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Materials and Methods: After approval of the institutional review board and written informed consent, 100 patients (ASA I-III) of either gender (38 male) scheduled for routine surgery under general anaesthesia, in whom tracheal intubation was mandatory (mean±SD [range] age 52±15 [20–82], weight 81±17 [54–179]), were randomly assigned in a crossover design to direct laryngoscopy with a Macintosh blade (DL group), or to videolaryngoscopy with the C-MAC (size 3 blade; C-MAC group). Patients were excluded if they had any pathology of the upper respiratory or upper alimentary tract, if they were not fasted with subsequent increased risk of pulmonary aspiration of gastric contents (rapid sequence induction), or if a difficult airway mandatory of fiberoptic intubation was previously known.
Results and Discussion: With DL and C-MAC, a Cormack-Lehane class (C/L) 1 view of the glottis was seen in 83 and 81 patients, class 2a view in 12 and 13, class 2b in 3 and 4, and class 3 in 1 and 2 patients, respectively. One patient of the DL group had a class 4 view. Tracheal intubation in the DL (n=59) and C-MAC (n=41) groups was successful in 59/59 and 41/41 patients, respectively. In those patients with impeded intubation conditions (C/L>1; n=17), C/L view from DL to C-MAC improved by one class in 7 patients, three classes in one patient, or remained unchanged in 9 patients. The median time taken for tracheal intubation in the DL and C-MAC groups was 8 sec (range, 1–94 sec) and 8 sec (range, 1–60 sec), respectively.
Conclusion(s): Overall, the C-MAC size 3 blade showed comparable intubation conditions compared to conventional laryngoscopy; however, in patients with impeded glottic view, the C-MAC videolaryngoscope may improve C/L class and therefore facilitate intubation.
