Clinical evaluation of C-MAC videolaryngoscope with or without use of stylet for endotracheal intubation in patients with cervical spine immobilization

Abstract

Purpose: This study was carried out to evaluate the relative efficacy of the C-MAC videolaryngoscope as compared to the conventional Macintosh laryngoscope using both styletted and non-styletted endotracheal tube (ETT) in patients undergoing elective cervical spine surgery with head and neck stabilized by manual in-line stabilization.

Methods: We randomized 120 consenting adults into four groups (30 each) to undergo tracheal intubation using either the Macintosh laryngoscope or C-MAC videolaryngoscope with styletted and non-styletted ETT.

Results: There was no significant difference between the C-MAC videolaryngoscope and Macintosh laryngoscope in Intubation Difficulty Scale (IDS) score using either styletted [median (IQR) 2 (1, 3) vs. 3 (2, 4); p = 0.58] or non-styletted ETT [median (IQR) 4 (2, 6) vs. 3 (2, 8); p = 1.00]. Similarly, when using a similar ETT-stylet assembly, the duration of successful intubation attempt, first attempt success rate, complications, use of airway optimization maneuvers, and adjuncts to facilitate intubation were comparable. The Cormack-Lehane view of the glottis was better with the C-MAC videolaryngoscope (p < 0.001). The use of stylet significantly reduced the IDS score [median (IQR) 2 (1, 3) vs. 4 (2, 6); p = 0.02], intubation time [median (IQR) 27 s (23, 31) vs. 52 s (28, 76); p < 0.001], and use of gum elastic bougie (3.3% vs. 43.3%, p < 0.001) with the C-MAC videolaryngoscope whereas no such effect was observed with the Macintosh laryngoscope.

Conclusions: Use of the C-MAC videolaryngoscope and Macintosh laryngoscope resulted in similar levels of intubation difficulty during cervical immobilization when used with a similar ETT-stylet assembly. The inclusion of the stylet significantly reduced the intubation difficulty experienced with the C-MAC videolaryngoscope.