A randomized controlled comparative study of King Vision and McGrath video laryngoscopes for nasotracheal intubation in patients with predicted difficult airways during oral and maxillofacial surgery

doi:10.19438/j.cjoms.2020.01.008

Abstract

Abstract: PURPOSE: King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the usefulness of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators. METHODS: The study included 99 patients requiring nasal endotracheal intubation for elective oral and maxillofacial surgery with American Society of Anesthesiologists (ASA) classification of I or II and El-Ganzouri risk index 1-7. Three groups were randomly assigned to receive nasotracheal intubation by experienced anesthesiologists guided by non-channeled King Vision video laryngoscope (K group), McGrath video laryngoscope (M group), and Macintosh laryngoscope (C group). The intubation time, success rate of primary intubation, exposure time of glottis, view of glottis opening valued by Cormack-Lehane grade, hemodynamic changes (MAP, HR), number of assisted maneuvers and incidence of side effects were recorded and compared with GraphPad Prism 5.0 software package. RESULTS: The intubation time of King Vision and McGrath group was comparable (37.6±7.3 seconds vs. 35.4±8.8 seconds) and both were significantly shorter than Macintosh group (46.8±10.4 seconds, P<0.001). Both King Vision and McGrath groups had a 100% first attempt success rate, significantly higher than Macintosh group (85%, P<0.05). The laryngoscopy time was comparable between King Vision and McGrath group (16.7±5.5 seconds vs. 15.6±6.3 seconds) and was significantly shorter than Macintosh group (22.8±7.2 seconds, P<0.05). Compared with Macintosh laryngoscope, Glottis view was obviously improved when exposed with either non-channeled King Vision or McGrath MAC VL (P<0.001), and assist maneuvers required were reduced (P<0.001). The maximum fluctuations of MAP were significantly attenuated in VL group [(47.7±12.5) mmHg and (45.1±10.3) mmHg vs. (54.9±10.2) mmHg, P<0.05 and P<0.01). Most device insertions were graded as excellent in McGrath group, followed by Macintosh and King Vision group (P=0.0014). The tube advancements were easier in VLs compared with Macintosh laryngoscope (P<0.001). Sore throat was found more frequent in Macintosh group compared with King Vision group (P<0.05). CONCLUSIONS: Compared with Macintosh laryngoscope, both King Vision and McGrath video laryngoscopes facilitated nasotracheal intubation in managing predicted difficult airways during oral and maxillofacial surgery.

Key words: Video laryngoscope, Nasotracheal intubation, Difficult airway, Oral and maxillofacial surgery

CLC Number:

R782.05.4

ZHU Hao-zhen, SUN Yu. A randomized controlled comparative study of King Vision and McGrath video laryngoscopes for nasotracheal intubation in patients with predicted difficult airways during oral and maxillofacial surgery[J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(1): 42-47.

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