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Partial vs full glottic view with CMACTM D blade intubation of airway with simulated cervical spine injury: a randomized controlled trial

Cheong CC, Ong SY, Lim SM, Wan A WZ, Mansor M, Chaw SH

Expert Rev Med Devices, 2023 Feb;20(2):151-160.
PMID: 36715659 DOI: 10.1080/17434440.2023.2174850

PURPOSE: A previous study reported a shorter time to tracheal intubation by reducing percentage of glottic opening (POGO) view to <50% when intubating a normal adult airway using the GlidescopeTM blade. We evaluate the efficacy of reducing POGO to <50% when intubating patients with rigid cervical immobilization using CMACTM D blade.
METHODS: One hundred and four adult patients were randomized to group POGO 100% or POGO <50% . Laryngoscopy was performed by advancing tip of the D blade at vallecula. POGO 100% was achieved by exerting upward force to displace epiglottis until glottic opening from the anterior commissure to inter arytenoid notch. POGO < 50% was acquired by withdrawing the D blade tip dorsally from vallecula. The primary outcome was time to intubation.
RESULTS: The median time (IQR) to successful intubation was 29 (25-35) seconds for group POGO < 50% and 34 (28-40) seconds for group with POGO 100% (difference in medians, 5 seconds; 95% confidence interval, 2 to 8, p = 0.003). Complications were minor.
CONCLUSION: Using the CMACTM D blade with a reduced POGO in patients with cervical spine immobilization resulted in faster tracheal intubation.
TRIAL REGISTRATION: The trial is registered at ClinicalTrial.gov (CT.gov identifier: NCT04833166).

Matched MeSH terms: Laryngoscopy/methods
Fulltext LeHeR, a simple novel approach for difficult airway in non-trauma patients

Yezid NH, Poh K, Md Noor J, Arshad A

BMJ Case Rep, 2019 Aug 10;12(8).
PMID: 31401573 DOI: 10.1136/bcr-2019-230201

Managing the difficult airway presents a great challenge to anaesthesiologists and emergency physicians. Although there are many methods and scoring systems available to predict and anticipate difficult airway, the dictum in emergency airway is to always expect the unexpected. We have encountered a novel simple method of improving laryngoscopic view in difficult airway. We report four cases of difficult airway encountered in our district hospital from November 2017 to December 2018, in which intubation was performed using a simple manoeuvre called supine left head rotation (LeHeR). In all these cases, LeHeR manoeuvre has proven to be successful after more than a single attempt at intubation using various methods. The manoeuvre improves drastically the laryngoscopic view of Cormack-Lehane from 3B and 4 to 1 and 2.

Matched MeSH terms: Laryngoscopy/methods*
Tracheal T-tube: a novel endoscopic insertion technique

Rahimah AN, Shahfi FI, Masaany M, Gazali N, Siti SH

J Laryngol Otol, 2016 Oct;130(10):967-968.
PMID: 27774924

Laryngotracheal stenosis is a complex condition of airway compromise involving either the larynx or trachea, or both.

Matched MeSH terms: Laryngoscopy/methods
Fulltext Comparing insertion characteristics on nasogastric tube placement by using GlideScope™ visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients

Wan Ibadullah WH, Yahya N, Ghazali SS, Kamaruzaman E, Yong LC, Dan A, et al.

Braz J Anesthesiol, 2016 Jul-Aug;66(4):363-8.
PMID: 27343785 DOI: 10.1016/j.bjane.2014.11.013

BACKGROUND AND OBJECTIVE: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScope™ visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients.

METHODS: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded.

RESULTS: The results showed success rates of 74.5% in the GlideScope™ Group as compared to 58.3% in the MacIntosh Group (p=0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2±9.3s as compared to Group B, with a duration of 18.9±13.0s (p=0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p=0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking.

CONCLUSION: This study showed that using the GlideScope™ to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

Matched MeSH terms: Laryngoscopy/methods*
Comparison of Macintosh Laryngoscopy in Bed-up-Head-Elevated Position With GlideScope Laryngoscopy: A Randomized, Controlled, Noninferiority Trial

Tsan SEH, Lim SM, Abidin MFZ, Ganesh S, Wang CY

Anesth Analg, 2020 07;131(1):210-219.
PMID: 31348051 DOI: 10.1213/ANE.0000000000004349

