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Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A good traditional laryngoscope is a medical tool that is widely used when diagnosing and imaging the tissues of the larynx in maintaining the artificial airway through a tube connected to the ventilator to complete the intubation process and technical difficulties with laryngoscopy affect patient comfort. These challenges are considered engineering tasks to develop designs in order to improve functionality related to visualizing internal anatomy and also by applying advanced artificial intelligence methodologies. The current work focuses on computer-aided design and 3D printing technology to produce a laryngoscope that can display the parts of the larynx in real-time so that the captured data of cancerous tissues can be diagnosed and stored as an example through artificial intelligence techniques. The binoculars were manufactured using PLA and an FDM 3D printer. The different parts of the laryngoscope were designed according to multiple design considerations to produce a device with a good degree of acceptability, as the curved part of the laryngoscope was designed on the basis of the internationally approved Macintosh design. A model was designed on the basis of the organic and anatomical geometry of the larynx and with ergonomics that are compatible with the structure of the mouth to ensure a smooth and safe endoscopic process in the intubation process and does not injure the tongue tissues, as the curvature of the tip of the curved part of the designed endoscope plays a vital role in improving the mechanisms of lifting the epiglottis. The handle of the laryngoscope is also designed with high symmetry with ergonomic considerations, which is an important part of laryngoscopy as it allows the medical practitioner to move the laryngoscope to achieve the best possible spatial vision. This will allow medical practitioners to perform a less intimidating intubation procedure while reducing the margin of error for everyday use cases. The produced model helps improve the process of diagnosing and laryngoscopy by using modern artificial intelligence technology at all stages of design and manufacturing. And also in developing an artificial intelligence model for the detection of laryngeal cancer by taking advantage of endoscopy image data captured by a video camera. The characteristics of the blades of the endoscope model provide a number of solutions that improve the success rate while reducing the margin of error for the intubation process. A number of improvements have been made to the prototype to develop it and gain more reliability. [ABSTRACT FROM AUTHOR]

Background & objective: Endotracheal intubation is considered the gold standard for airway management. It has been shown that different types of laryngoscope blades effect the hemodynamic response differently. We evaluated hemodynamic stress response before, during and after laryngoscopy with McCoy and Macintosh laryngoscope blades. Methodology: A total of 68 patients were enrolled in the study and randomly allocated to the two study groups using computer-generated random numbers. Patients undergoing endotracheal intubation using the MacIntosh blade were labelled as Group MI, and those in which McCoy blade was used, were labelled as Group MC. Endotracheal tube placement and anesthesia maintenance were standardized for both study groups. The hemodynamic parameters, including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded before induction, before laryngoscopy, and at 1, 2, 3, 4, 5 and 10 min after laryngoscopy. Results: The groups were comparable in terms of age and body mass index with similar mean values in the two studies and also concerning the ASA physical status and Mallampati classification. All the hemodynamic parameters, including HR, SBP, DBP, and MAP increased after laryngoscopy and intubation in both the study groups, but McCoy laryngoscope showed significantly lower values of SBP, DBP, and MAP at 1st and 2nd min after intubation. Conclusion: McCoy's laryngoscope may be advantageous when compared to the Macintosh blade in situations where minimizing hemodynamic responses is crucial. Abbreviations: DBP: diastolic blood pressure; MAP: mean arterial pressure: SBP: systolic blood pressure [ABSTRACT FROM AUTHOR]

Abstract Background The head-elevated laryngoscopy position has been described to be optimal for intubation, particularly in obese patients and those with anticipated difficult airways. Horizontal alignment of the external auditory meatus and sternal notch (AM-S) can be used as endpoints for optimal positioning. Thus, we aligned the head-elevated position with the AM-S in the horizontal plane and evaluated its effect on laryngeal visualization and ease of intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway. Methods Sixty-four patients were included in this prospective, crossover, randomized controlled trial. A cervical collar was used to restrict neck movement and mouth opening. The head-elevated position was achieved by raising the back section of the operation room table and ensuring that the end point was horizontally aligned with the AM-S (table-ramp method). The laryngeal view was randomly assessed in both head-flat and head-elevated positions based on the percentage of glottic opening (POGO) score and modified Cormack–Lehane (MCL) grade. External laryngeal manipulation was not permitted when laryngeal visualization was scored. The trachea was intubated only once (in the second position). The ease of intubation was assessed based on the need for optimization maneuvers, intubation difficulty scale (IDS) scores and time to intubation. Results The mean table-ramp angle required to achieve the horizontal alignment of AM-S was 17.5 ± 4.1°. The mean POGO score improved significantly in the head-elevated position (59.4 ± 23.8%) when compared with the head-flat position (37.5 ± 24%) (P

