First-attempt awake tracheal intubation success rate using a hyperangulated unchannelled videolaryngoscope vs. a channelled videolaryngoscope in patients with anticipated difficult airway: a randomised controlled trial.
airway management
awake tracheal intubation
failed intubation
videolaryngoscopy
Journal
Anaesthesia
ISSN: 1365-2044
Titre abrégé: Anaesthesia
Pays: England
ID NLM: 0370524
Informations de publication
Date de publication:
29 Jul 2024
29 Jul 2024
Historique:
accepted:
18
06
2024
medline:
30
7
2024
pubmed:
30
7
2024
entrez:
30
7
2024
Statut:
aheadofprint
Résumé
There is uncertainty about the optimal videolaryngoscope for awake tracheal intubation in patients with anticipated difficult airway. The use of channelled and unchannelled videolaryngoscopy has been reported, but there is a lack of evidence on which is the best option. We conducted a randomised clinical trial to compare the efficacy of the C-MAC D-Blade® vs. Airtraq® in adult patients (aged ≥ 18 y) scheduled for elective or emergency surgery under general anaesthesia with anticipated difficult airway who required awake tracheal intubation under local anaesthesia and conscious sedation. The primary endpoint was the first-attempt tracheal intubation success rate. Secondary outcomes included the overall success rate; number of tracheal intubation attempts; Cormack and Lehane glottic view; level of difficulty (visual analogue score); patient discomfort (visual analogue score); and incidence of complications. Ninety patients (70/90 male (78%); mean (SD) age 65 (12) y) with anticipated difficult airways were randomly allocated to C-MAC D-Blade or Airtraq videolaryngoscopy. First-attempt successful tracheal intubation rate was higher in patients allocated to the C-MAC D-Blade group compared with those allocated to the Airtraq group (38/45 (84%) vs. 28/45 (62%), respectively; p = 0.006). The proportion of patients' tracheas that were intubated at the second and third attempt was 4/45 (9%) and 3/45 (7%) in those allocated to the C-MAC D-Blade group compared with 14/45 (31%) and 1/45 (2%) in those allocated to the Airtraq group (p = 0.006). There was no significant difference in overall tracheal intubation success rate (C-MAC D-Blade group 45/45 (100%) vs. Airtraq group 43/45 (96%), p = 0.494). In patients with anticipated difficult airway, first-attempt awake tracheal intubation success rate was higher with the C-MAC D-Blade compared with Airtraq laryngoscopy. No difference was found between the two videolaryngoscopes in overall tracheal intubation success rate.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Association of Anaesthetists.
Références
Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136: 31–81. https://doi.org/10.1097/ALN.0000000000004002.
Ahmad I, El‐Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2020; 75: 509–528. https://doi.org/10.1111/anae.14904.
El‐Boghdadly K, Onwochei DN, Cuddihy J, Ahmad I. A prospective cohort study of awake fibreoptic intubation practice at a tertiary centre. Anaesthesia 2017; 72: 694–703. https://doi.org/10.1111/anae.13844.
Abdellatif AA, Ali MA. GlideScope videolaryngoscope versus flexible fiberoptic bronchoscope for awake intubation of morbidly obese patient with predicted difficult intubation. Middle East J Anaesthesiol 2014; 22: 385–392.
Cohn AI, Zornow MH. Awake endotracheal intubation in patients with cervical spine disease: a comparison of the Bullard laryngoscope and the fiberoptic bronchoscope. Anesth Analg 1995; 81: 1283–1286. https://doi.org/10.1097/00000539‐199512000‐00027.
Kramer A, Müller D, Pförtner R, Mohr C, Groeben H. Fibreoptic vs videolaryngoscopic (C‐MAC® D‐BLADE) nasal awake intubation under local anaesthesia. Anaesthesia 2015; 70: 400–406. https://doi.org/10.1111/anae.13016.
Mahran EA, Hassan ME. Comparative randomised study of GlideScope® video laryngoscope versus flexible fibre‐optic bronchoscope for awake nasal intubation of oropharyngeal cancer patients with anticipated difficult intubation. Indian J Anaesth 2016; 60: 936–938. https://doi.org/10.4103/0019‐5049.195487.
Mendonca C, Mesbah A, Velayudhan A, Danha R. A randomised clinical trial comparing the flexible fibrescope and the Pentax Airway Scope (AWS)® for awake oral tracheal intubation. Anaesthesia 2016; 71: 908–914. https://doi.org/10.1111/anae.13516.
