title: Video laryngoscopy versus direct laryngoscopy for double-lumen endotracheal tube intubation: a retrospective analysis.
abstract: OBJECTIVE
  The authors hypothesized that video laryngoscopy (VL) facilitated double-lumen tube (DLT) insertion compared with direct laryngoscopy (DL).
  
  
  METHODS
  A retrospective analysis.
  
  
  METHODS
  An academic hospital.
  
  
  METHODS
  Patients older than 18 years of age undergoing thoracic surgery requiring DLT placement between 2005 and 2011.
  
  
  METHODS
  Patients without airway predictors of difficult intubation who were intubated under DL with Macintosh (DL-MAC, n = 40) or Miller (DL-MIL, n = 44) blades and VL with McGrath MAC (Aircraft Medical, Edinburgh, UK) and C-MAC (Karl Storz, Tuttlingen, Germany) laryngoscopes (n = 46) were included in the study. Patients who were intubated with both VL devices were grouped into a VL group.
  
  
  METHODS
  Patients in all 3 groups had comparable preoperative demographics. Mallampati scores and ease of manual ventilation after the induction of anesthesia were also similar in all groups. The Cormack Lehane (C-L) grade views were significantly higher in patients in the DL-MAC than in the DL-MIL and VL groups (p < 0.006). The number of intubation attempts was similar in all 3 groups; however, the percentage of intubation reported to be difficult was higher in the DL-MAC than in the other 2 groups (p = 0.014). No damage to the airway was found in any of the groups.
  
  
  CONCLUSIONS
  DLT placement using VL appeared to overcome some of the limitations of DL-MAC but was similar to DL-MIL. The authors speculated that the ease of placement was related to the improved visualization of the vocal cords because there was a significantly greater number of C-L views 3 and 4 in the DL-MAC group as compared with the VL and DL-MIL groups. Hence, the authors advocate using VL, particularly when the laryngoscopist is inexperienced using DL-MIL for DLT placement.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine. The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Ronaldo V
authors.initials: RV
authors.lastname: Purugganan
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Jackson
authors.forename: Jagtar Singh
authors.initials: JS
authors.lastname: Heir
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cata
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D007828:Laryngoscopy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020535:Video-Assisted Surgery / Q000295:instrumentation* / Q000379:methods*