Videolaryngoscopy vs. Macintosh laryngoscopy for double‐lumen tube intubation in thoracic surgery: a systematic review and meta‐analysis

Summary Double‐lumen intubation is more difficult than single‐lumen tracheal intubation. Videolaryngoscopes have many advantages in airway management. However, the advantages of videolaryngoscopy for intubation with a double‐lumen tube remain controversial compared with traditional Macintosh laryngoscopy. In this study, we searched MEDLINE , Embase , Cochrane Library and the Web of Science for randomised controlled trials comparing videolaryngoscopy with Macintosh laryngoscopy for double‐lumen tube intubation. We found that videolaryngoscopy provided a higher success rate at first attempt for double‐lumen tube intubation, with an odds ratio (95%CI) of 2.77 (1.92–4.00) (12 studies, 1215 patients, moderate‐quality evidence, p < 0.00001), as well as a lower incidence of oral, mucosal or dental injuries during double‐lumen tube intubation, odds ratio (95%CI) 0.36 (0.15–0.85) (11 studies, 1145 patients, low‐quality evidence, p = 0.02), and for postoperative sore throat, odds ratio (95%CI) 0.54 (0.36–0.81) (7 studies, 561 patients, moderate‐quality evidence, p = 0.003), compared with Macintosh laryngoscopy. There were no significant differences in intubation time, with a standardised mean difference (95%CI) of −0.10 (−0.62 to 0.42) (14 studies, 1310 patients, very low‐quality evidence, p = 0.71); and the incidence of postoperative voice change, odds ratio (95%CI) 0.53 (0.21–1.31) (7 studies, 535 patients, low‐quality evidence, p = 0.17). Videolaryngoscopy led to a higher incidence of malpositioned double‐lumen tube, with an odds ratio (95%CI) of 2.23 (1.10–4.52) (six studies, 487 patients, moderate‐quality evidence, p = 0.03).