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Videolaryngoscope is useful to improve the laryngeal view, especially during difficult intubation. There are several kinds of videolaryngoscopes and it is applicable during nasotracheal intubation. In this study, the investigators will compare the McGrath videolaryngoscope and Pentax-AWS with Macintosh laryngoscope for nasotracheal intubation in patients with manual in-line stabilization.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| McGrath Group | Experimental | MgGrath videolaryngoscope will be used for nasotracheal intubation with MILS |
|
| Pentax-AWS Group | Experimental | Pentax-AWS videolaryngoscope will be used for nasotracheal intubation with MILS |
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| Macintosh Laryngoscope Group | Experimental | Macintosh Laryngoscope will be used for nasotracheal intubation with MILS |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| MILS | Procedure | MILS(Manual in-line stabilization) will be applied during intubation. With MILS, different kinds of laryngoscope will be evaluated in a simulated difficult airway. |
| Measure | Description | Time Frame |
|---|---|---|
| time for intubation | from holding the laryngoscope until the 1st ventilation after intubation, within 90 seconds | |
| Cormack Lehane Laryngeal view | when laryngoscope is appropriately placed during intubation, approximately 2 seconds | |
| POGP score | Percentage of glottic opening(POGO) | when laryngoscope is appropriately placed during intubation, approximately 2 seconds |
| Measure | Description | Time Frame |
|---|---|---|
| external laryngeal manipulation | When the laryngeal view is insufficient during laryngoscope, another physician can manipulate the larynx externally to improve the laryngeal view. The necessity of external laryngeal manipulation will be recorded. | when laryngoscope is appropriately placed during intubation, approximately 2 seconds |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Go Un Roh, MD | Ajou University School of Medicine | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31144258 | Derived | Roh GU, Kwak HJ, Lee KC, Lee SY, Kim JY. Randomized comparison of McGrath MAC videolaryngoscope, Pentax Airway Scope, and Macintosh direct laryngoscope for nasotracheal intubation in patients with manual in-line stabilization. Can J Anaesth. 2019 Oct;66(10):1213-1220. doi: 10.1007/s12630-019-01409-5. Epub 2019 May 29. |
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| McGrath videolaryngoscope | Device | McGrath videolaryngoscope will be used for intubation |
|
| Pentax AWS videolaryngoscope | Device | Pentax AWS videolaryngoscope will be used for intubation |
|
| Macintosh laryngoscope | Device | Macintosh laryngoscope will be used for intubation |
|
| magill forceps |
when the nasotracheal tube can not introduced to vocal cord manually, magill forceps can hold the tube to advance the tube through vocal cord. The necessity of magill forceps during intubation will be recorded |
| when laryngoscope is appropriately placed during intubation, approximately 5 seconds |
| IDS (intubation difficulty scale) | IDS score is the sum of the following seven variables: N1: the number of intubation attempts>1 N2: the number of operators. 1 N3: the number of alternative intubation techniques used N4: glottic exposure (Cormack Lehane grade minus 1) N5: Lifting force required during laryngoscopy (0=normal; 1=increased) N6: necessity for external laryngeal pressure (0=not applied; 1=applied) N7: position of the vocal cords at intubation (0=abduction/ not visualized; 1=adduction) | during intubation, approximately 90 seconds |
| numeric rating scale for intubation | 0-10 (0; no difficulty, 10: hardest) | during intubation, approximately 90 seconds |
| grade of bleeding | After confirmation of successful intubation, Yankauer suction was introduced to access the intraoral bleeding during intubation. Grade is 4 points scale (none/trace/moderate/severe). | 10 seconds after completion of intubation |