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J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):381-385. doi: 10.4103/joacp.JOACP_296_17.

Ease of intubation and hemodynamic responses to nasotracheal intubation using C-MAC videolaryngoscope with D blade: A comparison with use of traditional Macintosh laryngoscope.

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Department of Anaesthesiology, Amrita Institute of Medical Sciences, AmritaVishwa Vidyapeetham, Kochi, Kerala, India.


Background and Aims:

Nasal intubation with traditional Macintosh laryngoscope usually needs the use of Magill's forceps or external laryngeal manipulation. The primary objective of this study was to assess the ease of intubation during C-MAC videolaryngoscope-assisted nasal intubation using D blade and to compare it with traditional Macintosh laryngoscope-aided nasal intubation. The secondary objectives were comparison of intubation time, attempts, trauma, and hemodynamic stress responses.

Material and Methods:

Sixty patients requiring nasal intubation were randomized into two groups, M and V. Patients in both the groups received general anesthesia as per a standardized protocol. Laryngoscopy was performed using the traditional Macintosh laryngoscope in group M and with Storz® C-Mac videolaryngoscope with D-blade in group V. Chi-square test, Mann-Whitney test, and independent samples t-test were used as applicable for data analysis.


Intubation was significantly easy in 70% of the patients in group V compared to only 3.3% in group M. Time to intubate was significantly shorter in group V (24 vs 68 s). Though majority of patients were intubated in the first attempt in both groups, the number was more in group V (96.7 vs 70%). There was no case of esophageal intubation in group V, but 2 patients (6.7%) had esophageal intubation in group M. Mucosal trauma was significantly more frequent in group M. There was no statistically significant difference in hemodynamics in both groups.


C MAC videolaryngoscope-aided nasotracheal intubation using D blade is superior in view of easier, quicker, and less traumatic intubation compared to the use of traditional Macintosh laryngoscope.


Hemodynamics; intubation; laryngoscopes

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