Gohil, Mitul Doshi Shilpa, Kamaliya Jignesh, and Tripathi Anjali. "Comparative Evaluation of Video Laryngoscope with Direct Laryngoscope in Patient Undergoing Tracheal Intubation for Elective Surgical Procedure: A Prospective, Randomized Study." International Journal of Toxicological and Pharmacological Research 14, no. 5 (2024): 108–15. https://doi.org/10.5281/zenodo.12786757.
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<strong>Background and Aim: </strong>Video laryngoscope (VL) is currently introduced Intubating device with high resolution CMOS camera. The primary aim of this study was to compare the efficiency of video laryngoscope with direct laryngoscope regarding their usefulness for tracheal intubation for elective surgical procedure. We compare suitability of video laryngoscope with direct laryngoscope in terms of glottic exposure time, tube insertion time, total duration of intubation, Number of attempts, Cormack and Lehane grading, optimization Maneuvers, Complications and hemodynamic changes. <strong>Materials and Methods:</strong> After taking written informed consent, patients between age of 18-60 years of both gender and ASA grade I and II scheduled to undergo elective general surgery were included. Patients with oral pathology, needing rapid sequence intubation and not willing were excluded. The patients were randomly assigned into Group V (video laryngoscope) and Group-M (Macintosh laryngoscope) using sealed envelope method. Glottic exposure time, tube insertion time, total duration of intubation, Number of attempts, Cormack and Lehane grading and optimization Maneuvers were recorded at the time of intubation. Haemodynamic and complications were recorded perioperatively. <strong>Results: </strong>Attempts of intubation, optimization maneuvers and complications were comparable amongst both the groups. Glottic exposure time and total duration of intubation time was more and quality of glottic visualization was better with video laryngoscope than with Macintosh Laryngoscope. Hemodynamic parameters were better in group V than in group M. <strong>Conclusion:</strong> Video laryngoscope takes short time to achieve successful intubation, offer hemodynamic stability and better quality of glottic view than Macintosh during intubation. Video laryngoscope less frequently need assist maneuvers, so facilitates intubation with less complication. Both devices are useful for routine intubation in adult patients.
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Gupta, Seema, Veerendra Singh Raghuwanshi, Akanksha Agarwal, and G. N. Chavan. "A Comparative Study of Cormack Lehane Grading by Macintosh, McCoy and Video Laryngoscope in Patients with Predicted Normal Airway." Indian Journal of Anesthesia and Analgesia 8, no. 3 (2021): 333–38. http://dx.doi.org/10.21088/ijaa.2349.8471.8321.48.
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Background: The conventional Macintosh laryngoscope is used most commonly due to its familiarity and ease of use. Newer devices like video laryngoscope are also being commonly now-a-days. Hence a comparative study of the 3 commonly used laryngoscopes has been done. Aims & Objectives: To compare direct laryngoscope view of the different laryngoscope blades & to find out the most suitable laryngoscope in patients with predicted normal airway. Methodology: 150 ASA grade I-II patients with 50 patients in each group were taken. Their stress response, CML grading & intubation time were compared. Results: Stress response was least & CML grading was best, however the time taken to intubate was maximum (P<.001) with Video-laryngoscope as compared to McCoy & Macintosh. Conclusion: Video-Laryngoscope provides better visualization of glottic opening as compared to Macintosh and McCoy with less stress response but being a newer device needs more expertise to intubate the patient. Keywords: Video-laryngoscope; Macintosh laryngoscope; CML; Tracheal intubation.
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Niranjan, Ramesh, Patyal Ashish, and Verma Anjana. "Evaluation of STOP BANG Questionnaire in Predicting the Difficult Mask Ventilation and Difficult Intubation in Obese Patients." International Journal of Pharmaceutical and Clinical Research 16, no. 6 (2024): 135–42. https://doi.org/10.5281/zenodo.12707843.
