Efficacy of Pentax airway scope versus Macintosh laryngoscope when used by novice personnel: A prospective randomized controlled study

Abstract

Objective To determine whether intubation education using the Pentax Airway Scope (AWS) in normal airways is more useful than direct laryngoscopy (Macintosh laryngoscope) in novice personnel. Methods Eleven intern doctors without intubation experience performed 60 sequential intubations with each device on a manikin and 10 sequential intubations in adult patients. The time required for successful intubation, percentage of glottic opening (POGO) score, number of intubation attempts, and number of dental injuries were analyzed for each intubation technique. Results The mean (standard deviation) time required for successful intubation decreased as the number of intubations increased and was significantly shorter with the Pentax AWS than direct laryngoscope [22.6 (7.3) vs. 29.6 (10.0) and 33.0 (8.0) vs. 44.7 (5.6) s, respectively] in both the manikin and clinical studies. The Pentax AWS was also associated with higher POGO scores than the direct laryngoscope [81.7 (8.9) vs. 55.1 (13.2) and 80.9 (9.7) vs. 49.6 (16.5), respectively] and fewer intubation attempts. Fewer dental injuries occurred with the Pentax AWS in the manikin study. Conclusions Novices performed intubation more rapidly and easily with an improved laryngeal view using the Pentax AWS. We suggest that intubation education with video laryngoscopy should be mandatory along with direct laryngoscope training.

Keywords: Anesthetic techniques; direct laryngoscopy; education; equipment; laryngoscopy; video laryngoscopy; videos.

Figure 1.

Flow diagram of patient recruitment and reasons for exclusion from the clinical study. M group, intubation with Macintosh blade laryngoscope; P group, intubation with Pentax Airway Scope.

Figure 2.

Results of the manikin study for each intubation attempt. (a) Duration of intubation. (b) POGO score. All data were obtained at the 1^st, 10^th, 20^th, 30^th, 40^th, 50^th, and 60^th procedure. All data are presented as mean and standard error. M group, intubation with Macintosh blade laryngoscope; P group, intubation with Pentax Airway Scope; POGO score, percentage of glottic opening score. *p  <  0.05 compared with P group; ^†p < 0.01 compared with P group.

Figure 3.

Results of the clinical study for each intubation attempt. (a) Duration of intubation. (b) POGO score. All data are presented as mean and standard error. M group, intubation with Macintosh blade laryngoscope; P group, intubation with Pentax Airway Scope; POGO score, percentage of glottic opening score. *p < 0.05 compared with P group; ^†p < 0.01 compared with P group.