Lateral intubation with the Macintosh laryngoscope and C-MAC D blade videolaryngoscope (LATIN): A randomized controlled trial

Background and aims: Lateral intubation is frequently encountered outside operating room settings, particularly for endoscopic procedures. Challenges faced by anesthesiologists include a lack of training and experience in performing intubation in the lateral position, and the paucity of data regarding the ideal method. This study was aimed at comparing the glottis visualization times and intubation times with Macintosh laryngoscopes and C-MAC D blade video laryngoscopes in American Society of Anesthesiologists (ASA) 1 and 2 patients without any risk factors for difficult airway, in the right lateral decubitus position. Materials and methods: The primary outcome was glottis visualization time. Secondary outcomes included intubation time, bougie use, intubation difficulty score, use of external laryngeal pressure, number of operators required, and complications. All intubators were trained experienced operators trained in lateral intubation on mannequins. Clinical trial registration is available at https://ctri.nic.in/Clinicaltrials/login.php, ID: CTRI/2024/06/068243. Results: This randomized controlled trial included 62 patients, 31 per group, undergoing elective procedures under general anesthesia and requiring endotracheal intubation. The patients were able to be intubated in the lateral position with a success rate of 96.8%. The mean glottis visualization time was 7.9 ± 3.1 s in the Macintosh (M) group (n = 32) and 6.8 ± 3.1 s in the C-MAC D blade (C) group (n = 29), and did not significantly differ between groups (p = 0.14). The intubation time was 7.5 ± 5 s (n = 31) in group M and 6 ± 3.5 s (n = 29) in group C, and did not significantly differ between groups (p = 0.61). No major complications were observed. Conclusion: Both Macintosh and C-MAC D blade laryngoscopes can be effectively used by trained clinicians for intubation in the lateral position. Registration details: Clinical trial registration is available at https://ctri.nic.in/Clinicaltrials/login.php, ID: CTRI/2024/06/068243.