TY - JOUR
T1 - Comparison of direct and video-assisted views of the larynx during routine intubation
AU - Kaplan, Marshal B.
AU - Hagberg, Carin A.
AU - Ward, Denham S.
AU - Brambrink, Ansgar
AU - Chhibber, Ashwani K.
AU - Heidegger, Thomas
AU - Lozada, Leonardo
AU - Ovassapian, Andranik
AU - Parsons, David
AU - Ramsay, James
AU - Wilhelm, Wolfram
AU - Zwissler, Bernhard
AU - Gerig, Haus J.
AU - Hofstetter, Christian
AU - Karan, Suzanne
AU - Kreisler, Nevin
AU - Pousman, Robert M.
AU - Thierbach, Andreas
AU - Wrobel, Marc
AU - Berci, George
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2006/8
Y1 - 2006/8
N2 - Objective: To compare the direct and indirect (video monitor) views of the glottic opening using a new Macintosh blade that is modified to provide a video image of airway structures during laryngoscopy. Design: Prospective multicenter trial. Setting: 11 university-affiliated hospitals. Patients: 867 adults undergoing elective surgery requiring general anesthesia and tracheal intubation. Interventions: Patients received general anesthesia and were paralyzed. Direct laryngoscopy was supervised by one of the investigators at each institution. The best possible view was obtained with a Macintosh video laryngoscope during direct vision using standard techniques such as external laryngeal manipulation and backward, upward, and rightward pressure, if necessary. The laryngoscopist then looked at the video monitor and performed any necessary maneuvers to obtain the best view on the video monitor. Thus, 2 assessments were made during the same laryngoscopy (direct naked-eye view vs video monitor view). Tracheal intubation was then performed using the monitor view. Glottic views were rated according to the Cormack-Lehane scoring system, as modified by Yentis and Lee. A questionnaire was completed for each patient. Measurements and Main Results: Data from 865 patients were suitable for analysis. Visualization was considered easy (Cormack-Lehane score < 3) in 737 patients and difficult (Cormack-Lehane score = 3 or 4) in 21 for both direct and video-assisted views. In 7 patients, the view was considered easy during direct visualization yet difficult on the video monitor view. On the other hand, the view was considered difficult in 100 patients during direct visualization yet easy on the video monitor view (P < 0.001). Conclusions: Video-assisted laryngoscopy provides an improved view of the larynx, as compared with direct visualization. This technique may be useful for cases of difficult intubation and reintubation as well as for teaching laryngoscopy and intubation.
AB - Objective: To compare the direct and indirect (video monitor) views of the glottic opening using a new Macintosh blade that is modified to provide a video image of airway structures during laryngoscopy. Design: Prospective multicenter trial. Setting: 11 university-affiliated hospitals. Patients: 867 adults undergoing elective surgery requiring general anesthesia and tracheal intubation. Interventions: Patients received general anesthesia and were paralyzed. Direct laryngoscopy was supervised by one of the investigators at each institution. The best possible view was obtained with a Macintosh video laryngoscope during direct vision using standard techniques such as external laryngeal manipulation and backward, upward, and rightward pressure, if necessary. The laryngoscopist then looked at the video monitor and performed any necessary maneuvers to obtain the best view on the video monitor. Thus, 2 assessments were made during the same laryngoscopy (direct naked-eye view vs video monitor view). Tracheal intubation was then performed using the monitor view. Glottic views were rated according to the Cormack-Lehane scoring system, as modified by Yentis and Lee. A questionnaire was completed for each patient. Measurements and Main Results: Data from 865 patients were suitable for analysis. Visualization was considered easy (Cormack-Lehane score < 3) in 737 patients and difficult (Cormack-Lehane score = 3 or 4) in 21 for both direct and video-assisted views. In 7 patients, the view was considered easy during direct visualization yet difficult on the video monitor view. On the other hand, the view was considered difficult in 100 patients during direct visualization yet easy on the video monitor view (P < 0.001). Conclusions: Video-assisted laryngoscopy provides an improved view of the larynx, as compared with direct visualization. This technique may be useful for cases of difficult intubation and reintubation as well as for teaching laryngoscopy and intubation.
KW - Laryngoscopy
KW - Macintosh video laryngoscope
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U2 - 10.1016/j.jclinane.2006.01.002
DO - 10.1016/j.jclinane.2006.01.002
M3 - Article
C2 - 16905081
AN - SCOPUS:33746818366
SN - 0952-8180
VL - 18
SP - 357
EP - 362
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
IS - 5
ER -