Impact of pillow height on double-lumen endotracheal tube intubation with McGRATH MAC: a prospective randomized clinical trial

• Published in: Journal of clinical anesthesia Vol. 34; pp. 339 - 343
• Main Authors: Deguchi, Shiho, MD, Komasawa, Nobuyasu, MD, PhD, Kido, Haruki, MD, Ueno, Takeshi, MD, Minami, Toshiaki, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Airway management; Anesthesia; Anesthesia & Perioperative Care; Bedding and Linens; Classification; Clinical trials; Double-lumen tracheal tube; Elective Surgical Procedures - methods; Equipment Design; Female; Glottis; Humans; Intubation; Intubation, Intratracheal - methods; Laryngoscopy - methods; Male; McGRATH MAC; Medical personnel; Middle Aged; One-Lung Ventilation; Pain; Pain Medicine; Patients; Pillow height; Posture; Prospective Studies; Thoracic surgery; Double-lumen tracheal tube; McGRATH MAC; Pillow height
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.05.024

Abstract Study objective This study aimed to compare the impact of pillow height on double-lumen tracheal tube (DLT) intubation with McGRATH MAC (McG) in patients undergoing elective surgery. Design Randomized clinical trial. Setting Operating room. Patients Fifty adult patients scheduled for elective surgery under 1-lung ventilation with an American Society of Anesthesiologists physical status of 1 to 3. Interventions DLT intubation with McG was performed with a high pillow (HP group; 25 patients) or low pillow (LP group; 25 patients) by anesthesiologists. Measurements Intubation time, number of laryngoscopy, number of tracheal intubation attempts to successful intubation, percentage of glottic opening score, and subjective difficulty of laryngoscopy and tube passage through the glottis were assessed. Main Results Intubation time was significantly shorter in the HP group compared with the LP group (HP: 32.1 ± 14.9 seconds vs LP: 49.4 ± 11.2 seconds, P < .001). The number of laryngoscopy were 1 (HP group, 22 patients; LP group, 17 patients), 2 (HP group, 3 patient; LP group, 7 patients), and 3 (HP group, 0 patient; LP group, 1 patient), with no significant difference between the 2 groups ( P = .197). Although the percentage of glottic opening score did not significantly differ between HP and LP groups (HP: 95.6% ± 6.7% vs LP: 96.0% ± 12.3%, P = .08), the number of tracheal intubation attempts was significantly lower in the HP group compared with the LP group ( P = .009). The visual analog scale score for laryngoscopy did not significantly differ between the 2 groups ( P = .54). However, the visual analog scale for tube passage through the glottis was significantly higher in the LP group than in the HP group ( P < .001). Conclusions Intubation with an HP was associated with a better DLT intubation profile than with an LP with McG, possibly due to smoother tracheal tube progression through the glottis.