GlideScope® versus C-MAC®(D) videolaryngoscope versus Macintosh laryngoscope for double lumen endotracheal intubation in patients with predicted normal airways: a randomized, controlled, prospective trial

Abstract

Background: The double lumen endotracheal tube (DLT) is the most widely-used device for single lung ventilation in current thoracic anesthesia practice. In recent years, the routine application of the videolaryngoscope for single lumen endotracheal intubation has increased; nevertheless there are few studies of the use of the videolaryngoscope for DLT. We wondered whether there were benefits to using the videolaryngoscope for DLT placement in patients with predicted normal airways. Therefore, this study was designed to compare the performances of the GlideScope®, the C-MAC®(D) videolaryngoscope and the Macintosh laryngoscope in DLT intubation.

Methods: This was a randomized, controlled, prospective study. We randomly allocated 90 adult patients with predicted normal airways into three groups. All patients underwent routine anesthesia using different laryngoscopes according to group allocation. We compared DLT insertion times, first-pass success rates, numerical rating scales (NRS) of DLT delivery and DLT insertion, Cormack-Lehane degrees (C/L), hemodynamic changes and incidences of intubation complications. All outcomes were analyzed using SPSS13.0.

Results: Compared with the GlideScope, the Macintosh gave shorter times for DLT insertion (median: 96 (IQR: 51 [min-max: 62-376] s vs 73 (26 [48-419] s, p = 0.003); however, there was no difference between the Macintosh and C-MAC(D) (p = 0.610). The Macintosh had a significantly higher successful first attempt rate than did the GlideScope or C-MAC(D) (p = 0.001, p = 0.028, respectively). NRS of DLT delivery and insertion were significantly lower in the Macintosh than in the others (p < 0.001). However, the C/L degree in the Macintosh was significantly higher than in the others (p < 0.001). The incidences of oral bleeding, hoarseness, sore throat and dental trauma were low in all groups (p > 0.05). There were no significant differences in DLT misplacement, fiberoptic time or hemodynamic changes among the groups.

Conclusions: Compared with the Macintosh laryngoscope, the GlideScope® and C-MAC®(D) videolaryngoscopes may not be recommended as the first choice for routine DLT intubation in patients with predicted normal airways.

Trial registration: The study was prospectively registered at the Chinese Clinical Trial Registry (no. ChiCTR1900025718); principal investigator: Z.L.H.; date of registration: September 6, 2019.

Keywords: C-MAC®(D) videolaryngoscope; Double lumen tracheal tube; Endotracheal intubation; GlideScope® videolaryngoscope; Macintosh laryngoscope.

Fig. 1

CONSORT flow diagram of patient selection and allocation

Fig. 2

The time taken for bronchial insertion with GlideScope was significantly longer compared with those taken for Macintosh and C-MAC(D). GlideScope vs C-MAC(D) vs Macintosh: 96 s (51 [62–376] s) vs 72.5 s (46 [47–467] s) vs 73 s (26 [48–419] s); ^aaP < 0.01, between the GlideScope and Macintosh groups. ^cP < 0.05, between the GlideScope and C-MAC(D) groups

Fig. 3

Del and Ins represent Delivery and Insertion. As for NRS (scored from 0 to 10), difficulty score of DLT delivery was 5 (3 [–9]) with the GlideScope, 3 (2 [0–6]) with the C-MAC(D) (p = 0.000), 2 (1.75 [0–3]) with the Macintosh (p = 0.000). C-MAC(D) vs the Macintosh (p = 0.001). Difficulty score of DLT insertion was 3 (3 [0–9]) with the GlideScope, 3 (1.75 [0–6]) with C-MAC(D) (p = 0.039) and 1 (2 [0–10]) with Macintosh (p = 0.001). C-MAC(D) vs Macintosh p = 0.026. ^aaP < 0.01, between the GlideScope and Macintosh groups; ^bbP < 0.01, between the C-MAC(D) and Macintosh groups; ^bP < 0.05, between the GlideScope and C-MAC(D) groups; ^ccP < 0.01, between the C-MAC(D) and Macintosh groups; ^cP < 0.05, between the C-MAC(D) and Macintosh groups

Fig. 4

T0 represents the basic heart rate 10 min before the study. T1, T2 and T3 represent 1 min, 3 min and 5 min after intubation, respectively. Heart rate increased 1 min after intubation in all three groups and increased 3 min after intubation in the C-MAC(D) group. Compared with T0, GlideScope *P < 0.05, C-MAC(D) **P < 0.01, Macintosh **P < 0.01 in T1, C-MAC(D) P < 0.01 in T2

Fig. 5

T0 represents the basic mean arterial pressure 10 min before the study. T1, T2 and T3 represent 1 min, 3 min and 5 min after intubation, respectively. Mean arterial pressure decreased 3 min after intubation in all three groups. Compared with T0, three groups **P < 0.01 in T2