Original contributionIndirect versus direct laryngoscopy for routine nasotracheal intubation☆,☆☆
Section snippets
1. Introduction
Indirect laryngoscopy may be used for nasotracheal intubation of dental and maxillofacial surgery patients. Studies involving orotracheal intubation have shown that indirect laryngoscopy consistently resulted in similar or superior laryngeal exposure compared with direct laryngoscopy [1], [2], [3], [4], [5], [6], [7], [8]. Endotracheal advancement of the nasal tube also seems to be facilitated by this approach. A recent study by Jones et al. [9] showed the superiority of the GlideScope
2. Materials and methods
This study was registered with ClinicalTrials.gov (NCT00910156). After approval by the Ethics Committee of Upper Austria and written, informed patient consent, a total of 62 patients were enrolled in this prospective, randomized study. Inclusion criteria were the need for nasotracheal intubation for elective dental or maxillofacial surgery, ASA physical status 1 or 2, and age between 18 and 80 years. Exclusion criteria were any predictors of difficult airway management (eg., history, Mallampati
3. Results
The total number of patients included in this study was 62. Two patients were withdrawn from analysis according to the exclusion criteria. One Group A patient underwent tube advancement that required more than 120 seconds, despite a CL 2 view with the Airtraq. In the other patient, who was randomized to Group M, repeated intubation attempts (> three attempts) were unsuccessful, resulting from a CL 4 grade laryngoscopic view.
All 60 patients who remained in the study underwent successful
4. Discussion
In this study, IDS and NRS were chosen as endpoints to compare ease of routine nasotracheal intubation using indirect laryngoscopes versus the traditional Macintosh laryngoscope. In our opinion, IDS and NRS appear to be the best indicators of intubation difficulties available thus far. While NRS is a very subjective assessment, IDS was applied to more objectively compare intubating conditions [7], [12]. With the highest score of 3, IDS values of all included 60 intubations were consistently low
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Cited by (29)
Videolaryngoscopy versus direct laryngoscopy for nasotracheal intubation: A systematic review and meta-analysis of randomised controlled trials
2019, Journal of Clinical AnesthesiaCitation Excerpt :Two studies [37,38] used a 0–100 mm visual analogue scale (0 being ‘worst’ and 100 ‘best’), and results were not pooled due to significant heterogeneity; 3 [6,38,42] used the Intubation Difficulty Scale (IDS) score, and one [20] used a modified naso-intubation difficulty scale (MNIDS). Punchner et al. [6] also used a numeric rating scale (NRS, 0 being ‘easiest’ and 10 “the most difficult’) to rate difficulties in managing the airway; the ease of intubation was classified as easy or difficult in one study [34]. The above all studies showed a significant difference in the ease of intubation between groups, with VL being superior to DL (p < 0.05).
A comparison of the video laryngoscopes with Macintosh laryngoscope for nasotracheal intubation
2017, Asian Journal of AnesthesiologySeldinger technique for nasal intubation: a case series
2016, Journal of Clinical AnesthesiaMcGrath Video Laryngoscopy Facilitates Routine Nasotracheal Intubation in Patients Undergoing Oral and Maxillofacial Surgery: A Comparison with Macintosh Laryngoscopy
2016, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Other indirect laryngoscopes (GlideScope and Airtraq [Prodol Meditec SA, Vizcaya, Spain]) improve the Cormack and Lehane glottic grade and require less OELM for routine nasotracheal intubation than the Macintosh laryngoscope.9 The same study reported a considerably lower intubation difficulty scale (IDS) score during routine nasotracheal intubation compared with direct laryngoscopy.9 Despite the lack of IDS scoring, IDS values might have been lower in the McGrath group than in the Macintosh group owing to better glottic views before OELM and less need for OELM and Magill forceps.
Truview EVO2 laryngoscope reduces intubation difficulty in maxillofacial surgeries
2015, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :In contrast to the indirect laryngoscope, direct laryngoscopes require a greater lifting force, increased laryngeal pressure, and other manipulations for glottic visualization.5 The results are in accordance with previous trials that have documented statistical decreases in the IDS score with indirect versus direct laryngoscopes.11–13 In the present study, the rate of successful intubation using the Macintosh laryngoscope or Truview laryngoscope was similar (100% in 2 attempts), with none of the patients requiring a third attempt for intubation.