Abstract
Purpose
To document tracheal intubation success rates and airway instrumentation times using the newly designed McGrath® videolaryngoscope.
Methods
We prospectively recorded factors associated with difficult tracheal intubation, factors causing actual difficulty in tracheal intubation, as well as complications arising from use of the new McGrath® videolaryngoscope in a series of adult patients with normal preoperative airway examinations. All patients were undergoing scheduled or elective surgery. In the first 75 patients (phase I), experience with airway instrumentation was documented, while in the second 75 patients (phase II), the time required to obtain an optimal view of the larynx was recorded, as well as the time to complete tracheal intubation.
Results
Ninety-eight percent of all tracheal intubations were successful using the McGrath® videolaryngoscope. Cormack and Lehane grade I views were obtained in 143 patients (95%) and grade II views were achieved in six (4%). In phase II, the median time required to obtain an adequate view was 6.3 sec [interquartile range 4.7-8.7 (range 2-26.3)], and to complete tracheal intubation was 24.7 sec [18.5-34.4(11.4-286)]. Forty-nine (65%) of the tracheal intubations were completed within 30 sec, and 72 (96%) were completed within one minute. No complications were encountered in any patient.
Conclusions
The McGrath® videolaryngoscope is an effective aid to airway management in patients with normal airways, based upon intubation success rates and the ability to rapidly secure the airway. Its potential advantages of convenience and portability warrant further evaluation in comparison with other airway devices and in patients with difficult airways.
Résumé
Objectif
Documenter les taux de réussite d’intubation trachéale et les temps d’instrumentation des voies aériennes pour le nouveau vidéolaryngoscope McGrath®.
Méthode
Nous avons enregistré, de façon prospective, les facteurs associés à une intubation trachéale difficile, ceux causant une difficulté réelle de l’intubation trachéale ainsi que les complications dues à l’utilisation du nouveau vidéolaryngoscope McGrath® chez une série de patients adultes présentant une anatomie des voies aériennes normales avant l’opération. Tous les patients devaient subir une chirurgie élective. Nous avons documenté notre expérience de prise en charge des voies aériennes chez les 75 premiers patients (Phase I) et, chez les 75 autres patients (Phase II), nous avons mesuré le temps requis jusqu’à obtention d’une visualisation optimale du larynx ainsi que le temps jusqu’à l’intubation trachéale complète.
Résultats
Le taux de réussite des intubations trachéales pratiquées à l’aide du vidéolaryngoscope McGrath® a été de 98%. Nous avons obtenu une visualisation de type I sur l’échelle de Cormack et Lehane chez 143 patients (95 %) et de type II chez six patients (4 %). Pendant la phase II, le temps moyen requis pour obtenir une visualisation adéquate était de 6,3 sec [écart interquartile 4,7-8,7 (écart 2-26,3)], et de 24,7 sec avant intubation trachéale complète [18,5-34,4 (11,4-286)]. On a effectué 49 (65 %) intubations trachéales en 30 sec ou moins, et 72 (96 %) en une minute ou moins. II n’y a eu aucune complication.
Conclusion
Le vidéolaryngoscope McGrath® est un outil efficace pour la prise en charge des voies aériennes chez des patients avec une anatomie normale, si l’on se base sur les taux de réussite d’intubation et la capacité de sécuriser rapidement les voies aériennes. Sa facilité d’utilisation et sa portabilité justifient une évaluation plus poussée, incluant une comparaison avec d’autres dispositifs semblables et une utilisation chez des patients présentant des difficultés d’intubation.
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Competing interests: All three investigators have assisted Aircraft Medical in the development of the McGrath® videolaryngoscope. The employing authority of the investigators has received payment from Aircraft Medical for professional advice given by Drs. McKeown and Ray on a consultative basis. Disposable laryngoscope blades were provided free of charge by Aircraft Medical for this clinical evaluation.
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Shippey, B., Ray, D. & McKeown, D. Case series: The McGrath® videolaryngoscope — an initial clinical evaluation. Can J Anesth 54, 307–313 (2007). https://doi.org/10.1007/BF03022777
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DOI: https://doi.org/10.1007/BF03022777