C-MAC D-blade video laryngoscope tied to faster nasotracheal intubation during traumatic cervical spine surgery

Patients with cervical spine instability have difficulty managing their airways because neck manipulations carry a risk of neurological impairment. It has been shown that the McCoy laryngoscope, with its distinctive design, offers superior glottic vision compared to the traditional Macintosh blade. In comparison to the McCoy laryngoscope, a recently published research assessed the effectiveness of the C-MAC-D blade in facilitating quicker tracheal intubation and improving glottic visibility in patients with cervical spine injuries.

The study included fifty individuals, aged 18 to 60, undergoing cervical spine surgery. People with a body mass index more than 24.9 kg/m2 and those with an impaired airway were not admitted. The whole population was randomly split into two groups using a random number table produced by the computer. The study used a McCoy laryngoscope for Nasal Intubation (NTI) in Group M and a C-MAC video laryngoscope for Group C. After preparing oxymetazoline hydrochloride, the nasal passage was lubricated with 2% xylocaine jelly. The NTI period was divided into three phases, with Magill forceps being utilised as required. Intubation failure was defined as a drop in SpO2 below 92% and an inability to intubate after 120 seconds or three efforts. Furthermore, measurements were taken of the heart rate, mean arterial pressure, and SpO2 just before to intubation as well as one and three minutes afterwards.

50 of the 79 individuals that underwent screening were selected to take part in the study. Group C had a much shorter intubation duration than Group M. Both groups required almost the same amount of time for the first stage of the intubation, roughly the same amount of time for the second step, and much less time for Group C for the third stage. Magill forceps were used on all patients in Group M, however they were required on just three patients in Group C. At one and three minutes after NTI, both groups' MAP and HR significantly increased in comparison to their pre-NTI values (P < 0.001). Regarding MAP (P = 0.257) and HR (P = 0.632), there were no intergroup differences.

In the current research, intubation times were shorter for the group using a C-MAC D-blade video laryngoscope than for the group using a McCoy laryngoscope. The D-blade's pronounced curvature considerably reduced the oropharyngeal–laryngeal axis's necessary alignment. Additionally, this blade lessened the need for any extra force to be used during laryngoscopy. It takes longer to secure the airway with alternative laryngoscopes because more supportive motions are needed.

Reference –

Singh, Swati1; Kumar, Amit1; Kumar, Brajesh2; Singh, Swarnika1. Comparison between C-MAC D-blade video laryngoscope and McCoy laryngoscope for nasotracheal intubation in traumatic cervical spine surgery – A randomised controlled trial. Indian Journal of Anaesthesia 67(9):p 821-824, September 2023. | DOI: 10.4103/ija.ija_347_23