Objective: This study aimed to compare the effectiveness of videolaryngoscopy and Macintosh laryngoscopy on adult patients who were scheduled for elective surgery under general anaesthesia. Methods: Of the 200 adult patients who were scheduled to undergo general anaesthesia, 100 were intubated with a videolaryngoscope and 100 with a Macintosh laryngoscope. The patients' age, sex, American Society of Anesthesiologists score, height, weight, body mass index, smoking and alcohol habits, comorbidity, and neck circumference were recorded. Their El-Ganzouri Risk Index score, which considers the parameters of mouth opening, thyromental distance, Mallampati score, neck movement, propensity for prognathism, body weight, and history of difficult intubation, was also calculated and recorded. The time to achieve intubation was then recorded. The number of intubation attempts, number of cases of difficult intubation, Cormack-Lehane scores, and incidences of trauma or complication were also evaluated. Results: The mean intubation time was found to be significantly lower in the videolaryngoscope group compared to the Macintosh laryngoscope group. Although the number of patients with difficult intubation was high in the videolaryngoscope group, when we evaluated their glottic view, the Cormack-Lehane score was found to be significantly lower. The number and ratio of complications due to intubation were lower in the videolaryngoscope group compared to the Macintosh laryngoscopy group. Conclusions: In patients undergoing endotracheal intubation for general anaesthesia, it was concluded that videolaryngoscopy is superior to Macintosh laryngoscopy as it enlarges the glottic view, shortens the time to achieve intubation, facilitates intubation, and has less risk of complications. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of Macintosh blade size used during direct laryngoscopy (DL) on first-attempt intubation success of orotracheal intubation in French intensive care units (ICUs). We hypothesized that success rate would be higher with Macintosh blade size No3 than with No4.Methods: Multicenter retrospective observational study based on data from prospective trials conducted in 48 French ICUs of university, and general and private hospitals. After each intubation using Macintosh DL, patients' and operators' characteristics, Macintosh blade size, results of first DL and alternative techniques used, as well as the need of a second operator were collected. Complications rates associated with intubation were investigated. Primary outcome was success rate of first DL using Macintosh blade.Results: A total of 2139 intubations were collected, 629 with a Macintosh blade No3 and 1510 with a No4. Incidence of first-pass intubation after first DL was significantly higher with Macintosh blade No3 (79.5 vs 73.3%, p = 0.0025), despite equivalent Cormack-Lehane scores (p = 0.48). Complications rates were equivalent between groups. Multivariate analysis concluded to a significant impact of Macintosh blade size on first DL success in favor of blade No3 (OR 1.44 [95% CI 1.14-1.84]; p = 0.0025) without any significant center effect on the primary outcome (p = 0.18). Propensity scores and adjustment analyses concluded to equivalent results.Conclusion: In the present study, Macintosh blade No3 was associated with improved first-passed DL in French ICUs. However, study design requires the conduct of a nationwide prospective multicenter randomized trial in different settings to confirm these results. [ABSTRACT FROM AUTHOR]

Introduction: Laryngoscopy is one of the critical points in the intubation process and a mechanical trauma that provides noxious stimulation, affecting cardiovascular, respiratory, and intracranial changes. Practitioner competence is a significant factor that supports laryngoscope intubation procedures. That can influence the intubation duration and amount of mechanical trauma besides caused by laryngoscope type. Objective: To analyze the effectiveness of using Macintosh blade compared to McCoy blade in intubation laryngoscopy by Anesthesia Residents. Materials and Methods: This research is an experimental study in adult patients who underwent elective surgery at GBPT Dr. Soetomo Hospital. Intubation did by Anesthesia Residents at levels 5-9 using Macintosh or McCoy Laryngoscope and chosen randomly. The data of laryngeal visualization (Cormack Lehane), hemodynamics (blood pressure, pulse), pain scale (qNOX), intubation time length, and pain scale data (VAS) after extubation were taken during intubation laryngoscope. Result and Discussion: The study was conducted on 28 samples that met the criteria. Anesthesia Resident's competence levels based on the semester in both groups laryngoscopes were not different (p 0.868). Based on laryngeal visualization data laryngoscopy, the McCoy's blade had better visualization with CL 1 at 85.7% of the samples and p-value 0.020. This good visualization makes it possible to speed up the laryngoscope-intubation in the McCoy blade group with a significant difference of time compared to the Macintosh blade group. Hemodynamic parameters, there were significant differences for hemodynamics increase. In the Macintosh blade group, the blood pressure and pulse were significantly increased after laryngoscopy intubation. The pain scale during the intubation procedure, which was rated based on the qNOx score, showed a significant increase in the Macintosh blade group with a p-value of 0.003. The postoperative pain scale (VAS) was smaller in the McCoy blade group compared to the Macintosh group (p-value

