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A Randomized Prospective Study Comparing C-Mac D-Blade, Airtraq, and Fiberoptic Bronchoscope for Intubating Patients with Anticipated Difficult Airway

Hesham M Marouf and Naglaa Khalil

Background: Several complications may be correlated with difficult airway up to death. Fiberoptic bronchoscope is the gold stander to deal with difficult intubation. Airtraq laryngoscope and C-MAC^® video laryngoscope are new devices that are used successfully for tracheal intubation. We compared using C-MAC D-blade video laryngoscope, Airtraq laryngoscope, and Fiberoptic bronchoscope for intubation of patient likely to have difficult intubation.

Patients and methods: Ethical committee permission was obtained before 120 adult patients (ASA I-III) with expected difficult intubation were incorporated in this prospective study. Participants were randomly distributed to 3 equal groups to be intubated using either C-MAC D-blade (group 1), Airtraq (group 2), or Fiberoptic technique (group 3) after anesthesia was induced. Our primary outcome was time to tracheal intubation. Intubation data, hemodynamics, and SpO2 were evaluated.

Results: Time to visualize the vocal cords (T1) and time to tracheal intubation (T2) were significantly shorter in CMAC D-blade group (group 1) and Airtraq group (group 2) than Fiberoptic group (group 3) and there was insignificant variance between group 1 and group 2. All participants were intubated in the 1st attempt except one in C-MAC Dblade group who needed 2 intubation attempts. There were insignificant variances between the 3 groups regarding number of successful trial (success rate), and manipulation used to improve vocal cord visualization or intubation. Sore throat grades were significantly lower in group 2 and 3 than group 1. Lowest SpO2 was significantly lower in group 3 than the other 2 groups. Mean arterial blood pressure and heart rate measured at 1 min and 3 min after intubation were significantly higher in group 1 than group 2 and 3.

Conclusion: When compared to Fiberoptic bronchoscope both C-mac D-blade and Airtraq comparably showed shorter time to visualize vocal cords and intubate patients with anticipated difficult intubation.