Comparison of learning direct laryngoscopy using a McGrath videolaryngoscope as a direct versus indirect laryngoscope: a randomized controlled trial

Objective Tracheal intubation using a direct laryngoscope is difficult to teach. The McGrath videolaryngoscope, a Macintosh-like device with a camera, can be used as a direct laryngoscope to educate novices under supervision using the screen. We compared the effect on Macintosh laryngoscopy skills following training with a McGrath videolaryngoscope as a direct versus indirect laryngoscope. Methods Thirty-seven participants were randomized into direct and indirect groups according to the training method using a McGrath videolaryngoscope. Participants attempted Macintosh direct laryngoscopy in normal and difficult airway scenarios. The primary endpoint was the intubation time, and the rate of successful intubation, dental trauma, and difficulty were secondary outcomes. Results The intubation time after education decreased significantly in both groups and was significantly shorter in the direct group than in the indirect group across time. The difficulty degree in the direct group was lower than that in the indirect group across time; however, the rate of dental trauma was not significantly different. Conclusion Both direct and indirect laryngoscopy using a McGrath videolaryngoscope improved the performance of Macintosh direct laryngoscopy in novices, while direct laryngoscopy using a McGrath videolaryngoscope demonstrated better educational effects than indirect laryngoscopy. Registered at ClinicalTrials.gov (NCT03471975).

Successful airway management of twin coincidental supraglottic and thyroid masses with difficult fiber optic intubation: a case report

Background Aberrant airway anatomy in cases of laryngeal carcinomas makes airway management a herculean task for the anesthesiologist. What can further compound the situation is an external compression by thyroid mass. Case presentation We present a case report of successful airway management by awake nasal fiberoptic intubation in a 65-year-old male who was found to have compressive symptoms due to thyroid swelling in addition to supraglottic obstructive mass. Although a detailed airway examination and indirect laryngoscope did assist in planning the procedure, but what lay inside could only be dealt with by having an in-depth orientation of airway anatomy, practical know-how to fiberoptic scope, and swift reflexes to prevent an adverse event. Conclusion From our experience, fiberoptic intubation can only be optimally utilized if emphasis is laid on planning and preparation for the procedure which are key elements in making any difficult airway management successful.

Chevalier Jackson Lecture Analysis of New Optical Systems in Bronchoesophagology

A new image transmitting system (Hopkins rod lens) made it possible to redesign the entire armamentarium of rigid broncho- and esophago- laryngology. The introduction of an optical biopsy forceps made tissue sampling more accurate. The increased light transmission produces a brighter image and easier perception. The larger viewing angle facilitates orientation. The new miniature pediatric bronchoscope, with a telescope, changed the pinpoint vision to a panoramic view. The optical foreign body forceps is of great help in fast and precise manipulations. The indirect laryngoscope proved to be a great investigative tool with the capability to obtain, with ease, a movie filmstrip for detailed analysis in the outpatient clinic. The introduction of the flexible fiber bronchoscope brought new dimensions in tissue sampling of peripheral lesions, treatment of pulmonary complications in the intensive care units, and became an important aid in intubating patients with difficult anatomy. The possibility to obtain movie films and to study our visual findings, at leisure, is an important diagnostic and teaching aid.