title: Does C-MAC®video laryngoscope improve the nasotracheal intubating conditions compared to Macintosh direct laryngoscope in paediatric patients posted for tonsillectomy surgeries?
abstract: OBJECTIVE
  C-MAC®video laryngoscope (VL) with Macintosh blade has been found to improve Cormack-Lehane (C-L) laryngoscopic view as well as intubating conditions for orotracheal intubation. However, studies done on the performance of C-MAC®VL for nasotracheal intubation (NTI) are very few in number. Hence, we compared laryngoscopy and intubating conditions between Macintosh direct laryngoscope and C-MAC®VL for NTI.
  
  
  METHODS
  Sixty American Society of Anesthesiologists Physical Status I, II patients, aged 8-18 years, posted for tonsillectomy surgeries under general anaesthesia with NTI were randomised, into two groups. Patients in group 1 were intubated using Macintosh direct laryngoscope and group 2 with C-MAC®VL. C-L grading, time required for intubation, need for additional manoeuvres and haemodynamic changes during and after intubation were compared between the groups.
  
  
  RESULTS
  C-L grade 1 views were obtained in 26 and 29 patients in group 1 and group 2, respectively (86.7% vs. 96.7%). Remaining patients were having C-L grade 2 (13.3% vs. 3.3%). Duration of intubation was less than a minute in group 2 (93.3%). Need for additional manoeuvres (M1-M5) were more in group 1 (97% vs. 77%). M1 (external manipulation) was needed more in group 2 compared to group 1 (53.3% vs. 30%). Magill's forceps alone (M4) and M4 with additional external manipulation (M5) were needed more in group 1 compared to group 2 (60% vs. 16%).
  
  
  CONCLUSIONS
  The overall performance of C-MAC®VL was better when compared to conventional direct Macintosh laryngoscope during NTI in terms of glottis visualisation, intubation time and need for additional manoeuvres.
authors.affiliation: Department of Anaesthesiology, DM WIMS Medical College and Hospital, Wayanad, Kerala, India.
authors.forename: Vinuta V
authors.initials: VV
authors.lastname: Patil
authors.affiliation: Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari Karnataka, India.
authors.forename: Bala H
authors.initials: BH
authors.lastname: Subramanya
authors.affiliation: Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari Karnataka, India.
authors.forename: N
authors.initials: N
authors.lastname: Kiranchand
authors.affiliation: Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari Karnataka, India.
authors.forename: S Bala
authors.initials: SB
authors.lastname: Bhaskar
authors.affiliation: Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari Karnataka, India.
authors.forename: Srinivasalu
authors.initials: S
authors.lastname: Dammur
keywords: C-MAC® video laryngoscope; Macintosh direct laryngoscope; nasotracheal intubation