title: Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways: a manikin study.
abstract: BACKGROUND
  The forces applied to the soft tissues of the upper airway may have a deleterious effect. This study was designed to evaluate the performance of the GlideScope compared with the Macintosh laryngoscope.
  
  
  METHODS
  Twenty anaesthetists and 20 trainees attempted tracheal intubation of a Laerdal SimMan manikin. Forces and pressure distribution applied by both laryngoscope blades onto the soft upper airway tissues were measured using film pressure transducers. The minimal force needed to achieve a successful intubation, in the same simulated scenario, was measured; additionally, we considered the visualization score achieved by using the Cormack-Lehane grades.
  
  
  RESULTS
  All participants applied, on average, lower force with the GlideScope than with the Macintosh in each simulated scenario. Forces [mean (sd)] applied in the normal airway scenario [anaesthetists: Macintosh 39 (22) N and GlideScope 27 (15) N; trainees: Macintosh 45 (24) N and GlideScope 21 (15) N] were lower than forces applied in the difficult airway scenario [anaesthetists: Macintosh 95 (22) N and GlideScope 66 (20) N; trainees: Macintosh 100 (38) N and GlideScope 48 (16) N]. All the intubations using the GlideScope were successful, regardless of the scenario and previous intubation experience. The average pressure on the blades was 0.13 MPa for the Macintosh and 0.07 MPa for the GlideScope, showing a higher uniformity for the latter.
  
  
  CONCLUSIONS
  The GlideScope allowed the participants to obtain a successful intubation applying a lower force. A flatter and more uniform pressure distribution, a higher successful rate, and a better glottic view were observed with the GlideScope.
authors.affiliation: Department of Anaesthesia, University Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy. m.carassiti@unicampus.it
authors.forename: M
authors.initials: M
authors.lastname: Carassiti
authors.forename: R
authors.initials: R
authors.lastname: Zanzonico
authors.forename: S
authors.initials: S
authors.lastname: Cecchini
authors.forename: S
authors.initials: S
authors.lastname: Silvestri
authors.forename: R
authors.initials: R
authors.lastname: Cataldo
authors.forename: F E
authors.initials: FE
authors.lastname: Agrò
mesh_terms: D000704:Analysis of Variance; D003627:Data Interpretation, Statistical; D004867:Equipment Design; D005931:Glottis / Q000033:anatomy & histology; D006801:Humans; D020704:Laryngoscopes / Q000009:adverse effects*; D007828:Laryngoscopy / Q000009:adverse effects* / Q000193:education / Q000379:methods*; D008348:Manikins; D011312:Pressure; D014160:Transducers, Pressure