Turkiye Klinikleri Journal of Anesthesiology Reanimation

.: ORIGINAL RESEARCH
Comparison of C-MAC Video Laryngoscope with Macintosh Laryngoscope for Elective Tracheal Intubation in Patients with Diabetes Mellitus: Randomized Controlled Trial
Diabetes Mellitus Olan Hastalarda C-MAC Video Laringoskop ve Macintosh Laringoskopun Elektif Trakeal Entübasyon İçin Karşılaştırılması: Randomize Kontrollü Çalışma
Dilek ÜNAL YAZICIOĞLU a , Emine ARIK a, Başak GÜLEL a, Burak NALBANT a , Melis SUMAK HAZIR a
aDepartment of Anesthesiology and Reanimation, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
Turkiye Klinikleri J Anest Reanim. 2022;20(1):23-32
doi: 10.5336/anesthe.2021-86595
Article Language: EN
Full Text
ABSTRACT
 Objective: C-MAC video laryngoscope and Macintosh direct laryngoscope were compared in terms of intubation conditions, during elective tracheal intubation in patients with diabetes mellitus (DM) who have a high risk for difficult airway. Material and Methods: One hundred and ten American Society of Anesthesiologist physical class II-III patients with DM undergoing elective surgery were randomized to be intubated using C-MAC video laryngoscope or Macintosh laryngoscope. Glottic view Cormack Lehane (CL) score, intubation time, intubation difficulty scale (IDS) score, and first attempt intubation success were compared. Results: Similar intubation times were detected [Macintosh laryngoscope: 39.6±30.1 seconds; C-MAC: 46.7±35.4 seconds (p=0.098). C-MAC provided significantly better CL scores]. Grade 1 CL laryngeal view was observed in 37 (68%) C-MAC vs. 26 (47.3%) Macintosh laryngoscope intubations (p=0.04). An IDS score of >5 was determined in 11 (20.4%) patients with C-MAC and in 10 (18.2%) with Macintosh laryngoscope (p=0.04), indicating an overall 20.1% moderate-to-severe intubation difficulty (p=0.536). The mean IDS score was 3.2±2.9 and 2.4±3.3 with C-MAC and Macintosh laryngoscopes, (p=0.04). First-attempt intubation success was 83.3% vs. 87.0% with C-MAC vs. Macintosh laryngoscope (p=0.786). Conclusion: In patients with DM, CMAC provided improved glottis visualization, similar intubation time and first-attempt intubation success as a first-attempt intubation device compared with the Macintosh laryngoscope. However IDS scores were higher with the C-MAC. The incidence of actual intubation difficulty was found 20.1% in this diabetic study population.

Keywords: Airway management; intubation, difficult; video laryngoscope
ÖZET
 Amaç: C-MAC video laringoskop ve Macintosh direkt laringoskop, zor havayolu görülme riski yüksek bir hasta popülasyonu olan diabetes mellituslu (DM) hastaların, elektif trakeal entübasyonunda, entübasyon koşulları bakımından karşılaştırıldı. Gereç ve Yöntemler: Amerikan Anestezistler Derneği fizyolojik sınıfı II-III olan ve elektif cerrahi girişim geçiren 110 diyabetik hasta, C-MAC video laringoskop veya Macintosh laringoskop ile entübe edilmek üzere rastgele 2 gruba yarıldı. Glottik görüntü Cormack Lehane (CL) skoru, entübasyon süresi, entübasyon güçlüğü skalası skoru ve ilk denemede entübasyon başarısı oranı karşılaştırıldı. Bulgular: Grupların entübasyon süresi benzer bulundu [Macintosh laringoskop: 39,6±30,1 sn; CMAC: 46,7±35,4 sn (p=0,098)]. CL skoru, C-MAC ile belirgin olarak daha iyiydi; Grade 1 CL laringeal görüntü, C-MAC ile 37 (%68) hastada ve Macintosh ile 26 (%47,3) hastada elde edildi (p=0,04). Entübasyon güçlüğü skoru >5, C-MAC ile 11 (%20,4), Macintosh ile 10 (%18,2) hastada saptandı (p=0,04); araştırma popülasyonda toplam %20,1 orta-ciddi derecede entübasyon güçlüğü saptandı (p=0,536). Ortalama zor entübasyon skalası skoru C-MAC ve Macintosh laringoskopla sırasıyla 3,2±2,9 ve 2,4±3,3 bulundu (p=0,04). İlk denemede entübasyon başarısı C-MAC ile %83,3; Macintosh ile %87,0 bulundu (p=0,786). Sonuç: Macintosh laringoskop ile karşılaştırıldığında DM'li hastalarda, C-MAC daha üstün laringeal görüntü kalitesi, benzer ilk deneme başarısı ve benzer entübasyon süresi sağlamasına rağmen C-MAC ile entübasyon güçlüğü skoru daha yüksek bulunmuştur. Bu diyabetik çalışma popülasyonunda zor entübasyon insidansı %20,1 bulundu.

Anahtar Kelimeler: Havayolu yönetimi; entübasyon, zor; video laringoskop
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