Comparison of ıntubation conditions of mccoy laryngoscopy blades and storz tm C-MAC ® videolaryngoscope

ABSTRACT Introduction and Purpose: Intubation during anesthesia provides benefits such as; airway and control of breathing, respiration effort, dead space and reduce the risk of aspiration, anesthetist and equipment to provide comfort and surgical removal of the surgical field and provides benefits such as control of the airway during resuscitation. However it is not easy to laryngoscopy and endotracheal intubation in every case. Successfully concluded intubation is not always possible due to difficult anatomical features a variety of cases, systemic diseases (eg, acromegaly, ankylosing spondylitis, thyroid, etc.). In addition, the larynx and trachea by laryngoscopy and tracheal intubation due to mechanical stimulation of reflex sympathetic creating a response as a result of increased plasma catecholamine concentrations, tachycardia, hypertension, arrhythmias and myocardial ischemia may result, especially in patients with limited cardiac reserve. Direct laryngoscopy according to the form used for the purpose laryngoscopes blades are divided into types as straight and curved blades. Flat blades are Magill, curved blades are known as Macintosh type. Laryngoscopy process, the placement of the tip of blades vary in terms of the epiglottis. In adults, if there is no contraindication, usually curved blade laryngoscope is preferred. McCoy laryngoscope blades, as distinct from the standard laryngoscope blades has a proximal lifts. Proximal lifting end provides elevation of epiglottis during intubation. McCoy laryngoscope blade has two advantages. Firstly, McCoy laryngoscope blades use less force and it causes less stress response. Secondly, it removes the epiglottis and provides better vision field in difficult intubation. Latest developments in video technology and fiber-optic systems resulted in new tools such as video laryngoscopes. İn videolaryngoscopes, an optical system is placed in tips of blades for allowing a view through the indirect laryngoscopy and intubation and this situation considered as different approach. VL development is based on the combination of standard laryngoscope blade endoscopic system. In these systems, camera is combined with ergonometric designed handle. Thus, the anatomical structures can be seen as enlarged on the monitor and the image area can be increased. VL is seen as a good solution for routine practice and learn completly under visual control. The image of the VL uses the enlarged image of the airway and maintains perfect image. High-resolution images and light beams are integrated with handle and video images may modify the structure of the airway. Camera participated in modified handle in a simple and fast way. The camera also be used in fiber-optic intubation. Material and Method: This study was conducted at the Faculty of Medicine Hospitals of Dicle University, Turkey between December 2013 and December 2014. Demographic characteristics of patients such as gender, age and body weight were investigated. Criteria for inclusion in the study; 100 ASA I-II patients, who will undergo an elective surgery, in the 25-85 age group that have a Mallampati score 2 and above, and have a positive test result in the intubation difficulty tests according to the preoperative evaluation questionnaire were included in the study. Results: Of the patients, 43% were female and 57% were male. The mean age of female patients was 47.82+-12.71, and the mean age of male patients was 46.51+-13.01. Looking at the Cormack-Lehane Scores (D-Blade videolaryngoscopy) of the patients, 50% had a grade I, 34% had grade II and 15% had grade III; and, the mean Cormack-Lehane Score was found to be 1.66+-0.74. There was a statistically significant difference between the groups according to the values taken in the Cormack-Lehane Score (p=0.001). And, the mean intubation time (D-Blade videolaryngoscopy) of the patients was 18.94+-11.22. When we look at the intubation times of Maccoy and D-Blade videolaryngoscopies, the time of the D-Blade videolaryngoscopy was found to be longer than of Maccoy's. There was a statistically significant difference between Intubation times of Maccoy and D-Blade videolaryngoscopies. Conclusion: The primary role of videolaryngoscopy should be to achieve a better performance than intubations which are difficult or impossible with conventional methods. The clinical role of videolaryngoscopy needs to be supported with further studies on difficult airway management. Keywords: McCoy blades, C-Mac® Videolaryngoscope, Intubation