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<strong>Introduction:</strong> Airway is still the most challenging entity for anaesthesiologist even after invention of wide variety of airway gadgets. Unanticipated difficult airway is most difficult to manage, so anticipation of difficult airway is most crucial for anaesthesiologist which can be done by pre-operative assessment. The morbidity and mortality associated with unanticipated difficult airway is very high especially in obese patient as obesity affects multiple organs. By correct anticipation and taking appropriate measures we can reduce it significantly. <strong>Objective:</strong> To evaluate STOP-Bang score as a tool for predicting difficult mask ventilation and difficult intubation in obese patients. <strong>Methodology:</strong> 150 obese patients (BMI ≥ 30) with ASA physical status II and III aged 18 years or older undergoing various surgeries under general anaesthesia with endotracheal tube placement were enrolled for the study after taking informed written consent. Preoperatively, these patients were given STOP-Bang questionnaire. Based on questionnaire response and examination, STOP-Bang scoring was done. Score was used to classify obese patients as high risk (≥3) or low risk (<3) for OSA. After attaching standard ASA monitors i.e. electrocardiogram, heart rate, pulse oximeter and non-invasive blood pressure, baseline values were recorded. Mask ventilation grade, Modified Cormack-Lehane Grade, number of attempts of intubation and use of rescue measures were also evaluated in each patient. The collected data was analysed using SPSS version 21, whereas P<0.05 was considered significant. Quantitative data were described using mean ± standard deviation. Comparison between the quantitative variables were done by using t test and ANOVA. <strong>Results:</strong> In our study we found that the mask ventilation grade was significantly associated with STOP-Bang score (p<0.01). It showed that higher the STOP-Bang score, greater the difficulty in mask ventilation. The laryngoscopy grade (Cormack-Lehane grading) was not significantly associated with STOP-Bang score (p=0.125). The patients with high STOP-Bang score required more intubation attempts in comparison to low STOP-Bang score (p value 0.353, statistically not significant). <strong>Conclusion:</strong> High STOP-Bang score is a good predictor of difficult mask ventilation rather than difficult laryngoscopy however one criterion of STOP-Bang score i.e; neck circumference has direct correlation in predicting difficult airway (mask ventilation and laryngoscopy).
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Roblot, C., M. Ferrandière, D. Bierlaire, J. Fusciardi, C. Mercier, and M. Laffon. "Impact du grade de Cormack et Lehane sur l'utilisation du masque laryngé Fastrach™ : étude en chirurgie gynécologique." Annales Françaises d'Anesthésie et de Réanimation 24, no. 5 (2005): 487–91. http://dx.doi.org/10.1016/j.annfar.2005.02.017.
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Oh, Seok Kyeong, Byung Gun Lim, Young Sung Kim, Jae Hak Lee, and Young Ju Won. "ETView VivaSight single lumen vs. conventional intubation in simulated studies: a systematic review and meta-analysis." Journal of International Medical Research 48, no. 6 (2020): 030006052092565. http://dx.doi.org/10.1177/0300060520925653.
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Objective The ETView VivaSight single lumen airway tube (ETView) is a tracheal tube incorporating a video camera. We carried out a meta-analysis of previous simulation studies by inexperienced personnel to determine if the ETView could improve the success rate of first-attempt intubation. Methods We collected data from randomized controlled trials comparing the use of the ETView VivaSight single lumen versus a conventional endotracheal tube in a simulated manikin or cadaver study. Results Eleven studies (558 participants, 3,254 intubations, and 19 scenarios) were included. The ETView had a significantly higher success rate and shorter insertion time than conventional intubation in both normal airways (with or without chest compression) and in difficult airways. In addition, the ETView demonstrated better results in terms of a higher rate of Cormack−Lehane grade 1 and a lower incidence of dental trauma. Conclusions Inexperienced personnel can insert the ETView more rapidly and with a higher intubation success rate compared with a conventional tube.