Background: Direct Laryngoscopy and intubation lead to extensive stress response and sympathetic stimulation in the body which can be critical for some patient subsets like cardiac ischemia, raised intracranial tension, cerebral aneurysm, open globe injury, glaucoma etc. Hence reduction of the intense stress response is of utmost importance for a stable and safe hemodynamics in those patients. Aims and Objectives: 1. To find out the hemodynamic stress response exerted by the Macintosh blade and McCoy blade. 2. To compare the hemodynamic stress responses between the two blades. Materials and Methods: In this study we had selected 60(male and female in equal number) ASA grade-1 and grade- 2 patients posted for elective general surgery. They were randomly divided into two groups - group 1(laryngoscopy done by McCoy blade)and group 2(laryngoscopy done by Macintosh blade). Systolic Blood Pressure, Diastolic Blood Pressure , Mean Blood Pressure and Heart Rate were recorded before and after anaesthesia induction, just after intubation and one, three and six minutes after orotracheal intubation. Results: The results were compared over time between the two groups. Mean values of Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure and heart rate were significantly higher in group 2 as compared to group 1(with p values as 0.009, 0.008, 00.004 and 0.000 respectively). Conclusion: Thus we conclude that the stress response was significantly higher when laryngoscopy was done with Macintosh blade as compared with McCoy blade. We would also like to stress that the art of laryngoscopy should just not be mastered but all anaesthesiologists should think of and practise techniques which would make laryngoscopy smooth and less stressful for our patients. Intubation with McCoy laryngoscope blade is one such technique.

Background: The head-elevated laryngoscopy position has been described to be optimal for intubation, particularly in obese patients and those with anticipated difficult airways. Horizontal alignment of the external auditory meatus and sternal notch (AM-S) can be used as endpoints for optimal positioning. Thus, we aligned the head-elevated position with the AM-S in the horizontal plane and evaluated its effect on laryngeal visualization and ease of intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway. Methods: Sixty-four patients were included in this prospective, crossover, randomized controlled trial. A cervical collar was used to restrict neck movement and mouth opening. The head-elevated position was achieved by raising the back section of the operation room table and ensuring that the end point was horizontally aligned with the AM-S (table-ramp method). The laryngeal view was randomly assessed in both head-flat and head-elevated positions based on the percentage of glottic opening (POGO) score and modified Cormack–Lehane (MCL) grade. External laryngeal manipulation was not permitted when laryngeal visualization was scored. The trachea was intubated only once (in the second position). The ease of intubation was assessed based on the need for optimization maneuvers, intubation difficulty scale (IDS) scores and time to intubation. Results: The mean table-ramp angle required to achieve the horizontal alignment of AM-S was 17.5 ± 4.1°. The mean POGO score improved significantly in the head-elevated position (59.4 ± 23.8%) when compared with the head-flat position (37.5 ± 24%) (P < 0.0001). MCL grade 1 or 2a was achieved in 56 (85.9%) and 28 (43.7%) of patients in the head-elevated and head-flat positions, respectively (P < 0.0001). Optimization maneuvers for intubation were required in 7 (21.9%) and 17 (53.1%) patients in the head-elevated and head-flat positions, respectively (P < 0.0001). The IDS scores and time to intubation did not differ significantly between the two positions. Conclusion: In the head-elevated position, aligning the AM-S in the horizontal plane consistently improved laryngeal visualization without worsening the view when the McGrath MAC videolaryngoscope was used in patients with simulated difficult airways. It also improved the ease of intubation, which reduced the need for optimization maneuvers. Trial registration: This trial was registered with www.clinicaltrials.gov, NCT04716218, on 20/01/2021. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Direct Laryngoscopy and intubation lead to extensive stress response and sympathetic stimulation in the body which can be critical for some patient subsets like cardiac ischemia, raised intracranial tension, cerebral aneurysm, open globe injury, glaucoma etc. Hence reduction of the intense stress response is of utmost importance for a stable and safe hemodynamics in those patients. Aims and Objectives: 1. To find out the hemodynamic stress response exerted by the Macintosh blade and McCoy blade. 2. To compare the hemodynamic stress responses between the two blades. Materials and Methods: In this study we had selected 60(male and female in equal number) ASA grade-1 and grade- 2 patients posted for elective general surgery. They were randomly divided into two groups - group 1(laryngoscopy done by McCoy blade)and group 2(laryngoscopy done by Macintosh blade). Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure and Heart Rate were recorded before and after anaesthesia induction, just after intubation and one, three and six minutes after orotracheal intubation. Results: The results were compared over time between the two groups. Mean values of Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure and heart rate were significantly higher in group 2 as compared to group 1(with p values as 0.009, 0.008, 00.004 and 0.000 respectively). Conclusion: Thus we conclude that the stress response was significantly higher when laryngoscopy was done with Macintosh blade as compared with McCoy blade. We would also like to stress that the art of laryngoscopy should just not be mastered but all anaesthesiologists should think of and practise techniques which would make laryngoscopy smooth and less stressful for our patients. Intubation with McCoy laryngoscope blade is one such technique. [ABSTRACT FROM AUTHOR]

