A randomized comparative study of Airtraq®, McCoy and Macintosh laryngoscopes for endotracheal intubation in patients with simulated difficult airway using a rigid cervical neck collar in elective surgeries under general anaesthesia

Abstract

Laryngoscopy in patients with suspected neck injuries has one goal: sufficient laryngeal exposure with least cervical spine movement. This is achieved by either Manual In-line Stabilisation (MILS), a forehead tape or rigid cervical collars. Cervical collars reduce movements of spine and also mouth opening leading to difficult direct laryngoscopy. This is due to difficulty in aligning the oro-pharyngo-laryngeal axes. The laryngoscope giving best glottic view with least cervical spine movement in the shortest time would be most ideal. We intend to compare Airtraq, McCoy and Macintosh laryngoscopes in terms of intubation time and Cormack-Lehane glottic view in patients undergoing elective surgeries with simulated neck immobilization using rigid cervical collar. : Following approval from Institutional Ethical Committee, 90 consenting patients, aged 18-65years were assigned into three groups by random sampling (Serially numbered Opaque Sealed Envelope), namely Group A (Airtraq), M (McCoy) or C (Macintosh). Intubation time, Intubation difficulty scale (IDS) and Modified Cormack-Lehane grading were noted.: Mean intubation time was 27.2sec(± 6.47), 40.2sec (± 12.36) and 33.10sec (± 23.05) for Airtraq, McCoy and Macintosh respectively(p-value 0.00 7). IDS values were 0,3 and 2 respectively(P< 0.0001). Cormack Lehane glottic view was 2 for Macintosh and McCoy and 1 for Airtraq, respectively (P< 0.0001). Airtraq improves ease of intubation significantly when compared to McCoy and Macintosh blade with shorter intubation time and IDS Score, in patients with simulated difficult airway using neck immobilization.