title: Comparison of three video laryngoscopy devices to direct laryngoscopy for intubating obese patients: a randomized controlled trial.
abstract: OBJECTIVE
  To compare three different video laryngoscope devices (VL) to standard direct laryngoscopy (DL) for tracheal intubation of obese patients undergoing bariatric surgery.
  
  
  OBJECTIVE
  VL (vs DL) would reduce the time required to achieve successful tracheal intubation and improve the glottic view.
  
  
  METHODS
  Prospective, randomized and controlled.
  
  
  METHODS
  Preoperative/operating rooms and postanesthesia care unit.
  
  
  METHODS
  One hundred twenty-one obese patients (ASA physical status I-III), aged 18 to 80 years, body mass index (BMI) >30 kg/m(2) undergoing elective bariatric surgery.
  
  
  METHODS
  Patients were prospectively randomized assigned to one of 4 different airway devices for tracheal intubation: standard Macintosh (Mac) blade (DL); Video-Mac VL; Glide Scope VL; or McGrath VL.
  
  
  METHODS
  After performing a preoperative airway evaluation, patients underwent a standardized induction sequence. The glottic view was graded using the Cormack Lehane and percentage of glottic opening (POGO) scoring systems at the time of tracheal intubation. Times from the blade entering the patient's mouth to obtaining a glottic view, placement of the tracheal tube, and confirmation of an end-tidal CO2 waveform were recorded. In addition, intubation attempts, adjuvant airway devices, hemodynamic changes, adverse events, and any airway-related trauma were recorded.
  
  
  RESULTS
  All three VL devices provided improved glottic views compared to standard DL (p < 0.05). Video-Mac VL and McGrath also significantly reduced the time required to obtain the glottic view. Video-Mac VL significantly reduced the time required for successful placement of the tracheal tube (vs DL and the others VL device groups). The Video-Mac and GlideScope required fewer intubation attempts (P< .05) and less frequent use of ancillary intubating devices compared to DL and the McGrath VL.
  
  
  CONCLUSIONS
  Video-Mac and GlideScope required fewer intubation attempts than standard DL and the McGrath device. The Video-Mac also significantly reduced the time needed to secure the airway and improved the glottic view compared to standard DL.
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: Roya.Yumul@cshs.org.
authors.forename: Roya
authors.initials: R
authors.lastname: Yumul
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: loanidoc@yahoo.com.
authors.forename: Ofelia L
authors.initials: OL
authors.lastname: Elvir-Lazo
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA; White Mountain Institute, The Sea Ranch, CA 95497, USA; Instituto Ortopedico Rizzoli, University of Bologna, Italy. Electronic address: Paul.White@cshs.org.
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: alejandro.sloninsky@cshs.org.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sloninsky
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: kaplanm@cshs.org.
authors.forename: Marshal
authors.initials: M
authors.lastname: Kaplan
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: Kurby2125@yahoo.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Kariger
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: robert.naruse@cshs.org.
authors.forename: Robert
authors.initials: R
authors.lastname: Naruse
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: parkernw@gmail.com.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Parker
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA; St. Vincent Medical Center (actual), 2131 W 3rd St, Los Angeles, CA 90057, USA. Electronic address: christinepham@hotmail.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Pham
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: Xiao.Zhang@cshs.org.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA. Electronic address: Ronald.Wender@cshs.org.
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Wender
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050110:Bariatric Surgery / Q000379:methods; D004867:Equipment Design; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D020704:Laryngoscopes / Q000009:adverse effects; D007828:Laryngoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011446:Prospective Studies; D020535:Video-Assisted Surgery / Q000295:instrumentation* / Q000379:methods; D055815:Young Adult
keywords: Direct laryngoscopy; GlideScope; McGrath; Obesity; Video laryngoscopy; Video-Mac