A Comparison of Mcgrath Video Laryngoscope and Mcintosh Laryngoscope During Nasotracheal Intubation: A Randomized Controlled Study

Background: Video laryngoscope offers better glottic visualisation than direct laryngoscope in anticipated difficult airways. We compared the effectiveness of nonchanelled McGrath video laryngoscope with conventional Macintosh laryngoscope during nasotracheal intubation. Methods: ASA I-II patients aged 18 to 60 years of both sex with anticipated difficult intubation posted for elective faciomaxillary surgeries requiring nasotracheal intubation from September 2019 and February 2020 were recruited in this prospective, randomized study. 60 patients were allocated into two groups: (Group ML, Group McG) of 30 each. Primary outcome were Nasotracheal intubation time: (T1 time: nasotracheal tube passing from nostril to nasopharynx, T2 time: nasotracheal tube passing from nasopharynx till tracheal intubation confirmation by ETCO 2 and total time: T1+T2) and ease of intubation by modified Intubation Difficulty Scale (IDS). Secondary outcome were: Cormac Lehane grade), use of additional manouvers, intubation failure, tracheostomy incidence, and associated complications. Results: T 1 intubation time (mean± SD) was less in Group ML (6.07±2.16 sec) than Group McG (7.17±1.96 sec) with p = 0.044. Group ML T2 time (mean±SD) (24.03±10.82 sec) was significantly shorter than Group McG (52.2±19.56 sec) with p =0.000. Thus, Group ML required statistically lower total time for intubation (T1+T2) (30.10±11.50 sec) than Group McG (59.37±19.89 sec) with p =0.000. McG VL facilitated better laryngoscopic view (p=0.002) with low IDS scores, less lifting force (p=0.002), reduced incidence of lip trauma (p=0.002) and lower magills forceps use.(p=0.002) than group ML.Conclusion: Intubation time was longer but the glottic view was superior with reduced use of lifting force and magills forceps leading to low IDS scores and decreased airway trauma by nonchanelled McGrath Video laryngoscope than direct Macintosh laryngoscope. Thus McGrath Video laryngoscope is an effective alternative to Macintosh laryngoscope for nasotracheal intubation.