Video & Direct Laryngoscopes

Devices allowing simultaneous video and direct laryngoscopy represent a safety advantage over either direct laryngoscopes or video laryngoscopes. Intubation is more likely to be successful, with less airway trauma.

Video&direct laryngoscopes which are smaller and easily portable provide an advantage over those that aren’t.

The McGrathMAC and C Mac portable possess these ideal properties.

The first attempt at intubation should be the best (and ideally the only) attempt. Laryngoscopes offering the combination of direct and video laryngoscopy serves this well.

My background:

I’ve been an anaesthetic consultant for over 10 years with half of my work being in a large public tertiary referral hospital. I’ve experienced most in hospital difficult airway scenarios.

The tertiary hospital I work at may be unique in that for the past 4 years in all 26 theatres there exists a McGrathMAC. To my knowledge nothing has been published about this in the literature.

At this hospital most anaesthetists, when intubating adult patients with a laryngoscope, will elect to use the McGrathMAC first line. Most accept, if they’re going to perform direct laryngoscopy with a standard MacIntosh blade, they’re only doing this to maintain skills in case they work in an environment where video laryngoscopy is unavailable. (A cover may be put over the McGrathMAC screen to simulate this)

I have experience with and have used pretty much all of the other video laryngoscopes currently on the market.
I have not found much difference between the video view they provide, however I will note:

– I would shy away from channeled video laryngoscopes (most hospitals I work at have not purchased them)

– I like the freedom of being able to manipulate the ETT where I want to.

– We did use some McGrath series 5 laryngoscopes for a few years however found them to be temperamental – the screens occasionally blacking out because of poor contact between blade and handle. I would not recommend them.

– Video laryngoscopes requiring a midline approach to laryngoscopy (such as the Glidescope) provide a less familiar approach to laryngoscopy.

– Video laryngoscopes that allow the screen to be in front of you avoid you turning your head sideways during intubation.

– Big screens and great optics improve the screen appearance however the bigger the screen the less portable the equipment.

– From my own experience, and from speaking to my colleagues, we don’t envisage a situation where if we attempted intubation with a C-Mac or McGrath and failed we would then attempt with a different video laryngoscope. (Note C-Mac has the D Blade and McGrathMAC has the X Blade- they are curvier – this may be the only reasonable additional step, however most of us like to think we could have predicted the need for this prior).

– I have seen but never used the Airtraq even though it is available at some institutions – frankly it is not a video laryngoscope, it is a dangerously inferior product that is detrimental to patient safety as some institutions may purchase it instead of a true videolaryngoscope.

– When intubating with a VL&DL the assistant (and others) have a view. The assistant is able to visualise any necessary manipulation of the trachea, and will know (prior to any verbalisation) difficulties presented – in turn they can pre-empt next management step before you’ve even mentioned it.

The C Mac and McGrathMAC both offer VL&DL.

The McGrathMAC has the advantage of being portable, and is positioned cost wise to allow numerous devices in multiple locations. I do not envisage every theatre having their own dedicated C Mac, and also they don’t t seem like an option for paramedics.

I’ve bought my own McGrathMAC to take to other hospitals and day surgeries.

I have no financial interest with McGrath, Covidien, or any other suppliers of this product. I welcome the introduction of similar products to the McGrathMAC – their introduction to the marketplace will competitively improve the price.

4 thoughts on “Video & Direct Laryngoscopes

  1. Very happy to include other recommended video laryngoscopes. The McGrath is very portable (does not require seperate screen to be brought in) and cost is not excessive – in some hospitals they are now used routinely instead of traditional laryngoscopes. Please let us know of others that you feel are as good.

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  2. King Vission, Karl Store C-Mac, Glidescope, Pentax, Copilot
    We have included a list of other video laryngoscope manufacturers. A number of our members are senior anaesthetists with many years experience. We are not reps for McGrath, however recognise that it’s portability, sturdiness, direct line of sight, ability to be used for direct laryngoscopy, and reasonable price put it in a position to replace conventional laryngoscopes – this would create a first (and ?only) intubation attempt best intubation attempt scenario – less airway trauma and allow for a more rapid progress to the next step in maintaining the airway if intubation is not established. In one of our members hospitals they have a McGrath in every theatre (25 theatres) and are encouraged to use it routinely as a cost saving as well as a safety measure.

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  3. I think this argument would be stronger with some citations. It intuitively makes sense that a combination VL/DL blade would be helpful (Although mostly having experience with the Glidescope & KingVision, I do wonder, if the blade is not hyperangulated, what I am seeing through the camera that I could not see through my eyes?) but we have all seen intuitions about medical practice go down in flames.

    On the topic of intubation and procedures in general, I’d like to note that THE MOST powerful predictor of a successful intubation is a practiced and skill intubator. In the United States, only fifty(!) intubations are required in the training of a board-certified emergency physician (you know, the folks doing crash intubations on unknown & unscreened patients who are almost definitionally unstable.) A large survey in 1999 (the last year I could find) had EM resident averaging 65 intubations in training.

    The powerful (and necessary) movement towards optimizing patient safety, the progress that has been made in advert futile end of life care, limited work hours and new data on the dangers of repeated intubation attempts are putting students and residents under great pressure to acquire competence with inadequate opportunities for practice.

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