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Indian J Anaesth. 2011 Sep;55(5):508-12. doi: 10.4103/0019-5049.89889.

Improvement in Cormack and Lehane grading with laparoscopic assistance during tracheal intubation.

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Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital,Old Rajinder Nagar, New Delhi, India.



To use laparoscope as an easily available and easy to use alternative option to videolaryngoscope.


The aim of the study was to assess the improvement in the glottic view using a conventional direct laryngoscope (DL) assisted by a laparoscope with its endovision system along with the time taken for tracheal intubation.


A prospective, double blind, randomized, controlled study was conducted in a tertiary care centre.


Sixty patients with American Society of Anesthesiologists (ASA) physical status I and II requiring general anaesthesia and tracheal intubation for elective surgery were included in the study. The patients were anaesthetized, paralysed, DL was performed and Cormack and Lehane grade (C and L) noted, followed by the introduction of the laparoscope alongside the flange of the Macintosh laryngoscope and a further C and L grading done as seen on monitor. Demographic data, ASA physical status, airway assessment, mouth opening, modified Mallampatti class, jaw protrusion, thyromental and sternomental distances, optimal external laryngeal manipulation, time taken for intubation, pulse oximetry, blood on; tracheal tube, lip, dentition or mucosal trauma, sore throat, hoarseness of voice, excessive secretions and regurgitation were recorded.


Statistical analysis was done using statistics package for social sciences software (17.0 version). A P-value less than 0.05 was considered statistically significant.


Eighty-three percent of the patients showed improvement in glottic view after laparoscopic assistance. Eighty-one and 85% of the patients with C and L grade II and III respectively on DL had an improved glottic view with this technique. The mean time to intubate was 37 seconds.


Laparoscopic assistance provided a better glottic view than DL in most patients (83%). It has a potential advantage over standard DL in difficult intubation.


Airway management; airway management; endoscopes; intubation

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