Nasotracheal intubation for dental surgery: A comparison of direct laryngoscopy with mcgrath videolaryngoscopy

Aim: The purpose of this study was to compare McGrath videolaryngoscope (VL) with Macintosh direct laryngoscope (DL) for nasotracheal intubation in patients with expected normal airway. It was compared the McGrath VL and Macintosh DL for time to intubation, effects on haemodynamic responses, easy of intubation, use of Magill forceps. Materials and Methods: ASA I-II, 70 patients who were undergone elective dental surgery required nasotracheal intubation included in this study. The patients were divided to two groups as intubated by McGRATH® VL (n=35) and Macintosh DL (n=35). The patients were monitorised with ECG, noninvasive arterial pressure, SpO2 after they were taken to operating room. Preoxygenation was performed with facemask for at least 3 minutes with 100% O2. It vas performed 2 mg.kg-1 propofol, 1 μg.kg-1 fentanyl for anesthesia induction and 0,6 mg.kg-1 rocuronium for muscular relaxation. Nasotracheal intubation was performed 3 minutes after rocuronium injection by a nasotracheal tube (Portex® Ivory PVC, North Facing, Nasal, Profile Soft Seal Cuff, Polar Preformed Endotracheal Tube). Anesthesia was maintained with sevoflurane and 50% oxygen-air mixture. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), SpO2 and EtCO2 were recorded at baseline, after anesthesia induction and 1., 2., 3. and 5. minutes after intubation. Cormack-Lehane and Mallampati Scores, laryngeal compression, time to intubation, use of Magill forceps, easy of intubation and the incidence of complications related to intubation were recorded. Results: The demographic characteristics and ASA classifications of the groups were similar. In terms of intubation success, no significant difference was observed between VL group and DL group. However, when times to intubation were compared, there was a significant difference between groups. Time to intubation was shorter in VL group. There was a statistically significant increase at SAP values, 1, and 5. minutes after intubation in DL group compared to VL group. No statistically significant difference was observed at DAP, MAP and HR values. Intubation by videolaryngoscopy was significantly easier than direct laryngoscopy The frequency of Magill forceps use was lower in the VL group than DL group, but it wasn't statistically significant. There was no difference for complications. Conclusion: Nasotracheal intubation by McGrath VL were faster and easier than Macintosh DL. After intubation, hemodynamic response was better in McGrath VL than Macintosh DL. It was considered that McGrath VL is preferable to nasotracheal intubation. Key Words: videolaryngoscopy, direct laryngoscopy, nasotracheal intubation, time to intubation, hemodynamic response