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Comparison of Laryngoscopic Views between C-MAC™ and Conventional Laryngoscopy in Patients with Multiple Preoperative Prognostic Criteria of Difficult Intubation. An Observational Cross-Sectional Study

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Department of Anesthesia and Critical Care, AHEPA University Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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Psychology Department, The University of Sheffield International Faculty, City College, 546 26 Thessaloniki, Greece
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3rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, 541 24 Thessaloniki, Greece
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Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
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Thoracic Surgery Department, “Interbalkan” European Medical Center, 555 35 Thessaloniki, Greece
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Oncology Department, General Hospital of Kavala, 655 00 Kavala, Greece
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(12), 760; https://doi.org/10.3390/medicina55120760
Received: 26 October 2019 / Revised: 18 November 2019 / Accepted: 25 November 2019 / Published: 27 November 2019
Background and Objectives: Video laryngoscopy has been proven useful under difficult airway scenarios, but it is unclear whether anticipated improvement of visualization is related to specific difficult intubation prognostic factors. The present study evaluated the change in laryngoscopic view between conventional and C-MAC® laryngoscopy and the presence of multiple difficult intubation risk factors. Materials and Methods: Patients scheduled for elective surgery with >2 difficult intubation factors, (Mallampati, thyromental distance (TMD), interinscisor gap, buck teeth, upper lip bite test, cervical motility, body mass index (BMI)) were eligible. Patients underwent direct laryngoscopy (DL) followed by C-MAC™ laryngoscopy (VL) and intubation. Change of view between DL and VL, time for best view, intubation difficulty scale (IDS) and correlation between prognostic factors, laryngoscopic view improvement, and IDS were measured. Results: One-hundred and seventy-six patients completed the study. VL lead to fewer Cormarck–Lehane (C/L) III-IV, compared to DL (13.6% versus 54.6%, p < 0.001). The time to best view was also shorter (VL: 10.82 s, DL: 12.08 s, p = 0.19). Mallampati III-IV and TMD ≤ 6 cm were related to improvement of C/L between DL and VL. Logistic regression showed these two factors to be a significant risk factor of the glottis view change (p = 0.006, AUC-ROC = 0.57, 95% CI: 0.47–0.66). 175/176 patients were intubated with VL. 108/176 were graded as 0 < IDS ≤ 5 and 12/176 as IDS > 5. IDS was only correlated to the VL view (p < 0.0001). Conclusion: VL improved laryngoscopic view in patients with multiple factors of difficult intubation. Mallampati and TMD were related to the improved view. However, intubation difficulty was only related to the VL view and not to prognostic factors. View Full-Text
Keywords: laryngoscopy; c-mac; intubation; conventional laryngoscopy laryngoscopy; c-mac; intubation; conventional laryngoscopy
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Amaniti, A.; Papakonstantinou, P.; Gkinas, D.; Dalakakis, I.; Papapostolou, E.; Nikopoulou, A.; Tsatali, M.; Zarogoulidis, P.; Sapalidis, K.; Kosmidis, C.; Koulouris, C.; Giannakidis, D.; Romanidis, K.; Oikonomou, P.; Michalopoulos, N.; Ioannidis, A.; Tsakiridis, K.; Vagionas, A.; Kesisoglou, I.; Grosomanidis, V. Comparison of Laryngoscopic Views between C-MAC™ and Conventional Laryngoscopy in Patients with Multiple Preoperative Prognostic Criteria of Difficult Intubation. An Observational Cross-Sectional Study. Medicina 2019, 55, 760.

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