Endotrol-tracheal tube assisted endotracheal intubation during video laryngoscopy
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Video laryngoscopes allow indirect visualization of the glottis and provide superior views of the glottis compared to direct laryngoscopes in patients with both normal and difficult airways, but it may be difficult to advance the endotracheal tube (ETT) through the vocal cords into the trachea, unless a stylet is used. We propose that the Endotrol® ETT may be an effective tool to facilitate video laryngoscope-assisted orotracheal intubation without the use of a stylet. After obtaining written and oral informed consent, 60-adult patients scheduled for elective surgery requiring general anesthesia with orotracheal intubation were enrolled. Patients were randomized, respectively, to 1 of 4 groups: Group A1, (15 patients): McGrath® with Endotrol® ETT; Group A2, (15 patients): McGrath® with GlideRite®-styletted standard ETT; Group B1, (15 patients): GlideScope® with Endotrol® ETT; Group B2, (15 patients): GlideScope® with GlideRite®-styletted standard ETT. Statistical analysis was performed with Stata (Stata Corp v10, College Station). Mean time to intubation was longer in the Endotrol® groups compared to the GlideRite® groups: 60.1 (31.6) vs. 44.4 (27.6) s (p < 0.05). It was subjectively more difficult to intubate using the Endotrol® than with a GlideRite®-styletted ETT (difficulty score median [range] 2 [1–5] vs. 1 [1–3], respectively). Three intubations using the Endotrol® were characterized as difficult, whereas there were no difficult intubations with the GlideRite®stylet. The Endotrol® ETT, as compared to a standard ETT with a non-malleable stylet, is associated with longer intubation times and a subjective increase in difficulty of use. It may, however, still be a clinically viable alternative in video laryngoscope-assisted orotracheal intubation when use of a rigid stylet is undesirable.
KeywordsDifficult airway Airway management Video laryngoscopy Endotracheal intubation
This study is funded by Covidien, LMA North America (McGrath).
Conflicts of interest
Davide Cattano received research funding from Coviden, consulted for Smith-medical, USA, and received research funding from Karl Storz, Germany. For the present study, he received research support (material) from LMA, NA (McGrath) and Verathon (Glidescope). Carlos Artime reported no conflicts of interest. Vineela Maddukuri reported no conflicts of interest. William H. Daily reported no conflicts of interest. Alfonso Altamirano reported no conflicts of interest. Normand reported no conflicts of interest. Clarence E. Gilmore, IV reported no conflicts of interest. Carin A. Hagberg consulted for Coviden, consulted for AMBU, received research funding from AMBU, reported a conflict of interest with AMBU, and reported a conflict of interest with LMA North America for other on AMBU and LMA North America. Dr. Hagberg is on the speaker’s bureau.
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