Background and Aims: Paediatric airway, because of its consistent anatomical differences from that of an adult, often encounters difficulty in aligning the line of sight with the laryngeal inlet during intubation. Paediatric videolaryngoscopes (VLs), by obviating the need for aligning the line of sight with the glottis, offer several advantages over direct laryngoscopy. Therefore, this study aimed to compare the recently introduced paediatric King Vision™ VL (KVL) and the direct laryngoscope with Macintosh blade for elective tracheal intubation in infants of age <1 year. Methods: Seventy‑eight infants of American Society of Anesthesiologists physical status 1 and 2, scheduled for elective surgery, were enrolled for this prospective randomised clinical trial and randomised into either of the two groups – Group K and Group C, where the infants were intubated using size 1 King Vision or direct laryngoscope with Macintosh blade. The primary objective of this study was the time taken for intubation and the first‑attempt intubation success rate. Results: Time to intubate (25.90 ± 2.34 s vs. 25.03 ± 1.42 s, P = 0.05) and first‑attempt intubation success rate (100% vs. 100%, P = 1) were similar between the groups, whereas glottic visualisation (P = 0.01), alternate techniques used to assist intubation (P < 0.001), the ease of intubation (P = 0.02) and intubation difficulty score (P = 0.01) were better in Group K than that in Group C. Conclusion: The outcome of KVL and Macintosh laryngoscope was similar in terms of time taken for intubation and first‑attempt intubation success rate with KVL having superior glottic visualisation, better ease of intubation and lower intubation difficulty score for elective intubations in children of age <1 year. [ABSTRACT FROM AUTHOR]

This study aimed to compare Miller and Macintosh laryngoscopes in zero to 4-year-old children. A total of 72 children with a score of I and II, according to the American Society of Anesthesiologists (ASA) physical status classification, who were candidates for elective surgery with general anesthesia and tracheal intubation were enrolled in the study. The children were divided into two equal groups (36 persons) according to used laryngoscope: Miller laryngoscope (group 1) and Macintosh laryngoscope (group 2). Observations and all laryngoscopies were performed by a single experienced anesthesiologist. Heart rate, systolic blood pressure, non-invasive arterial blood pressure, and hemoglobin saturation were measured and recorded. The number of endotracheal intubation attempts and complications were also recorded for both groups. In terms of gender, the first group consisted of 88.9% boys and 11.1% girls, and the second group consisted of 66.6% boys and 33.3% girls (p-value=0.05). The mean age was 16.7 months in the first group and 17.7 months in the second group (p-value=0.5). The mean weight of the children was 16988.5 g and 16300 g in the Miller and Macintosh groups, respectively (p-value=0.9). Regarding the Cormack-Lehane classification system, 5 patients were classified as grade 1 (13.9%), 14 patients as grade 2 (38.9%), 15 patients as grade 3 (41.7%), and 2 patients as grade 4 (5.6%) in the Macintosh group. In contrast, in the Miller group, 5 patients were classified as grade 1 (13.9%), 27 patients as grade 2 (75%), and 4 patients as grade 3 (11.1%) (p-value=0.004). These results can provide more data about the tracheal intubation method with the Macintosh and Miller laryngoscopes, the ease of intubation, and the best laryngoscopic view with each blade. [ABSTRACT FROM AUTHOR]