BACKGROUND: Approximately half of all difficult tracheal intubations (DTIs) are unanticipated; hence, proper positioning during intubation is critical to increase the likelihood of success. The bed-up-head-elevated (BUHE) intubation position has been shown to improve laryngeal view, reduce airway complications, and prolong safe apneic time during intubation. In this study, we sought to determine whether the BUHE intubation position is noninferior to Glidescope (GLSC)-assisted intubation with regard to laryngeal exposure.
METHODS: A total of 138 American Society of Anesthesiologists (ASA) I to III patients were randomly assigned into 2 groups and underwent baseline laryngoscopy in the sniffing position. Group BUHE patients (n = 69) were then intubated in the BUHE position, while group GLSC patients (n = 69) were intubated using GLSC laryngoscopy. Laryngeal exposure was measured using Percentage of Glottic Opening (POGO) score and Cormack-Lehane (CL) grading, and noninferiority will be declared if the difference in mean POGO scores between both groups do not exceed -15% at the lower limit of a 98% confidence interval (CI). Secondary outcomes measured included time required for intubation (TRI), number of intubation attempts, use of airway adjuncts, effort during laryngoscopy, and complications during intubation.
RESULTS: Mean POGO score in group BUHE was 80.14% ± 22.03%, while in group GLSC it was 86.45% ± 18.83%, with a mean difference of -6.3% (98% CI, -13.2% to 0.6%). In both groups, there was a significant improvement in mean POGO scores when compared to baseline laryngoscopy in the sniffing position (group BUHE, 25.8% ± 4.7%; group GLSC, 30.7% ± 6.8%) (P < .0001). The mean TRI was 36.23 ± 14.41 seconds in group BUHE, while group GLSC had a mean TRI of 44.33 ± 11.53 seconds (P < .0001). In patients with baseline CL 3 grading, there was no significant difference between mean POGO scores in both groups (group BUHE, 49.2% ± 19.6% versus group GLSC, 70.5% ± 29.7%; P = .054).
CONCLUSIONS: In the general population, BUHE intubation position provides a noninferior laryngeal view to GLSC intubation. The laryngeal views obtained in both approaches were superior to the laryngeal view obtained in the sniffing position. In view of the many advantages of the BUHE position for intubation, the lack of proven adverse effects, the simplicity, and the cost-effectiveness, we propose that clinicians should consider the BUHE position as the standard intubation position for the general population.

Matched MeSH terms: Laryngoscopy/methods*
Vocal fold vibratory characteristics of healthy geriatric females--analysis of high-speed digital images

Ahmad K, Yan Y, Bless D

J Voice, 2012 Nov;26(6):751-9.
PMID: 22633334 DOI: 10.1016/j.jvoice.2011.12.002

A high proportion of the geriatric population suffers from presbylaryngis and presbyphonia; however, our knowledge of vibratory patterns in this population is almost nonexistent. In this study, we investigate the vocal fold vibratory patterns of healthy elderly females to determine which features or combination of them could best describe the geriatric voices.

Matched MeSH terms: Laryngoscopy/methods*
A bizarre case of accessory larynx in an infant with OEIS syndrome

Wong TL, Baki MM, Ishak S, See GB

Int J Pediatr Otorhinolaryngol, 2018 Nov;114:134-137.
PMID: 30262351 DOI: 10.1016/j.ijporl.2018.08.037

We report a bizarre case of accessory larynx in an infant with OEIS syndrome (omphalocele, cloacal exstrophy, imperforated anus & spinal defects). This is the first reported case in literature of a duplicate accessory larynx which is a mirror image of the true larynx. A congenital duplication of the larynx is a rare anomaly and can present in various forms. In this case, the infant presented with recurrent lung infection and inability to wean off oxygen. Scope revealed severe laryngomalacia in addition to the accessory larynx. Hence, supraglottoplasty was done with aim to resolve the lung and airway problem.

Matched MeSH terms: Laryngoscopy/methods
Fulltext Nasopharyngeal diffuse large B-cells lymphoma causing acute airway obstruction amid COVID-19 crisis: an anaesthetist's nightmare

Yeap TB, Teah MK, Quay YJJ, Wong MTF

BMJ Case Rep, 2021 Jan 28;14(1).
PMID: 33509897 DOI: 10.1136/bcr-2020-241008

Acute stridor is often an airway emergency. We present a valuable experience handling an elderly woman who was initially treated as COVID-19 positive during the pandemic in November 2020. She needed an urgent tracheostomy due to nasopharyngeal (NP) diffuse large B-cell lymphoma causing acute airway obstruction. Fortunately, 1 hour later, her NP swab real-time PCR test result returned as SARS-CoV-2 negative. This interesting article depicts the importance of adequate preparations when handling potentially infectious patients with anticipated difficult airway and the perioperative issues associated with it.

Matched MeSH terms: Laryngoscopy/methods