Comparison of Tracheal Intubation with the Macintosh or the Airtraq Laryngoscope in Simulated Difficult Laryngoscopy Using Rigid Neck Collar: A Randomized, Controlled Clinical Trial

Background and Aims: Airtraq laryngoscope provides view of glottis without alignment of oral, pharyngeal and laryngeal axis. We decided to compare safety and efficacy of Macintosh and Airtraq laryngoscope in simulated difficult laryngoscopy using rigid neck collar. Methods: It was a prospective, randomized, controlled clinical trial conducted in a tertiary care teaching hospital. Patients with American Society of Anesthesiologist (ASA) physical status I and II, age 18 to 60 years and scheduled recruited for elective surgery requiring general anesthesia with oral endotracheal intubation were included. The patients were divided into Macintosh and Airtraq groups comprising of 40 patients each. Difficult laryngoscopy was simulated using rigid neck collar. Macintosh and Airtraq laryngoscope was used respectively. The primary outcome measure was time of intubation. The secondary outcome measures were: number of attempts, ease of intubation, overall success rate, modified Intubation Difficulty Score, Percentage of Glottic Opening score, hemodynamic parameters and complications. Results: The time of intubation was significantly low for Airtraq (27.80 sec) compared to Macintosh laryngoscopes (p = 0.04). Number of successful first intubation attempt was significantly higher in the Airtraq group though the overall success rate was similar in the two groups. The median visual rating scale of the ease of intubation and the mean Intubation Difficulty Score were significantly lower and the median POGO score was also significantly improved in the Airtraq group. Conclusions: The Airtraq optical laryngoscope allowed a shorter intubation time, fewer intubation attempts, and greater ease of intubation compared with the Macintosh laryngoscope.