Journal of Anesthesia

, Volume 28, Issue 1, pp 51–57 | Cite as

Comparison of intubation performance between the King Vision and Macintosh laryngoscopes in novice personnel: a randomized, crossover manikin study

  • Yuki Akihisa
  • Koichi MaruyamaEmail author
  • Yukihide Koyama
  • Rieko Yamada
  • Akira Ogura
  • Tomio Andoh
Original Article



The King Vision laryngoscope is a newly developed video laryngoscope. We conducted a simulation study to evaluate the efficacy of the King Vision in novice personnel.


Thirty-one registered nurses with no previous experience with tracheal intubation were enrolled. Participants made 6 consecutive attempts at intubation of the manikin’s trachea with a Macintosh laryngoscope (MAC) and the King Vision with channeled blade (KVC) and non-channeled blade (KVNC) in a randomized cross-over fashion. The Grading Scale of Intubation Difficulty (GSID) was rated on a 5-point scale.


Overall median (range) intubation times (sec) were 16.9 (8.0–60.0) with the MAC, 20.5 (7.2–60.0) with the KVC, and 60.0 (11.0–60.0) with the KVNC. The KVNC required significantly longer intubation time compared with the MAC or the KVC (p < 0.001). Success rate with the KVNC was 47.3 %, which was significantly inferior to that with the MAC (91.4 %) or KVC (86.6 %). Median GSID was 2 (range 1–5) with the KVC and 3 (1–4) with the MAC, which were both significantly lower than the 4 (2–5) with the KVNC (p < 0.001). Esophageal intubation with the MAC occurred in 18 of 186 attempts, whereas no incidents of esophageal intubation occurred with the KVC or KVNC.


The KVC facilitated intubation by novice personnel without incidence of esophageal intubation. However, intubation times, success rates, and GSID scores were similar to the values obtained with the MAC. These findings suggest that the KVC, but not the KVNC, could be used as an alternative device for intubation by novice personnel.


Tracheal intubation Airway Simulation 



Financial support and sponsorship: none declared.

Conflict of interest

None declared.


