A comparison of the video laryngoscopes with Macintosh laryngoscope for nasotracheal intubation.

Nasotracheal intubation (NTI) is usually required in patients undergoing maxillofacial surgery. Though video-scopes have been demonstrated to perform well in oral endotracheal intubation, limited information is available concerning NTI. The aim of the study is to compare the efficiency of video-scopes and the traditional direct laryngoscopy in NTI. One hundred and eight patients scheduled for elective oro-maxillofacial surgery under nasotracheal intubation general anesthesia were randomly allocated into one of 3 groups of GlideScope, Pentax AirWay Scope, or Macintosh laryngoscope respectively. The primary outcome measures were total intubation time and each separate time interval (time A: for placement for the nasotracheal tube from selected nostril to oropharynx; time B: for use of devices to view the glottic opening; time C: for advancing nasotracheal tube from oropharynx into trachea and removing the scope from the oral cavity). The secondary outcomes were measurement of scores of modified naso-intubation difficulty scale (MNIDS) and attempts at intubation.
RESULTS: Mean total intubation time and time C interval were taken with GlideScope (33.1 s and 9.7 s), Pentax (38.4 s and 12.9 s), and Macintosh (42.2 s and 14.9 s) respectively. There was a significant difference among the groups (total time, P = 0.03; time C, P = 0.02). The median score of MNIDS was significantly lower using GlideScope or Pentax compared with using Macintosh in NTI (P = 0.037) and difficult intubation grading by MNIDS presented as easier in the GlideScope group than in the Macintosh group (0.016). Using GlideScope, intubation was successful at the first attempt in 80% patients whereas only 65% and 72.5% with the Pentax and Macintosh (P = 0.02).
CONCLUSION: As compared with the Macintosh laryngoscope, the GlideScope video laryngoscope facilitated nasotracheal intubations with shortened intubation time and reduced intubation difficulty in patients undergoing oromaxillofacial surgery.

RCT Entities:   Population Interventions Outcomes