title: Indirect versus direct laryngoscopy for routine nasotracheal intubation.
abstract: OBJECTIVE
  To compare the effectiveness of the indirect laryngoscopes, Airtraq (A) and GlideScope (G), with the Macintosh (M) laryngoscope in routine nasotracheal intubation.
  
  
  METHODS
  Randomized, single-blinded study.
  
  
  METHODS
  University-affiliated, tertiary-care hospital.
  
  
  METHODS
  62 adult, ASA physical status 1 and 2 patients with normal airways requiring nasotracheal intubation for dental or maxillofacial surgery.
  
  
  METHODS
  Patients in Groups A and G underwent nasal intubation with the Airtraq and GlideScope, respectively, while laryngoscopy in Group M was performed with the Macintosh blade.
  
  
  METHODS
  Performance of the intubating tools was judged by the ease [Intubation Difficulty Scale (IDS) and numeric rating scale (NRS)] and time to intubation (laryngoscopy and endotracheal tube advancement). In addition, hemodynamic parameters, severity of postoperative sore throat, and posture of the intubator were recorded.
  
  
  RESULTS
  IDS score was significantly lower with the Airtraq and GlideScope than with the Macintosh laryngoscope (mean ± SD: A 0.1 ± 0.3, G 0.3 ± 0.6, M 0.8 ± 1.0; P = 0.013). NRS reported by the intubators showed a similar preference for indirect over direct laryngoscopy (A 0.9 ± 0.7, G 1.1 ± 0.6, M 1.9 ± 1.1; P = 0.001). Duration of laryngoscopy and endotracheal tube insertion was similar in all groups. No significant intergroup differences in hemodynamic parameters were recorded. Postoperative sore throat was significantly reduced using the GlideScope compared with the other devices (P = 0.048).
  
  
  CONCLUSIONS
  The Airtraq and GlideScope facilitated nasotracheal intubation more so than the Macintosh laryngoscope in adults with apparently normal airways.
authors.affiliation: Department of Anesthesia and Intensive Care, General Hospital Linz, A-4020, Linz, Austria. wolfgang.puchner@akh.linz.at
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Puchner
authors.forename: Lukas
authors.initials: L
authors.lastname: Drabauer
authors.forename: Klemens
authors.initials: K
authors.lastname: Kern
authors.forename: Charlotte
authors.initials: C
authors.lastname: Mayer
authors.forename: Jan
authors.initials: J
authors.lastname: Bierbaumer
authors.forename: Peter H
authors.initials: PH
authors.lastname: Rehak
authors.forename: Hans
authors.initials: H
authors.lastname: Gombotz
mesh_terms: D000293:Adolescent; D000328:Adult; D004867:Equipment Design; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D009296:Nasal Cavity; D019647:Oral Surgical Procedures / Q000379:methods*; D010612:Pharyngitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016037:Single-Blind Method; D055815:Young Adult