  1. 1.
    Wang HE, Seitz SR, Hostler D, Yealy DM. Defining the learning curve for paramedic student endotracheal intubation. Prehosp Emerg Care. 2005;9:156–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Gerbeaux P. Should emergency medical service rescuers be trained to practice endotracheal intubation? Crit Care Med. 2005;33:1864–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Mulcaster JT, Mills J, Hung OR, MacQuarrie K, Law JA, Pytka S, Imrie D, Field C. Laryngoscopic intubation: learning and performance. Anesthesiology. 2003;98:23–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Garza AG, Gratton MC, Coontz D, Noble E, Ma OJ. Effect of paramedic experience on orotracheal intubation success rates. J Emerg Med. 2003;25:251–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Ray DC, Billington C, Kearns PK, Kirkbride R, Mackintosh K, Reeve CS, Robinson N, Stewart CJ, Trudeau T. A comparison of McGrath and Macintosh laryngoscopes in novice users: a manikin study. Anaesthesia. 2009;64:1207–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth. 2005;52:191–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Sun DA, Warriner CB, Parsons DG, Klein R, Umedaly HS, Moult M. The GlideScope Video Laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth. 2005;94:381–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Maharaj CH, O’Croinin D, Curley G, Harte BH, Laffey JG. A comparison of tracheal intubation using the Airtraq or the Macintosh laryngoscope in routine airway management: a randomised, controlled clinical trial. Anaesthesia. 2006;61:1093–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Hirabayashi Y, Seo N. Airtraq optical laryngoscope: tracheal intubation by novice laryngoscopists. Emerg Med J. 2009;26:112–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Di Marco P, Scattoni L, Spinoglio A, Luzi M, Canneti A, Pietropaoli P, Reale C. Learning curve of the Airtraq and the Macintosh laryngoscopes for tracheal intubation by novice laryngoscopists: a clinical study. Anesth Analg. 2011;112:122–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Nasim S, Maharaj CH, Malik MA, O’Donnell J, Higgins BD, Laffey JG. Comparison of the Glidescope and Pentax AWS laryngoscopes to the Macintosh laryngoscope for use by advanced paramedics in easy and simulated difficult intubation. BMC Emerg Med. 2009;9:9.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Hirabayashi Y. Seo N Tracheal intubation by non-anesthesia residents using the Pentax-AWS airway scope and Macintosh laryngoscope. J Clin Anesth. 2009;21:268–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Woollard M, Mannion W, Lighton D, Johns I, O’meara P, Cotton C, Smyth M. Use of the Airtraq laryngoscope in a model of difficult intubation by prehospital providers not previously trained in laryngoscopy. Anaesthesia. 2007;62:1061–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Miki T, Inagawa G, Kikuchi T, Koyama Y, Goto T. Evaluation of the Airway Scope, a new video laryngoscope, in tracheal intubation by naive operators: a manikin study. Acta Anaesthesiol Scand. 2007;51:1378–81.PubMedCrossRefGoogle Scholar
  15. 15.
    Dyson A, Harris J, Bhatia K. Rapidity and accuracy of tracheal intubation in mannequin: comparison of the fibreoptic with the Bullard laryngoscope. Br J Anaesth. 1990;65:268–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Lim Y, Lim TJ, Liu EH. Ease of intubation with the GlideScope or Macintosh laryngoscope by inexperienced operators in simulated difficult airways. Can J Anaesth. 2004;51:641–2.PubMedCrossRefGoogle Scholar
  17. 17.
    Koyama Y, Inagawa G, Miyashita T, Kikuchi T, Miura N, Miki T, Kurihara R, Kamiya Y, Goto T. Comparison of the Airway Scope, gum elastic bougie and fibreoptic bronchoscope in simulated difficult tracheal intubation: a manikin study. Anaesthesia. 2007;62:936–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Sreevathsa S, Nathan PL, John B, Danha RF, Mendonca C. Comparison of fibreoptic-guided intubation through ILMA versus intubation through LMA-CTrach. Anaesthesia. 2008;63:734–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Maharaj CH, Higgins BD, Harte BH, Laffey JG. Evaluation of intubation using the Airtraq or Macintosh laryngoscope by anaesthetists in easy and simulated difficult laryngoscopy–a manikin study. Anaesthesia. 2006;61:469–77.PubMedCrossRefGoogle Scholar
  20. 20.
    Savoldelli GL, Schiffer E, Abegg C, Baeriswyl V, Clergue F, Waeber JL. Comparison of the glidescope, the McGrath, the Airtraq and Macintosh laryngoscopes in simulated difficult airways*. Anaesthesia. 2008;63:1358–64.PubMedCrossRefGoogle Scholar
  21. 21.
    Schebesta K, Hüpfl M, Ringl H, Machata AM, Chiari A, Kimberger O. A comparison of paediatric airway anatomy with the SimBaby high-fidelity patient simulator. Resuscitation. 2011;82:468–72.PubMedCrossRefGoogle Scholar
  22. 22.
    Schebesta K, Hüpfl M, Rössler B, Ringl H, Müller MP, Kimberger O. Degrees of reality: airway anatomy of high-fidelity human patient simulators and airway trainers. Anesthesiology. 2012;116:1204–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Rai MR, Popat MT. Evaluation of airway equipment: man or manikin? Anaesthesia. 2011;66:1–3.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2013

Authors and Affiliations

  • Yuki Akihisa
    • 1
  • Koichi Maruyama
    • 1
    Email author
  • Yukihide Koyama
    • 2
  • Rieko Yamada
    • 1
  • Akira Ogura
    • 1
  • Tomio Andoh
    • 1
  1. 1.Department of AnesthesiologyUniversity Hospital Mizonokuchi, Teikyo University School of MedicineKawasakiJapan
  2. 2.Department of Anesthesiology and Critical Care MedicineYokohama City University Graduate School of MedicineYokohamaJapan

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