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Intubation without use of stylet for McGrath videolaryngoscopy in patients with expected normal airway

View Article: PubMed Central - PubMed

ABSTRACT

Background:: During McGrath videolaryngoscope (VL) intubation, a styletted endotracheal tube maintaining an upward distal tip angle is recommended by some manufacturers. However, a styletted endotracheal tube can elicit rare but potentially serious complications. The purpose of this study was to demonstrate that a nonstyletted tube with exaggerated curvature would be noninferior to a styletted tube for orotracheal intubation using McGrath VL in patients with expected normal airway, by comparing the time to intubation and ease of intubation.

Methods:: One hundred forty patients, ages 19 to 70 years (American Society of Anesthesiologists physical status I–II), undergoing tracheal intubation for elective surgery were randomly allocated to the nonstylet group (n = 70) or the stylet group (n = 70). Anesthesia induction consisted of propofol, remifentanil, and rocuronium. The primary outcome was time to intubation assessed by a blind observer. Cormack and Lehane glottic grade, easy of intubation, and intubation difficulty score (IDS) were also assessed.

Results:: Median time to intubation [interquartile range] was not different between the nonstylet group and the stylet group (26 [24–32.5] s vs 27 [25–31] s, P = 0.937). There was no significant in median IDS between the nonstylet group and the stylet group (P = 0.695).

Conclusion:: This study shows that a nonstyletted endotracheal tube with exaggerated curvature has a similar performance to a styletted tube with a hockey-stick curvature during intubation using McGrath VL regarding time taken to successful intubation and easiness of intubation.

No MeSH data available.


Box plots illustrating the time to intubation in the nonstylet and stylet groups (A) and mean time difference in the time to intubation (B). The horizontal line in the box, the outer horizontal lines of the box, and error bar indicate median, the 25th and 75th interquartiles, and 95% confidence interval (CI), respectively. As the 95% CI of time difference (−4.48 to 4.08 s) in this study is within the upper and lower limits of noninferiority (Δ), the result demonstrates the noninferiority (equivalence) between the nonstylet and stylet groups.
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Figure 4: Box plots illustrating the time to intubation in the nonstylet and stylet groups (A) and mean time difference in the time to intubation (B). The horizontal line in the box, the outer horizontal lines of the box, and error bar indicate median, the 25th and 75th interquartiles, and 95% confidence interval (CI), respectively. As the 95% CI of time difference (−4.48 to 4.08 s) in this study is within the upper and lower limits of noninferiority (Δ), the result demonstrates the noninferiority (equivalence) between the nonstylet and stylet groups.

Mentions: In the majority of patients (137 patients, 98%), endotracheal intubation was successful within 60 s on the first attempt (2/70 [2.8%] in the nonstylet group vs 1/70 [1.4%] in the stylet group, P = 1.00). A Kaplan–Meier plot was illustrated to show the intubation success as a function of time (Fig. 3). Median time to intubation [interquartile range] was not different between the nonstylet group and the stylet group (26 [24–32.5] s vs 27 [25–31] s, P = 0.937) (Table 2). Mean difference between the groups in time to intubation was −0.2 s (95% confidence interval −4.48 to 4.08) (Fig. 4). Regarding the degree of difficulty in intubation, there was no significant in median IDS between the nonstylet and stylet groups (P = 0.695), and the proportion of patients with IDS = 0 was not different between the nonstylet and stylet groups (83% vs 86%). Laryngoscopic glottis view grade was not different between the 2 groups. There were no significant differences in hemodynamic and BIS values between the groups over time. During endotracheal intubation, major complications including mucosal perforation and dental damage did not occur.


Intubation without use of stylet for McGrath videolaryngoscopy in patients with expected normal airway
Box plots illustrating the time to intubation in the nonstylet and stylet groups (A) and mean time difference in the time to intubation (B). The horizontal line in the box, the outer horizontal lines of the box, and error bar indicate median, the 25th and 75th interquartiles, and 95% confidence interval (CI), respectively. As the 95% CI of time difference (−4.48 to 4.08 s) in this study is within the upper and lower limits of noninferiority (Δ), the result demonstrates the noninferiority (equivalence) between the nonstylet and stylet groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134778&req=5

Figure 4: Box plots illustrating the time to intubation in the nonstylet and stylet groups (A) and mean time difference in the time to intubation (B). The horizontal line in the box, the outer horizontal lines of the box, and error bar indicate median, the 25th and 75th interquartiles, and 95% confidence interval (CI), respectively. As the 95% CI of time difference (−4.48 to 4.08 s) in this study is within the upper and lower limits of noninferiority (Δ), the result demonstrates the noninferiority (equivalence) between the nonstylet and stylet groups.
Mentions: In the majority of patients (137 patients, 98%), endotracheal intubation was successful within 60 s on the first attempt (2/70 [2.8%] in the nonstylet group vs 1/70 [1.4%] in the stylet group, P = 1.00). A Kaplan–Meier plot was illustrated to show the intubation success as a function of time (Fig. 3). Median time to intubation [interquartile range] was not different between the nonstylet group and the stylet group (26 [24–32.5] s vs 27 [25–31] s, P = 0.937) (Table 2). Mean difference between the groups in time to intubation was −0.2 s (95% confidence interval −4.48 to 4.08) (Fig. 4). Regarding the degree of difficulty in intubation, there was no significant in median IDS between the nonstylet and stylet groups (P = 0.695), and the proportion of patients with IDS = 0 was not different between the nonstylet and stylet groups (83% vs 86%). Laryngoscopic glottis view grade was not different between the 2 groups. There were no significant differences in hemodynamic and BIS values between the groups over time. During endotracheal intubation, major complications including mucosal perforation and dental damage did not occur.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: During McGrath videolaryngoscope (VL) intubation, a styletted endotracheal tube maintaining an upward distal tip angle is recommended by some manufacturers. However, a styletted endotracheal tube can elicit rare but potentially serious complications. The purpose of this study was to demonstrate that a nonstyletted tube with exaggerated curvature would be noninferior to a styletted tube for orotracheal intubation using McGrath VL in patients with expected normal airway, by comparing the time to intubation and ease of intubation.

Methods:: One hundred forty patients, ages 19 to 70 years (American Society of Anesthesiologists physical status I–II), undergoing tracheal intubation for elective surgery were randomly allocated to the nonstylet group (n = 70) or the stylet group (n = 70). Anesthesia induction consisted of propofol, remifentanil, and rocuronium. The primary outcome was time to intubation assessed by a blind observer. Cormack and Lehane glottic grade, easy of intubation, and intubation difficulty score (IDS) were also assessed.

Results:: Median time to intubation [interquartile range] was not different between the nonstylet group and the stylet group (26 [24–32.5] s vs 27 [25–31] s, P = 0.937). There was no significant in median IDS between the nonstylet group and the stylet group (P = 0.695).

Conclusion:: This study shows that a nonstyletted endotracheal tube with exaggerated curvature has a similar performance to a styletted tube with a hockey-stick curvature during intubation using McGrath VL regarding time taken to successful intubation and easiness of intubation.

No MeSH data available.