title: Tracheal intubation with a flexible fibreoptic scope or the McGrath videolaryngoscope in simulated difficult airway scenarios: a randomised controlled manikin study.
abstract: BACKGROUND
  Flexible fibreoptic endoscopic (FFE) intubation is considered the 'gold-standard' when difficult airway management is anticipated. Several videolaryngoscopes have been developed to facilitate intubation by laryngoscopy.
  
  
  OBJECTIVE
  The aim of the study was to compare the performance of the McGrath series 5 videolaryngoscope (McGrath videolaryngoscope) and the FFE for tracheal intubation in manikins with a simulated difficult airway, hypothesizing that the McGrath videolaryngoscope intubation would prove faster than FFE intubation.
  
  
  METHODS
  A randomised controlled study.
  
  
  METHODS
  The Danish Institute for medical simulation between December 2009 and June 2010.
  
  
  METHODS
  Twenty-eight anaesthesia residents participating in the Danish mandatory 3-day airway management course.
  
  
  METHODS
  All participants received instructions and training in the use of the McGrath videolaryngoscope and FFE. The participants then performed tracheal intubation on a SimMan manikin once with the McGrath videolaryngoscope and once with the FFE in three difficult airway scenarios: (1) pharyngeal obstruction; (2) pharyngeal obstruction and cervical rigidity; (3) tongue oedema.
  
  
  METHODS
  We measured successful intubations, defined as intubation within 120  s, and time to tracheal intubation.
  
  
  RESULTS
  The trachea was intubated within 120  s with the McGrath videolaryngoscope in 25 out of 27 (93%), 25 out of 28 (89%) and 18 out of 28 (64%) occasions compared with 11 out of 28 (40%), 11 out of 28 (40%) and 16 out of 28 (57%) with the FFE in scenarios (1), (2) and (3), respectively. Time to tracheal intubation was shorter with the McGrath videolaryngoscope in scenarios (1) and (2) than with the FFE (Wilcoxon signed rank sum test, P < 0.0001).
  
  
  CONCLUSIONS
  The McGrath videolaryngoscope is a valuable device with higher success rate and a quicker performance in simulated difficult airways. In patients, videolaryngoscopy may have a role in difficult airway algorithms, but the optimal device has yet to be found.
authors.affiliation: From the Department of Anaesthesia, Copenhagen University Hospital, Hillerød (JHC, MLT, RCV), Department of Anaesthesiology, Copenhagen University Hospital, Herlev (GRM, TB), Department of Anaesthesia, Centre of Abdominal Surgery, Copenhagen University Hospital, Rigshospitalet (RB) and Danish Institute for Medical Simulation (DIMS), Copenhagen University Hospital, Herlev, Denmark (RM).
authors.forename: Cecilie H
authors.initials: CH
authors.lastname: Jepsen
authors.forename: Mona R
authors.initials: MR
authors.lastname: Gätke
authors.forename: Bente
authors.initials: B
authors.lastname: Thøgersen
authors.forename: Lene T
authors.initials: LT
authors.lastname: Mollerup
authors.forename: Birgitte
authors.initials: B
authors.lastname: Ruhnau
authors.forename: Mikael
authors.initials: M
authors.lastname: Rewers
authors.forename: Charlotte V
authors.initials: CV
authors.lastname: Rosenstock
mesh_terms: D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D000402:Airway Obstruction / Q000473:pathology; D000465:Algorithms; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003718:Denmark; D004867:Equipment Design; D005336:Fiber Optic Technology; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000193:education*; D008348:Manikins; D010614:Pharynx / Q000473:pathology; D013997:Time Factors; D014741:Video Recording