Indirect videolaryngoscopy with C-MAC D-Blade and GlideScope: a randomized, controlled comparison in patients with suspected difficult airways

Background. Recently, indirect videolaryngoscopes have become increasingly important devices in difficult airway management. The aim of the present study was to investigate laryngoscopic view and intubation success using the new C-MAC* D-Blade in comparison to the established GlideScope* videolaryngoscope and conventional direct laryngoscopy in a randomized controlled trial. Methods. Ninety-six adult patients with expected difficult airways undergoing elective ear, nose and throat surgery (ENT) requiring general anesthesia were investigated. Repeated laryngoscopy was performed using a conventional direct Macintosh laryngoscope (DL), C-MAC D-Blade (DB) and GlideScope (GS) in a randomized sequence before patients were intubated with the last device used. Results. Both videolaryngoscopes showed significantly better C/L (Cormack-Lehane) classes than DL. Insufficient laryngoscopic view, defined as C/L >= III, was experienced in 18 patients (19.2%) with DL, in two patients with GS (2.1%) and in none with DB (0%). Time to best achievable laryngoscopic view did not differ between devices. Intubation time was significantly longer with both videolaryngoscopes (Median [Range] DB: 18 [8-33] s, and GS: 19 [9-34] s) than with DL (11 [5-26] s). However, intubation success was 100% for both DB and GS, whereas four patients could not be intubated using conventional direct laryngoscopy. Conclusion. Compared to direct Macintosh laryngoscopy, both C-MAC* D-Blade and GlideScope* comparably resulted in an improved view of the glottic opening with successful tracheal intubation in all patients. (Minerva Anestesiol 2013;79:121-9)