A Comparison of McGrath® versus C-MAC® Videolaryngoscopes in Morbidly Obese Patients Undergoing Bariatric Surgery: A Randomized, controlled Clinical Trial
Sedat Akbas, Ahmet Selim Ozkan, Erol Karaaslan
Department of Anesthesiology, Inonu University Medical Faculty, Malatya, Turkey
BACKGROUND AND AIM: Airway management in morbidly obese patients is a technical challenge for the anesthesiologists. Increased body mass index (BMI) is associated with an increased possibility of difficult intubation. Therefore, we aimed to compare the McGrath with C-MAC videolaryngoscopes for tracheal intubation in morbidly obese patients.
METHODS: Eighty morbidly obese patients with a BMI≥40 scheduled for bariatric surgery included in this study. The patients were randomly allocated to two study groups: McGrath® (n = 40) and C-MAC® (n = 40). The demographic characteristics and procedure data, preoperative airway assessment, incidence and attempts for successful intubation, time to intubation, position for successful intubation, percentage of glottic opening (POGO score), ease of intubation, hemodynamic response and adverse events of tracheal intubation were recorded.
RESULTS: The two groups were similar with respect to age, gender, height, weight, BMI, IBW, ASA physical status, smoking, comorbidities, Mallampati score, thyromental distance, mouth opening and type of the surgeries. Incidence and attempts for successful intubation, use of Magill pens and position for successful intubation were similar. Time to intubation was significantly shorter in C-MAC in comparison with McGrath (p<0.001). The POGO scores were similar in both groups (p=0.057). The heart rate and the mean arterial pressure of McGrath was significantly higher than C-MAC after tracheal intubation at 1st min (p=0.002). There was no significant difference between the two groups in terms of adverse events of tracheal intubation.
CONCLUSIONS: Both devices efficiently improved the glottic view without failed intubation and had no any meaningful adverse events of tracheal intubation in morbidly obese patients. However, the C-MAC videolaryngoscope demonstrated shorter tracheal intubation times, better glottic visualization, and produced less cardiovascular response after tracheal intubation compared to the McGrath. Also the C-MAC was an easier device to use. We therefore concluded that intubation of morbidly obese patients with the C-MAC was superior over the McGrath.
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