Author(s): Apoorva Mahendera Garhwal1, Anjali Rakesh Bhure2, Sumita Vivek Bhargava3, Ketki Sushant Marodkar4, Arihant Ravikumar Jain5, Himanshu Prabhudayal Nandwani6, Nikita Narayan Jagtap7
Previous studies suggest glottic view is better achieved with straight blades while tracheal intubation is easier with curved blades and videolaryngoscope is better than conventional laryngoscope.
Comparison of conventional laryngoscope (Macintosh blade and Miller blade) with channelled videolaryngoscope (King VisionTM) with respect to laryngeal visualisation and difficulty in endotracheal intubation.
SETTINGS AND DESIGN
This prospective randomised comparative study was conducted at a tertiary care hospital (in ASA I and ASA II patients) after approval from the Institutional Ethics Committee.
We compared Macintosh, Miller, and the King Vision-TM videolaryngoscope for glottic visualisation and ease of tracheal intubation. Patients undergoing elective surgeries under general anaesthesia requiring endotracheal intubation were randomly divided into three groups (N=180). After induction of anaesthesia, laryngoscopy was performed and trachea intubated.
We recorded visualisation of glottis (Cormack-Lehane grade-CL), ease of intubation, number of attempts, need to change blade, and need for external laryngeal manipulation.
Demographic data, Mandibular length, Mallampati classification were compared using ANOVA, Chi-square test, Kruskal-Wallis Test, where P value <0.005 is statically significant. RESULTS CL grade 1 was most often observed in King Vision-TM VL group (90%) which is followed by Miller (28.33%), and Macintosh group (15%). We found intubation was to be easier (grade 1) with King Vision-TM VL group (73.33%), followed by Macintosh (38.33%), and Miller group (1.67%). External manipulation (BURP) was needed more frequently in patients in Miller group (71.67%), followed by Macintosh (28.33%) and in King Vision-TM VL group (6.67%). All (100%) patients were intubated in the 1st attempt with King Vision-TM VL group, followed by Macintosh group (90%) and Miller group (58.33%).
In patients with normal airway, glottis direct laryngoscope with Miller blade may provide better glottis view than Macintosh blade, but intubation was easier with Macintosh blade laryngoscope. Our study supports the superior performance of King Vision TM videolaryngoscope for both glottis visualisation and ease to intubate.