Background: The invention of McCoy blade in the early 1990s is a modification of the Macintosh blade with a hinged tip. The McCoy blade reduces the amount of force applied during laryngoscopy and endotracheal intubation, thus the increased reflex haemodynamic changes in response to tracheal intubation becomes less significant. Objective: To determine the advantages of McCoy blade laryngoscope in obtunding the pressor response, better glottic visualization and ease of intubation during laryngoscopy and endotracheal intubation as compared to Macintosh blade laryngoscope. Methods: The present study was done on 60 adult patients of ASA I and II, between the age group of 20 to 50 years. We observed the haemodynamic changes, glottic view and ease of intubation by using either Macintosh or McCoy blade laryngoscope during general anesthesia at laryngoscopy and endotracheal intubation. The changes in HR, SBP, DBP, and MAP were recorded before induction, at laryngoscopy and intubation and at 1 min, 3 min and 5 min after tracheal intubation. Glottic view obtained on laryngoscope was compared as per Cormack and Lehene grading. Tracheal intubation grading was also compared between the groups. Complications during the procedure like arrhythmias, injury, and bleeding were noted. Results: In our study, a significant haemodynamic changes were observed in both the groups following laryngoscopy and endotracheal intubation. The rise in HR, SBP, DBP and MAP were more significant with Macintosh blade laryngoscope, where as better visualization of the glottis, ease of intubation and less haemodynamic changes were noted with McCoy blade laryngoscope. Conclusion: McCoy blade laryngoscope produces significantly less marked haemodynamic changes, better glottic view and ease of intubation as compared to Macintosh blade laryngoscope during laryngoscopy and tracheal intubation.

Background and Aims: Several devices enabling double-lumen tube (DLT) placement for thoracic surgeries are available, but there are no studies for D-blade video laryngoscope-guided DLT insertion. We compared the CMac D-blade videolaryngoscope™ and the Macintosh laryngoscope for DLT endobronchial intubation using parameters of time and attempts required for intubation, glottic view, incidence of complications and haemodynamic changes. Methods: Prospective, parallel group, randomised controlled clinical trial where sixty American Society of Anesthesiologists I and II patients aged 18-80 years scheduled for thoracic surgeries entailing DLT placement were randomly allocated in two groups based on the laryngoscopic device used for endobronchial intubation. Data were subjected to statistical analysis SPSS (version 17), the paired and Student′s t-test for equality of means. Nominal categorical data between the groups were compared using Chi-squared test or Fisher′s exact test as appropriate. P ˂ 0.05 was considered statistically significant. Results: Time required for intubation was comparable (37.41 ± 18.80 s in Group-M and 32.27 ± 11.13 s in Group-D). Number of attempts and incidence of complications (trauma, DLT cuff rupture, oesophageal intubation) was greater in the Macintosh group, except malpositioning into the wrong bronchus (easily rectified fibre-optic bronchoscopically), which was greater with the D-blade. Greater haemodynamic changes were observed during Macintosh laryngoscopy. Conclusion: D-blade videolaryngoscope™ is a useful alternative to the standard Macintosh laryngoscope for routine DLT insertion.

Background: Laryngoscopy and intubation is known to produce an exaggerated stress response. The aim in general anesthesia is to attenuate this stress response. Method: This was a prospective, randomized, and a single blinded study. Ethical committee approval was obtained and 100 patients, aged 20-50 years, ASA grade I and II of either gender undergoing elective surgery under general anesthesia at a tertiary care center in India between 2015 and 2016 were recruited. We compared the Macintosh and McCoy laryngoscope blades regarding intubation time, laryngoscopic view and hemodynamic variables. Results: Both groups were comparable regarding age, gender, height and baseline vitals. Patients intubated with McCoy blade showed no or minimal change in heart rate and mean arterial pressure as compared to Macintosh blade. The intubation time was comparable in both groups. Conclusion: McCoy blade was better in attenuating the stress response to laryngoscopy and tracheal intubation. [ABSTRACT FROM AUTHOR]

