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Forces applied to the maxillary incisors by video laryngoscopes and the M acintosh laryngoscope
Author(s) -
LEE R. A.,
ZUNDERT A. A. J.,
MAASSEN R. L. J. G.,
WIERINGA P. A.
Publication year - 2011
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2011.02541.x
Subject(s) - laryngoscopes , medicine , glottis , intubation , laryngoscopy , orthodontics , maxillary central incisor , mallet , surgery , dentistry , larynx , archaeology , history
Background Modern video laryngoscopes ( VLSs ) provide a superior view of the glottis, facilitating easier intubations. This study evaluates the forces applied to the maxillary incisors when using various VLSs and a M acintosh blade. Methods Fifty consecutive surgery patients were randomly assigned to receive laryngoscopy from a pair of four blades investigated in the study – the VLS GlideScope ® (Verathon Inc., Bothell, WA, USA), V‐Mac ™ S torz ® (Karl Storz, Tuttlingen, Germany), and McGrath ™ (Aircraft Medical, Edinburgh, United Kingdom); and the classic M acintosh blade also from S torz ® (Karl Storz). An endotracheal tube ( ETT ) was brought into position anterior to the vocal cords, with actual intubation carried out only with the second of the laryngoscopes. Sensors measured the forces directly applied to the patient's maxillary incisors while inserting the ETT . Other common metrics of intubation difficulty (e.g. M allampati grade, C ormack– L ehane grade, and time) were also recorded. Results Only one patient was not intubated within the standard study parameters and was converted to the hospital protocols for difficult intubations. The forces applied to the maxillary incisors were significantly greater with the M acintosh blade compared with all VLSs . There were no differences between the VLSs with regard to the forces. Patient characteristics, including M allampati grade, were not predictive of the forces applied. Conclusions All VLSs considered were safer for the patient than was the M acintosh blade in terms of the forces applied to the maxillary teeth, time, number of insertion attempts, and view achieved of the glottic arch. There is a small, but significant, difference in the time and number of insertion attempts required during laryngoscopy with the different VLSs . There was no difference in the forces applied. The geometry of the respective blades may be an important component in the ease of laryngoscopy.