A comparison of McGrath video laryngoscope and Macintosh laryngoscope during nasotracheal intubation: A randomised controlled study.

Background: Nasotracheal intubation is challenging for anaesthesiologists in faciomaxillary injuries due to the anticipated difficult airways. The effectiveness of a non-channelled McGrath video laryngoscope was compared with a conventional Macintosh laryngoscope during nasotracheal intubation.

Methods: Sixty American Society of Anaesthesiologists I-II patients aged between 18 and 60 years of both sexes undergoing elective faciomaxillary surgeries from September 2019 to February 2020 were prospectively randomised into two groups (Macintosh laryngoscope Group, McGrath video laryngoscope Group) of 30. The primary outcome was ease of intubation (Modified Intubation Difficulty Scale) and Nasotracheal intubation time (T1 time: from nostril to nasopharynx, T2 time: from nasopharynx until the first ETCO2, total time: T1 + T2). The secondary outcomes were Cormac Lehane grade, additional manoeuvres requirement, intubation failure, tracheostomy incidence and associated complications.

Results: T1, T2 and total (T1 + T2) time (mean ± SD) were statistically prolonged in the McGrath video laryngoscope than Macintosh laryngoscope group, with p = 0.044, p = 0.000 and p = 0.000, respectively. The McGrath video laryngoscope facilitated a better laryngoscopic view (p = 0.002), favourable intubation difficulty scale scores, less lifting force (p = 0.002), reduced lip trauma (p = 0.002) and decreased Magill's forceps use (p = 0.002) than the Macintosh laryngoscope group.

Conclusion: Despite longer intubation time, the non-channelled McGrath video laryngoscope offered favourable intubating conditions with superior glottis view, less lifting force and reduced Magill's forceps requirement, causing decreased airway trauma, lower intubation difficulty scale scores than Macintosh laryngoscope for nasotracheal intubation.