Nishkarsh Gupta1, Anju Gupta2, Riniki Sarma1, Atul Batra3, Karan Madan4. 1. Department of Onco-Anaesthesia and Palliative Medicine, DR BRAIRCH, All India Institute of Medical Sciences, New Delhi. 2. Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi. 3. Department of Medical Oncology, DR BRAIRCH, All India Institute of Medical Sciences, New Delhi. 4. Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi.
Abstract
Background: Nasotracheal intubation (NTI) is commonly performed in oro-maxillofacial surgeries. The comparative characteristics of video laryngoscope (VL) versus direct laryngoscope (DL) for NTI in such patients are unclear. Methods: We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oro-maxillofacial surgery. The primary outcome was time to intubation (TTI). Secondary outcomes included the first attempt success, overall success, the incidence of nasal bleeding, Cormack and Lehane grade and requirement for maneuvers for NTI. Results: Of the 456 studies identified following a systematic search, 10 were included. Meta-analysis showed a significantly less TTI favouring VL [ mean difference -9.04; (95% CI) -12.71 to -5.36; P < 0.001, I2 = 59%]. VL was also associated with a greater first attempt success [RR 1.10, (95% CI) 1.04 to 1.16; P = 0.001]. Maneuvers to facilitate intubation were less with VL [RR 0.22, 95% CI 0.10 to 0.51; P < 0.001]. There was no difference in overall intubation success [RR 1.04, (95% CI) 0.98 to 1.10; P = 0.17]. The incidence of bleeding was not different between DL and VL. [RR 0.59, (95% CI) 0.32 to 1.08; P = 0.09]. Conclusions: In this systematic review and meta-analysis of RCT's, the use of a VL was associated with a significantly shorter time to NTI, a greater first attempt success rate and reduced need for maneuvers to facilitate NTI. However, there is no difference in overall success, glottic view obtained or bleeding between the two instruments.
Background: Nasotracheal intubation (NTI) is commonly performed in oro-maxillofacial surgeries. The comparative characteristics of video laryngoscope (VL) versus direct laryngoscope (DL) for NTI in such patients are unclear. Methods: We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oro-maxillofacial surgery. The primary outcome was time to intubation (TTI). Secondary outcomes included the first attempt success, overall success, the incidence of nasal bleeding, Cormack and Lehane grade and requirement for maneuvers for NTI. Results: Of the 456 studies identified following a systematic search, 10 were included. Meta-analysis showed a significantly less TTI favouring VL [ mean difference -9.04; (95% CI) -12.71 to -5.36; P < 0.001, I2 = 59%]. VL was also associated with a greater first attempt success [RR 1.10, (95% CI) 1.04 to 1.16; P = 0.001]. Maneuvers to facilitate intubation were less with VL [RR 0.22, 95% CI 0.10 to 0.51; P < 0.001]. There was no difference in overall intubation success [RR 1.04, (95% CI) 0.98 to 1.10; P = 0.17]. The incidence of bleeding was not different between DL and VL. [RR 0.59, (95% CI) 0.32 to 1.08; P = 0.09]. Conclusions: In this systematic review and meta-analysis of RCT's, the use of a VL was associated with a significantly shorter time to NTI, a greater first attempt success rate and reduced need for maneuvers to facilitate NTI. However, there is no difference in overall success, glottic view obtained or bleeding between the two instruments.