A Comparative Study between C-MAC Video-Laryngoscope and Fiberoptic Laryngoscope in Anticipated Difficult Intubation

Abstract Background Numerous indirect laryngoscopes have been introduced into clinical practice and compared with the Macintosh laryngoscope. Most studies have described a significantly better glottic view and a higher success rate in difficult tracheal intubations for the indirect laryngoscopes. Some case reports also describe the successful use of these tools under sedation with preserved spontaneous breathing. Objective To compare the C-MAC® D-Blade video laryngoscope and the flexible fiberoptic scope for intubation of patients with anticipated difficult intubation. The primary endpoint was the time to achieve successful tracheal intubation. Secondary endpoints included glottic view at intubation and the number of intubation attempts. The study was conducted on 60 patients at the operating theatres of Ain Shams University Hospitals. Patients and Methods After obtaining approval from the Research Ethical Committee, Faculty of Medicine, Ain Shams University and informed consents from patients, 60 American Society of Anaesthesiologists I-II adult patients with El-Ganzouri risk index score (EGRI) ≥ 4 (age range, 21- 60 years) undergoing elective surgeries requiring tracheal intubation were enrolled in this prospective study at the operating theaters of Ain Shams University Hospitals from March 2022 to October 2022. Results Our results showed Duration of intubation (s) among the study groups. Duration of intubation (s) in Video laryngoscope Group ranged from 22 to 34 seconds with mean ± SD = 27.87 ± 3.74 while in Fiberoptic Group the Duration of intubation (s) ranged from 60 to 75 seconds with mean ± SD = 66.77 ± 4.24 with highly statistically significant difference (p = <.001) between the two groups and showed POGO score among the study groups. Regarding POGO score, there was a significant difference between the two studied groups (p = 0.019). C-MAC video laryngoscope had become a good alternative and was associated with visualization of laryngeal structures in shorter time as compared to traditional flexible fiberoptic laryngoscopy. Conclusion This randomized, prospective study demonstrated that the C-MAC may offer an advantage over the fiberoptic laryngoscope with respect to the time required to obtain a clear glottic view and successful placement of the tracheal tube. However, the Flexible Fiberoptic Scope offered a better visualization of the glottic opening compared to the C-MAC video laryngoscope. The use of C-MAC as a usual tool was limited as it is expensive device, and the use of fiberoptic bronchoscope needs more experience and training.