Glidescope versus Airtraq DL for double-lumen tracheal tube insertion in patients with a predicted or known difficult airway: A randomised study

BACKGROUND: Double-lumen tracheal tube (DLT) insertion can be managed with videolaryngoscopes such as the Glidescope or indirect laryngoscopes like the Airtraq DL. No study has compared both devices when a difficult intubation is predicted. OBJECTIVE: Our hypothesis was that the Glidescope is superior to the Airtraq for double-lumen tube insertion in patients with a predicted or known difficult airway. DESIGN: Randomised study. PATIENTS: Adults scheduled for thoracic elective surgery, requiring one-lung ventilation with a predicted difficult intubation score of at least 7 (Arné risk index). INTERVENTION: Between March 2014 and March 2015, adult patients, scheduled for elective thoracic surgery, requiring double-lumen tracheal tube placement, and with a predicted risk (evaluated preoperatively using the Arné score) or a history of difficult intubation, were allocated to a Glidescope or an Airtraq group. MAIN OUTCOME MEASURES: The primary outcome was the overall success rate of tracheal intubation after two attempts. Secondary outcomes were success rates on the first attempt, duration of intubation, need for laryngeal pressure, Cormack and Lehane grade and side-effects. RESULTS: Of 277 patients, 78 were predicted to have a difficult airway. Finally, 72 patients were enrolled. Neither the overall success rates of tracheal intubation [Glidescope group 31/36 (86%) versus Airtraq group 34/36 (94%), P = 0.43] nor the side-effects differed between groups. There was no difference concerning visualisation of the glottis using the Cormack and Lehane grade (P = 0.18) or intubation time [Glidescope group 67 s (49 to 90) versus Airtraq group 81 s (59 to 101), P = 0.28]. All patients with a previous history of difficult intubation were intubated successfully. CONCLUSION: There is no difference in success rates of tracheal intubation with a double-lumen tube in patients with a predicted or known difficult airway when using either a Glidescope or Airtraq device. TRIAL REGISTRATION: National register of the French National Agency for Medicines and Health Products Safety No. 2014-A00143-44.

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