title: Comparison of plastic and metallic single-use and metallic reusable laryngoscope blades: a randomised controlled trial.
abstract: BACKGROUND
  Plastic single-use laryngoscope blades have been found to increase the difficulty of intubation. Metallic single-use blades may represent an alternative.
  
  
  OBJECTIVE
  To compare the rates of intubation failure at first laryngoscopy using metallic single-use, plastic single-use and metallic reusable laryngoscope blades.
  
  
  METHODS
  Randomised, superiority, single-centre, controlled trial.
  
  
  METHODS
  Operating theatres at a University Hospital from January 2008 to August 2009.
  
  
  METHODS
  A total of 1863 adults requiring general anaesthesia.
  
  
  METHODS
  Patients were randomised to one of three laryngoscope blades: metallic single-use, plastic single-use or metallic reusable.
  
  
  METHODS
  The primary end-point was the number of intubation failures at first laryngoscopy. Secondary end-points were glottic exposure and the Intubation Difficulty Scale.
  
  
  RESULTS
  The failure rate (absolute difference: 95% confidence interval) at the first attempt was greater for the plastic single-use blades (8.1%) than for the metallic reusable [3.2% (4.9%: 2.2 to 7.6%); P < 0.001] and metallic reusable blades [4.0% (4.0%: 1.2 to 6.9%); P < 0.006]. No difference was found between the metallic reusable and metallic single-use groups (0.9%: -1.3 to 3.1%). Scoring on the Intubation Difficulty Scale [median (interquartile range)] was higher in the plastic single-use group [1 (0 to 2)] than in the metallic groups [metallic reusable: 0 (0 to 1); P < 0.001 and metallic single-use: 0 (0 to 1); P < 0.007] groups. Glottic exposure was significantly better in the metallic reusable group (modified Cormack & Lehane score III and IV: 3.7%) compared with the plastic single-use group (modified Cormack & Lehane score III and IV: 9.4%; P < 0.03).
  
  
  CONCLUSIONS
  The rates of failed intubation at first laryngoscopy were similar in the metallic reusable and metallic reusable groups, but greater in the plastic single-use group.
authors.affiliation: Caen University Hospital, Department of Anaesthesiology and Intensive Care, Caen, F-14000, France. buleon-c@chu-caen.fr
authors.forename: Clément
authors.initials: C
authors.lastname: Buléon
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.forename: Anne
authors.initials: A
authors.lastname: Lesage
authors.forename: Wilfried
authors.initials: W
authors.lastname: Grandin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Pouliquen
authors.forename: Frédéric
authors.initials: F
authors.lastname: Flais
authors.forename: Thérèse
authors.initials: T
authors.lastname: Simonet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gérard
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hanouz
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D004209:Disposable Equipment; D004867:Equipment Design; D017743:Equipment Reuse; D005260:Female; D005931:Glottis; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation*; D008297:Male; D008670:Metals; D008875:Middle Aged; D010969:Plastics; D011446:Prospective Studies
chemical_list: D008670:Metals; D010969:Plastics