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Chambers, Neil A., and Bruce Hullett. "Direct laryngoscopy after potential difficult intubation in children only predicts standard Cormack and Lehane view to within one grade." Pediatric Anesthesia 23, no. 11 (2013): 1002–5. http://dx.doi.org/10.1111/pan.12208.
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Salem, M., A. Whelan, and M. Margarson. "The correlation of waist circumference with Cormack and Lehane grade of laryngoscopy in bariatric surgical patients: a prospective study." European Journal of Anaesthesiology 31 (June 2014): 280. http://dx.doi.org/10.1097/00003643-201406001-00810.
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Singh, Neha, Chitta Ranjan Mohanty, Sangeeta Sahoo, Manisha Mund, and Roncall Bhim Raju. "Comparison of McCoy, Macintosh, and Truview laryngoscope for bougie-aided naso-tracheal intubation: A randomized controlled study." International Journal of Critical Illness and Injury Science 14, no. 1 (2024): 3–8. http://dx.doi.org/10.4103/ijciis.ijciis_49_23.
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ABSTRACT Background: Video laryngoscopes are commonly used along with Macintosh and McCoy laryngoscopes for Nasotracheal intubation (NTI). The purpose of this study was to evaluate the performance of McCoy, Macintosh, and Truview laryngoscopes during bougie-aided NTI with respect to intubation time, success rate, and hemodynamic changes during the procedure. Methods: Forty-five American Society of Anesthesiologists (ASA) I-II adult patients, with Mallampati grade 1–4, requiring NTI, were enrolled after taking written informed consent. ASA III/IV, restricted mouth opening, and body mass index >30 were excluded from the study. Patients were randomly allocated to intubate with one of the three laryngoscopes (McCoy, Macintosh, and Truview) and the anesthesiologists were well experienced with all of them. The primary outcome was intubation time and secondary outcomes included first attempt success rate, external laryngeal manipulation, Cormack–Lehane (CL) grade, and hemodynamic responses. Results: The intubation time of McCoy, Macintosh, and Truview, was 86.87 ± 15.92, 82.87 ± 16.46, and 79.93 ± 14.53 (mean ± standard deviation) seconds, respectively, which is comparable with Truview being the shortest. CL grade 1 was obtained more in the Truview group (53.3%) compared to the other two groups, while CL grade 3 was obtained in 20% each in McCoy and Macintosh groups. Conclusions: McCoy, Macintosh, and Truview laryngoscopes were comparable in performance during bougie-aided NTI, with Truview having the shortest intubation time and better visualization.
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Horky, John, Andrew Pirotte, and Bailee Wilson. "Shoulder Abduction While Using the Bougie: A Common Mistake." Clinical Practice and Cases in Emergency Medicine 7, no. 1 (2022): 47–48. http://dx.doi.org/10.5811/cpcem.2022.10.56372.
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Case Presentation: A 72-year-old female presented to the emergency department (ED) with exacerbation of chronic obstructive pulmonary disease and congestive heart failure. The patient required intubation for airway protection and hypercapnic respiratory failure. The ED team used a video laryngoscope, Macintosh 3 blade and bougie as the endotracheal tube delivery device. Despite a grade 2a Cormack-Lehane airway view, the bougie repeatedly missed left posterolateral to the airway. During these missed attempts, the emergency medicine (EM) resident’s shoulder was noted to be abducted. The EM resident then readjusted his technique by adducting the shoulder. which allowed the tip of the bougie to pass the vocal cords resulting in successful intubation. Discussion: The bougie is a useful endotracheal tube delivery device when used properly. Optimal body mechanics and device orientation are critical to successful use. Shoulder abduction while using the bougie is a frequent mistake, which can lead to left posterolateral malposition in relation to the glottis/airway. In this brief review our goal is to aid the intubating clinician in optimal use of the bougie, yielding more successful endotracheal tube passage.