Moore A, El‐Bahrawy A, El‐Mouallem E, Lattermann R, et al. Videolaryngoscopy or fibreoptic bronchoscopy for awake intubation of bariatric patients with predicted difficult airways ‐ a randomised, controlled trial. Anaesthesia 2017; 72: 538–539. https://doi.org/10.1111/anae.13850.
Rosenstock CV, Thøgersen B, Afshari A, Christensen AL, Eriksen C, Gätke MR. Awake fiberoptic or awake video laryngoscopic tracheal intubation in patients with anticipated difficult airway management: a randomized clinical trial. Anesthesiology 2012; 116: 1210–1216. https://doi.org/10.1097/ALN.0b013e318254d085.
Wahba SSTT, Saeed AM. Comparative study of awake endotracheal intubation with Glidescope video laryngoscope versus flexible fiber optic bronchoscope in patients with traumatic cervical spine injury. Egypt J Anaesth 2012; 28: 257–260. https://doi.org/10.1016/j.egja.2012.05.002.
Kamga H, Frugier A, Boutros M, Bourges J, Doublet T, Parienti JJ. Flexible nasal bronchoscopy vs. Airtraq® videolaryngoscopy for awake tracheal intubation: a randomised controlled non‐inferiority study. Anaesthesia 2023; 78: 963–969. https://doi.org/10.1111/anae.16042.
Alhomary M, Ramadan E, Curran E, Walsh SR. Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: a systematic review and meta‐analysis. Anaesthesia 2018; 73: 1151–1161. https://doi.org/10.1111/anae.14299.
Desai N, Ratnayake G, Onwochei DN, El‐Boghdadly K, Ahmad I. Airway devices for awake tracheal intubation in adults: a systematic review and network meta‐analysis. Br J Anaesth 2021; 127: 636–647. https://doi.org/10.1016/j.bja.2021.05.025.
Heidegger T, Gerig HJ, Ulrich B, Schnider TW. Structure and process quality illustrated by fibreoptic intubation: analysis of 1612 cases. Anaesthesia 2003; 58: 734–739. https://doi.org/10.1046/j.1365‐2044.2003.03200.x.
Mihai R, Blair E, Kay H, Cook TM. A quantitative review and meta‐analysis of performance of non‐standard laryngoscopes and rigid fibreoptic intubation aids. Anaesthesia 2008; 63: 745–760. https://doi.org/10.1111/j.1365‐2044.2008.05489.x.
Ray DC, Billington C, Kearns PK, et al. A comparison of McGrath and Macintosh laryngoscopes in novice users: a manikin study. Anaesthesia 2009; 64: 1207–1210. https://doi.org/10.1111/j.1365‐2044.2009.06061.x.
Moore A, Schricker T. Awake videolaryngoscopy versus fiberoptic bronchoscopy. Curr Opin Anaesthesiol 2019; 32: 764–768. https://doi.org/10.1097/ACO.0000000000000771.
el‐Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg 1996; 82: 1197–1204. https://doi.org/10.1097/00000539‐199606000‐00017.
Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society Intubation Guidelines Working group: Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015; 115: 827–848. https://doi.org/10.1093/bja/aev371.
Donat N, Villevieille T, Masson Y, Vauthier A, Rousseau JM, Pelletier C. In case of difficult intubation with the Airtraq®: the gum elastic bougie may assist. Ann Fr Anesth Reanim 2011; 30: 87–88. https://doi.org/10.1016/j.annfar.2010.11.011.
Ali QE, Siddiqui OA, Amir SH, Chaudhri TR. Using stylet in airtraq optical laryngoscope for armored tube intubation: a new experience. J Anaesthesiol Clin Pharmacol 2013; 29: 124. https://doi.org/10.4103/0970‐9185.105822.
Segurola J, García J, Dos Santos L, Taboada M. Use of awake C‐MAC videolaryngoscope in spontaneous breathing for the diagnosis and intubation of a patient with upper airway obstruction due to floppy epiglottis. Arch Bronconeumol 2022; 58: 825–826. https://doi.org/10.1016/j.arbres.2022.07.016.
Taboada M, Cariñena A, Regueira J, Francisco C, Rodríguez M, Seoane‐Pillado T. Use of a flexible tip bougie (FlexTip) in the management of the first‐attempt failure intubation with the C‐MAC D‐Blade videolaryngoscope in the intensive care unit: a prospective, case series. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71: 58–63. https://doi.org/10.1016/j.redare.2023.02.006.
Oxenham O, Pairaudeau C, Moody T, Mendonca C. Standard and flexible tip bougie for tracheal intubation using a non‐channelled hyperangulated videolaryngoscope: a randomised comparison. Anaesthesia 2022; 77: 1368–1375. https://doi.org/10.1111/anae.15854.