A randomised comparative study of 'videoendoscope' with the Truview EVO2, C-MAC D blade videolaryngoscope and the Macintosh laryngoscope

Abstract

Background and Aims: Videolaryngoscopes are crucial components of a difficult airway cart. Issues of cost and availability, however, remain a problem. We compared the combination of an endoscope used in conjunction with the Macintosh laryngoscope with established videolaryngoscopes and the Macintosh laryngoscope using the intubation difficulty scale (IDS) score. Materials and Methods: A prospective randomised study including 120 adult patients, American Society of Anaesthesiologists (ASA) physical status I-III, with an anticipated difficult airway scheduled for elective surgery were randomly allocated to one of four groups: Truview EVO2 (group 1), C-MAC D Blade (group 2), videoendoscope (group 3), or Macintosh laryngoscope (group 4). The IDS score was the primary outcome. Secondary outcomes included the Cormack-Lehane grade, time to tracheal intubation, haemodynamic responses, and adverse events. Results: A significant proportion of patients in groups 2 and 3 had an IDS score of zero (73.3 and 70%, respectively). IDS scores were significantly lower in the C-MAC D blade and videoendoscope groups attributable to differences in parameters N4, N5 and N6 [C/L grades, lifting force and laryngeal pressure required] (P < 0.001). The C-MAC D blade and the Macintosh laryngoscope required less time for intubation as compared to the Truview EVO2 and videoendoscope. No differences were noted in post-intubation haemodynamic parameters and other adverse events. Conclusion: The performance of videoendoscope was comparable to C-MAC D Blade and superior to Truview EVO2 and Macintosh laryngoscope with respect to the IDS score and may thereby provide an effective alternative to commercial videolaryngoscopes in low resource settings.