Comparative evaluation of intubation difficulty score using C-Mac video-laryngoscope and macintosh laryngoscope in obese patients undergoing general anaesthesia
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242615Keywords:
C-mac videolaryngoscope, Intubation difficulty score, Inter incisor gap, Obesity, Wilson scoreAbstract
Background: Obesity, a global epidemic, predicted to have difficult airways which can be evaluated preoperatively with advancement of technologies for airway management. The present prospective study was done to evaluate and compare the intubation difficulty score (IDS) in videolaryngoscope with standard Macintosh laryngoscope.
Methods: Our study included 50 obese patients divided into two groups: Group OC (intubation done with C-Mac videolaryngoscope) and Group OM (Macintosh laryngoscope). The patients were evaluated for macroglossia, upper lip bite test, modified Mallampati grade, inter incisor gap and Wilson score in preoperative period. Intraoperatively IDS, time taken for intubation and complications were studied.
Results: IDS has sensitivity and specificity of 82.3% and 66.67% respectively. 12 patients in OM group and 3 in OC group had very difficult IDS (48% vs. 12%; p <0.05). Mean time taken for intubation was more in OM group (26.08 +/- 9.8 secs) as compared to OC group (15.96 +/- 7.2 secs). Inter incisor gap grade 2 have 8.3% of patients in easy IDS, 30.4% moderately difficult and 53.3% in very difficult IDS (p<0.05). Very difficult IDS group had total Wilson score of 5.60 as compared to 4.52 in moderately difficult group and 3.17 in easy IDS group.
Conclusions: This study reveals that as compared to standard Macintosh laryngoscope, C-Mac videolaryngoscope is better for intubation in obese patients in terms of IDS. Time taken for intubation and complications are less with videolaryngoscope. Inter incisor gap and Wilson score measured pre operatively are significant predictor of difficult airway in relation with IDS.
Metrics
References
Adnet F, Borron SW, Racine SX, Clemessy JL, Plaisance P, Lapandry C. The intubation difficulty scale (IDS) proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anaesthesiol: J Am Soci Anaesthesiol. 1997;87(6):1290-7.
Ahmed SM, Doley K, Athar M, Raza N, Siddiqi AO, Ali S. Comparison of endotracheal intubation time in neutral position between C-Mac and Airtraq laryngoscope: A prospective randomized study. Indian J Anaesth. 2017;61(4):338.
Kim J, Im KS, Lee JM, Ro J, Yoo KY, Kim JB. Relevance of radiological and clinical measurements in predicting difficult intubation using light wand (Surch-lite™) in adult patients. J Int Med Res. 2016;44(1):136-46.
Eberhart LH, Arndt C, Cierpka T, Schwanekamp J, Wulf H, Putzke C. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anaesth Analg. 2005;101(1):284-89.
Srinivasan C, Kuppuswamy B. Comparison of validity of airway assessment tests for predicting difficult intubation. Ind Anaesth Forum. 2017;18:63-8.
Narkhede HH, Patel RD, Narkhede HR. A prospective observational study of predictors of difficult intubation in Indian patients. J Anaesthesiol Clin Pharmacol. 2019;35(1):119-23.
Prakash S, Kumar A, Bhandari S, Mullick P, Singh R, Gogia AR. Difficult laryngoscopy and intubation in the Indian population: An assessment of anatomical and clinical risk factors. Ind J Anaesth. 2013;57:569-75.
Lundstrøm LH, Vester-Andersen M, Møller AM, Charuluxananan S, L’hermite J, Wetterslev J. Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177088 patients. Br. J. Anaesth. 2011;107(5):659-67.
Budde AO, Desciak M, Reddy V, Falcucci OA, Vaida SJ, Pott LM. The prediction of difficult intubation in obese patients using mirror indirect laryngoscopy: A prospective pilot study. J Anaesthesiol Clin Pharmacol. 2013;29:183-6.
Sakrikar GR, Shah PN. Correlation of anticipated difficult airway with concurrent intubation: A prospective observational study. Airway. 2019;2:22-7.
Shelgaonkar VC, Sonowal J, Badwaik MK, Manjrekar SP, Pawar M. A study of prediction of difficult intubation using mallampati and wilson score correlating with cormacklehane grading. J Evid Med Healthc. 2015;2(23):3458-66.
Siriussawakul A, Maboonyanon P, Kueprakone S, Samankatiwat S, Komoltri C, Thanakiattiwibun C. Predictive performance of a multivariable difficult intubation model for obese patients. PLoS One. 2018;13(8):e0203142.
Eiamcharoenwit J, Itthisompaiboon N, Limpawattana P, Siriussawakul A. The performance of the intubation difficulty scale among obese parturients undergoing cesarean section. Biomed Res Int. 2017;2017:3075756.
Yumul R, Elvir-Lazo OL, White PF, Sloninsky A, Kaplan M, Kariger R, et al. Comparison of three video laryngoscopy devices to direct laryngoscopy for intubating obese patients: a randomized controlled trial. J Clin Anesth. 2016;31:71-7.
Liu D, Ye Y, Zhu Y, Li J, He HY, Dong L, et al. Intubation of non-difficult airways using video laryngoscope versus direct laryngoscope: a randomized, parallel-group study. BMC Anesthesiol. 2019;19:75.
Aggarwal H, Kaur S, Baghla N. Hemodynamic response to orotracheal intubation: comparison between Macintosh, McCoy, and C-MAC Video Laryngoscope. Anesth Essays Res. 2019;13:308-12.
Sarkılar G, Sargın M, Sarıtaş TB, Borazan H, Gok F, Kilicaslan A, et al. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery. Int J Clin Exp Med. 2015;8(7):11477.
Leropoulos P, Tassoudis V, Ntafoulis N, Mimitou L, Vretzakis G, Tzovaras G et al. Do difficult airway techniques predispose obese patients to bronchospasm? Turk J Anaesthesiol Reanim. 2018;46(4):292-6.
Bakshi SG, Gawri A, Divatia JV. McGrath MAC video laryngoscope versus direct laryngoscopy for the placement of double-lumen tubes: A randomised control trial. Indian J Anaesth. 2019;63(6):456-61.
Downloads
Published
How to Cite
Issue
Section
