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Comparison of forces acting on maxillary incisors during tracheal intubation with different laryngoscopy techniques: A blinded manikin study

Anaesthesia Sep 05, 2019

Schieren M, Kleinschmidt J, Schmutz A, et al. - Given that tracheal intubation is often complicated with dental trauma and there is insufficient existing evidence to validly evaluate the influence of various laryngoscopy techniques on the incidence of dental trauma, therefore, researchers determined the force exerted onto dental structures during tracheal intubation. They used an intubation manikin equipped with hidden force sensors in all maxillary incisors. Tracheal intubations were performed by 104 anaesthetists, using direct laryngoscopy with a Macintosh blade, and videolaryngoscopy with a C-MAC, or the hyperangulated GlideScope or KingVision laryngoscopes in both normal and difficult airway conditions, during which, dental force was measured. They analyzed overall 624 tracheal intubations. In normal airways and in difficult airways, the measured median (IQR [range]) peak force of direct laryngoscopy was 21.1 (14.0–32.8 [2.3–127.6]) Newton (N) and 29.3 (17.7–44.8 [3.3–97.2]) N, respectively. A significantly reduced force exerted on maxillary incisors was observed in correlation with hyperangulated videolaryngoscopy. Furthermore, an attenuated risk for dental injury in clinical settings might be achieved with the use of hyperangulated videolaryngoscopy.
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