Teeth injury..which tool less harmful?

It is too common sequelae of difficult intubation are damage to soft tissues of the mouth and throat, and damage to the maxillary incisors of the patient.
This study evaluates the forces applied to the maxillary incisors when using various VLSs and a Macintosh blade.

Methods

Fifty consecutive surgery patients were randomly assigned to receive laryngoscopy from a pair of four blades investigated in the study – the VLSGlideScope^® (Verathon Inc., Bothell, WA, USA), V-Mac™ Storz^® (Karl Storz, Tuttlingen, Germany), and McGrath™ (Aircraft Medical, Edinburgh, United Kingdom); and the classic Macintosh blade also from Storz^® (Karl Storz).

An endotracheal tube (ETT) was brought into position anterior to the vocal cords, with actual intubation carried out only with the second of the laryngoscopes. Sensors measured the forces directly applied to the patient's maxillary incisors while inserting the ETT. Other common metrics of intubation difficulty (e.g. Mallampati grade, Cormack–Lehane grade, and time) were also recorded.

Conclusions

All VLSs considered were safer for the patient than was the Macintosh blade in terms of the forces applied to the maxillary teeth, time, number of insertion attempts, and view achieved of the glottic arch.

There is a small, but significant, difference in the time and number of insertion attempts required during laryngoscopy with the different VLSs. There was no difference in the forces applied. The geometry of the respective blades may be an important component in the ease of laryngoscopy.

Acta Anaesthesiologica Scandinavica Volume 56, Issue 2, pages 224–229, Febuary 2012

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