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Influence of videolaryngoscopy using McGrath Mac™ on the need for a helper to perform intubation during general anaesthesia: A multicentre randomised video - no-video trial

Fischler, Marc1

Published Jan 25, 2021 on Dryad. https://doi.org/10.5061/dryad.280gb5mp6

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Jan 25, 2021 version files 83.84 KB

Abstract

Objective: We hypothesized was that use of a videolaryngoscope modifies the practice of tracheal intubation.

Design: Randomized single-blinded study.

Setting: Three institutions: one academic, one non-profit and one profit.

Participants: Inclusion criteria were patients aged 18 years minimum, requiring orotracheal intubation, without a predicted difficult intubation (Arne score <11). Non-inclusion criteria was patients requiring a rapid-sequence intubation. 300 patients were included, 271 randomised, 256 analysed: 123 in the No-Video group and 133 in the Video group.

Intervention: Tracheal intubation uses a McGrath Mac™ videolaryngoscope. Patients were randomised into two groups: a Video group (screen activated) and a No-Video group (screen hidden).

Primary and secondary outcome measures: The main outcome was the need for help for the anaesthesiologist or the nurse anaesthetist in performing tracheal intubation, the sequence being video recorded. Secondary outcomes included the ease of intubation (intubation difficulty scale, Cormack and Lehane grade, percentage of glottic opening scale score, use of alternative techniques, duration, oxygen desaturation, especially). Other outcomes included the cooperation between members of the anaesthesiology team, the proportion of patients suffering from postoperative hoarseness or sore throat, and other adverse events.

Results:. Requirement for assistance was not decreased in the Video group: 36.1% [95% CI 27.9 to 44.9] versus 45.5% [95% 36.5 to 54.7] in the No-Video group (p=0.124). Intubation difficulty scale was lower in the Video group (p=0.009); glottis visualization (Cormack and Lehane score and glottic opening score) was better in the Video group (p<0.001). Duration of intubation was similar between groups. Oxygen desaturation or hypotension requiring treatment during the intubation period and postoperative complications (hoarseness or sore throat) were observed similarly in both groups. No other adverse event occurred.

Conclusion: In patients without risk of difficulty in airway management, videolaryngoscopy did not decrease the requirement for assistance to perform intubation.

Trial registration: Clinicaltrials.gov identifier: NCT02926144