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C-MAC® video-laryngoscope assisted removal of pediatric upper airway foreign body via apneic technique: Two case reports.

ABSTRACT: C-MAC® video-laryngoscope is often used by anesthetists in difficult intubation scenarios primarily in adults. Using this C-MAC® device in two of our pediatric cases, we successfully removed the laryngeal foreign body, while the anesthetist provided the apneic technique. A systematic review of PubMed and Google Scholar for similar cases was conducted. We found only one such case report of pediatric airway foreign body removal via video-laryngoscope in the English literature. The use of this high-quality, magnified video-laryngoscope in children in an emergency scenario is often not adequately applied. This procedure provides continuous real-time visualization to both the operating surgeon as well as the anesthetist in respect to the airway and thereby reduces the chance of any untoward complications. Here, we present two interesting case reports of C-MAC® video-laryngoscope assisted removal of laryngeal foreign body via apneic technique with spontaneous ventilation performed on two different children in our facility. Both these children had clinical symptoms of upper airway obstruction with fluctuating stridor simulating croup or asthma.

SUBMITTER: Punnoose SE

PROVIDER: S-EPMC6349973 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Difficult airways can be managed with a range of devices, with video laryngoscopes (VLs) being the most common. The C-MAC® Video-Stylet (VS; Karl-Storz Germany), a hybrid between a flexible and a rigid intubation endoscope, has been recently introduced. The aim of this study is to investigate the performance of the VS compared to a VL (C-MAC Macintosh blade, Karl-Storz Germany) with regards to the learning curve for each device and its ability to manage a simulated difficult airway manikin. This is a single-center, prospective, randomized, crossover study involving twenty-one anesthesia residents performing intubations on a Bill 1™ (VBM, Germany) airway manikin model. After a standardized introduction, six randomized attempts with VL and VS were performed on the manikin. This was followed by intubation in a simulated difficult airway (cervical collar and inflated tongue) with both devices in a randomized fashion. The primary end-point of this study was the total time to intubation. All continuous variables were expressed as the median [interquartile range] and analyzed using the Mann-Whitney U test. A 2-way ANOVA with Bonferroni's post hoc test was used to compare both devices at each trial. All reported p values are two sided. The median total time to intubation on a simulated difficult airway was faster with the VS compared to VL (17 [13.5-25] sec vs 23 [18.5-26.5] sec, respectively; 95% CI; P = 0.031). Additionally, on a normal airway manikin, the VS has a comparable learning curve to the VL. In this manikin-based study, the novel VS was comparable to the VL in terms of learning curve in a normal airway. In a simulated difficult airway, the total time to intubation, though likely not clinically relevant, was faster with the VS to the VL. However, given the above findings, this study justifies further human clinical trials with the VS to see if similar benefits-faster time to intubation and similar learning curve to VL-are replicated clinically.

Project description:BACKGROUND:King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the performance of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators. METHODS:Ninety nine ASA I or II adult patients, scheduled for oral maxillofacial surgeries with El-Ganzouri risk index 1-7 were enrolled. Patients were randomly allocated to intubate with one of three laryngoscopes (non-channeled King Vision, McGrath MAC and Macintosh). The intubators were experienced with more than 100 successful nasotracheal intubations using each device. The primary outcome was intubation time. The secondary outcomes included first success rate, time required for viewing the glottis, Cormack-Lehane grade of glottis view, the number of assist maneuvers, hemodynamic responses, the subjective evaluating of sensations of performances and associated complications. RESULTS:The intubation time of King Vision and McGrath group was comparable (37.6?±?7.3?s vs. 35.4?±?8.8?s) and both were shorter than Macintosh group (46.8?±?10.4?s, p?<?0.001). Both King Vision and McGrath groups had a 100% first attempt success rate, significantly higher than Macintosh group (85%, p?<?0.05). The laryngoscopy time was comparable between King Vision and McGrath group (16.7?±?5.5?s vs. 15.6?±?6.3?s) and was shorter than Macintosh group (22.8?±?7.2?s, p?<?0.05) also. Compared with Macintosh laryngoscope, Glottis view was obviously improved when exposed with either non-channeled King Vision or McGrath MAC VL (p?<?0.001), and assist maneuvers required were reduced (p?<?0.001). The maximum fluctuations of MAP were significantly attenuated in VL groups (47.7?±?12.5?mmHg and 45.1?±?10.3?mmHg vs. 54.9?±?10.2?mmHg, p?<?0.05 and p?<?0.01). Most device insertions were graded as excellent in McGrath group, followed by Macintosh and King Vision group (p?=?0.0014). The tube advancements were easier in VLs compared with the Macintosh laryngoscope (p?<?0.001). Sore throat was found more frequent in Macintosh group compared with King Vision group (p?<?0.05). CONCLUSIONS:Non-channeled King Vision and McGrath MAC VLs were comparable and both devices facilitated nasotracheal intubation in managing predicted difficult intubations compared with Macintosh laryngoscope. TRIAL REGISTRATION:ClinicalTrials registration number NCT03126344 . Registered on April 24, 2017.

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C-MAC® video-laryngoscope assisted removal of pediatric upper airway foreign body via apneic technique: Two case reports.

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