A comparison of intubation with C-MAC videolaryngoscope, MCCOY and macintosh laryngoscope in terms of; intubation technique and sex, postoperative sore throat, swallowing difficulty, hoarseness and patient satisfaction in patients with airway difficulty

The most important factor in functional breathing is the airway. Failure to perform intubation of people with difficult airway is the most common cause of mortality and morbidity in anesthesia practice. Recently, the prevalence of videolaringoscopes (VL) in the difficult airways is increasing. In our work; we compared intubation with C-MAC videolaryngoscope, McCoy and Macintosh laryngoscope in terms of; intubation technique and sex, postoperative sore throat, swallowing difficulty, hoarseness and patient satisfaction in patients with airway difficulty. Ninety patients; aged 18-65 with Mallapati 3 and above and Cormack Lehane Score 3-4, ASA I-II-III, difficult intubation, body mass index (BMI) greater than 30 kg/m², who will undergo elective surgery were included in the prospective randomized study. Age, BMI and Mallampati scores were recorded in preoperative examinations. The patients were randomly allocated to three groups of 30 persons each. Group I: Patients who were intubated with Mccoy laryngoscopy Group II: Patients who were intubated with Macintosh laryngoscopy Group III: Patients who were intubated with C-MAC VL Gender was also compared as Group Female and Group Male. Preoperative routine monitoring of the patients was performed. Patients were given 5 minutes (min) 100% O2 preoxygenation followed by 2-2.5 mg/kg propofol to induce general anesthesia. After propofol injection patients were ventilated for 45 seconds with mask, then muscle relaxation was achieved with 0.6 mg/kg rocuronium. Endotracheal tube (ETT) numbers 8.0 and 7.5 were used in male and female patients, respectively. ETT's cuffs was inflated with a cuffmeter at 20-30 cmH2O. Heart rate, mean blood pressure and peripheral oxygen saturation (SpO2); was recorded at; entry, 1st and 5th minutes. 40% O2, 60% air and 2% minimum alveolar concentration (MAC) maintenance was achieved by using sevoflurane inhalation and 0.2 mg/kg rocuronium. Immediately after the operation, the presence of sore throat, swallowing difficulty and hoarseness were assessed at 6th, 12th, 24th, 48th and 72th hours and patients were questioned whether they would like to receive anesthesia with the same method again. There was no significant difference between the groups when compared in terms of Mallampati and Cormack Lehane classification preoperatively. There was no significant difference between the groups in terms of age, gender, body mass index (BMI). When the heart rate and mean blood pressures were evaluated as Group I, II and III in the preoperative, intraoperative 1st, 2nd, 5th, 10th, 15th min and postoperative 15th min, there was no significant difference between the groups. At postoperative 12th and 24th hours sore throat was found to be significantly higher in Group II, than Groups I and III . When postoperative sore throat was evaluated according to sex, after 24 hours, sore throat was found less frequently in men than in women at significant level. The postoperative swallowing difficulty incidence was found to be significantly lower in men at immediately after and 24 hours after surgery. Postoperative hoarseness was found to be significantly lower in the male group at the 24th hour than in the female group. When duration of operation, duration of anesthesia, duration of intubation and patient satisfaction scores were compared; there was no statistically significant difference between the groups. In conclusion, the use of VL primarily in the intubation of adult patients considered airway difficulty is more advantageous in terms of the incidence of sore throat, hoarseness and swallowing difficulty and we can suggest that these postoperative side effects are seen more in females than in males, although the cuff pressure and the used intubation technique are standardized with the male group.