Background and Aims: Several devices enabling double-lumen tube (DLT) placement for thoracic surgeries are available, but there are no studies for D-blade video laryngoscope-guided DLT insertion. We compared the CMac D-blade videolaryngoscope™ and the Macintosh laryngoscope for DLT endobronchial intubation using parameters of time and attempts required for intubation, glottic view, incidence of complications and haemodynamic changes. Methods: Prospective, parallel group, randomised controlled clinical trial where sixty American Society of Anesthesiologists I and II patients aged 18-80 years scheduled for thoracic surgeries entailing DLT placement were randomly allocated in two groups based on the laryngoscopic device used for endobronchial intubation. Data were subjected to statistical analysis SPSS (version 17), the paired and Student's t-test for equality of means. Nominal categorical data between the groups were compared using Chi-squared test or Fisher's exact test as appropriate. P < 0.05 was considered statistically significant. Results: Time required for intubation was comparable (37.41 ± 18.80 s in Group-M and 32.27 ± 11.13 s in Group-D). Number of attempts and incidence of complications (trauma, DLT cuff rupture, oesophageal intubation) was greater in the Macintosh group, except malpositioning into the wrong bronchus (easily rectified fibre-optic bronchoscopically), which was greater with the D-blade. Greater haemodynamic changes were observed during Macintosh laryngoscopy. Conclusion: D-blade videolaryngoscope™ is a useful alternative to the standard Macintosh laryngoscope for routine DLT insertion. [ABSTRACT FROM AUTHOR]

Resumo Justificativa Comparar as alterações de pressão intraocular após laringoscopia e intubação com lâmina Macintosh convencional e laringoscópio óptico Airtraq. Métodos Noventa pacientes adultos foram randomicamente designados para os grupos estudo ou controle. No grupo estudo (n = 45) o laringoscópio Airtraq foi usado para laringoscopia e no grupo controle (n = 45) o laringoscópio Macintosh convencional foi usado para laringoscopia. A pressão intraocular foi mensurada no pré‐operatório com tonômetro Schiotz. A laringoscopia foi feita de acordo com o protocolo de cada grupo. Pressão intraocular e parâmetros hemodinâmicos foram registrados logo antes da inserção do dispositivo e três vezes após a inserção do dispositivo, com intervalo de um minuto. Resultados As características dos pacientes, os parâmetros hemodinâmicos basais e a PIO basal foram comparáveis nos dois grupos. Após a inserção do tubo endotraqueal com o laringoscópio Macintosh, houve um aumento estatisticamente significativo da frequência cardíaca e da pressão intraocular em comparação com o grupo Airtraq. Não houve alteração significativa da PAM. Oito pacientes do grupo Macintosh sofreram trauma de língua‐lábio‐dental durante a intubação, enquanto apenas dois pacientes sofreram trauma das vias aéreas superiores no grupo Airtraq. Conclusão Concluímos que o laringoscópio Airtraq, em comparação com o laringoscópio Macintosh, resultou em elevações significativamente menores da PIO e em aumentos clinicamente menos acentuados da resposta hemodinâmica à laringoscopia e intubação. Background We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. Methods Ninety adult patients were randomly assigned to study group or control group. Study group (n = 45) – Airtraq laryngoscope was used for laryngoscopy. Control group (n = 45) – conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. Results Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue‐lip‐dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. Conclusion We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation. [ABSTRACT FROM AUTHOR]

Molar intubation is a technique of laryngoscopy that can be used for anticipated difficult intubation in cases where standard laryngoscopy technique is difficult due to presence of any intraoral mass that anatomically hampers laryngoscopy or that bleeds on touch. This technique is very easy, reliable and rewarding but should be practiced on normal patients for easy application in actual difficult cases.

A 37-year-old morbidly obese man with a history of obstructive sleep apnea underwent elective tonsillectomy. The patient was successfully intubated with an 8.0-mm regular cuffed endotracheal tube. A large video laryngoscope (GlideScope, Verathon Inc, Bothell, Washington) was used for intubation, as airway assessment indicated a potentially difficult airway. The surgery was uneventful, but active bleeding was noticed in the oropharynx after extubation. The patient was reintubated, again with the use of a GlideScope. The bleeding site was cauterized, and the patient was extubated after meeting the criteria for an awake extubation. He was discharged home the following day. Eight days postoperatively, the patient returned to the emergency center with spontaneous bleeding from the oropharynx. He was taken to the operating room and, based on the previous GlideScope use, an attempt was made to intubate the patient with a GlideScope. The attempt failed, as the GlideScope screen was blurred by the presence of blood in the oropharynx, even though the oropharynx was suctioned. Resuctioning and reinsertion of the GlideScope probe did not provide an adequate visual field. After 2 failed attempts, the use of the GlideScope was abandoned. Subsequently, the patient's trachea was successfully intubated with a size 4 Macintosh blade. [ABSTRACT FROM AUTHOR]

Background: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope., Methods: Ninety adult patients were randomly assigned to study group or control group. Study group (n=45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n=45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device., Results: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group., Conclusion: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)