A comparison of the effectiveness of intubation using a McGrath Series 5 videolaryngoscope with either a Truflex articulating stylet or a standard intubation stylet in a group of medical students

Background. Intubation is the optimal method for opening the airway and effective ventilation of the patient. However, there are occasional problems with intubation, especially in patients with injuries under pre-hospital conditions. Therefore, it is important to identify devices, e.g., videolaryngoscopes or guides, which may facilitate and shorten the procedure. This study addresses the use of a Truflex articulated guide with a videolaryngoscope.

Objectives. The main objective of the study is to evaluate the effectiveness of intubation using a Truflex articulating stylet with a McGrath videolaryngoscope, and to determine whether the average time of intubation using a Truflex articulating stylet is shorter than that using a standard intubation stylet.

Materials and methods. The study involved 43 full-time 5th year medical students. All tests were performed on training manikins with a difficult airway in January 2013. Chi-square test was used for statistical analysis with a significance level of p< 0.01. Calculations were performed using the Statistica package.

Results. Intubation using a McGrath videolaryngoscope with a Truflex articulating stylet was more effective than that using a standard intubation stylet with the same laryngoscope: 71% as compared to 40%. The mean time of successful intubation using a Truflex articulating stylet was shorter than that using a standard intubation stylet guide (31.1 ± 12.8 s and 39.8 ± 12.4 s, respectively).

Conclusions. The mean time of tracheal intubation using a Truflex articulating stylet is shorter than that using a standard intubation stylet. Intubation is also more effective when a Truflex articulating stylet is used together with a McGrath videolaryngoscope.

Truflex articulating stylet, Truflex, intubation, McGrath

1. Jakubiak J, Gaszynski T, Gaszynski W. Nadkrtaniowe urządzenia do udrożnienia górnych dróg oddechowych z możliwością przeprowadzenia intubacji dotchawiczej – porównanie Cobra PLA i ILMA. Anaesth Resusc Med 2009;3:31-6.

2. Eftekharian Jahromi HR. Guide Wire J-Tip Technique for Easy Exchange of In Situ Endotracheal Tubes. Iran J Med Sci 2012;37:141-3.

3. Kluger MT, Tham EJ, Coleman NA, Runciman WB, Bullock FM. Inadequate pre-operative evaluation and preparation: a review of 197 reports from the Australian Incident Monitoring Study. Anaesthesia 2000;55:1173-8.

4. Ekweghariri C, Grunewald C, Kramcha T, Rahman MA, Atlas G. V-Scope Extendable Intubation Stylet. 38th Annual Northeast Bioengineering Conference (NEBEC) 16-18 March 2012. Philadelphia; 2012. p. 61-2.

5. Bell SF, Davies N, Crossley A. Glidescope guided intubation: Comparison of Frova introducer, GlideRite Rigid, GlideRite Auto and Truphatek Truflex stylets in a simulated difficult intubation: 19AP5-2. Eur J Anaesthesiol 2011;28:235.

6. Shirgoska B, Netkovski J. New techniques and devices for difficult airway management. Acta Clin Croat 2012;51:457-61.

7. Hirabayashi Y. Airway scope versus Macintosh laryngoscope: a manikin study. Emerg Med J 2007;24:357–8.

8. Al-Qasmi A, Al-Alawi W, Malik AM, Khan RM, Kaul N. Trials. Assessment of Truflex articulating stylet versus conventional rigid Portex stylet as an intubation guide with the D-blade of C-Mac videolaryngoscope during elective tracheal intubation: study protocol for a randomized controlled trial. BioMed

Central.2013;14:298.

9. Taylor AM, Peck M, Launcelott S, Hung OR, Law JA, MacQuarrie K, et al. The McGrath® Series 5 videolaryngoscope vs the Macintosh laryngoscope: a randomised, controlled trial in patients with a simulated difficult airway. Anaesthesia 2013;68:142-7.

10. Wetsch WA, Spelten O, Hellmich M, Carlitscheck M, Padosch SA, Lier H, et al. Comparison of different video laryngoscopes for emergency intubation in a standardized airway manikin with immobilized cervical spine by experienced anaesthetists. Resuscitation 2012;83:740-5.

11. Ray DC, Billington C, Kearns PK, Kirkbride R, Mackintosh K, Reeve CS, et al. A comparison of McGrath and Macintosh laryngoscopes in novice users: a manikin study. Anaesthesia 2009;64:1207–10.

12. Hirabayashi Y, Seo N. Tracheal intubation by non-anaesthetist physicians using the Airway Scope. Emerg Med J 2007;24:572–3.

13. Miki T, Inagawa G, Kikuchi T, Koyama Y, Goto T. Evaluation of the Airway Scope, a new video laryngoscope, in tracheal intubation by naive operators: a manikin study. Acta Anaesthesiol Scand 2007;51:1378–81.

14. Tan BH, Liu EHC, Lim RTC, Liow LMH, Goy RWL. Ease of intubation with the Glidescope or Airway Scope by novice operators in simulated easy and difficult airways – a manikin study. Anaesthesia 2009;64:187–90.

15. Reus E, Liening K, Wrobel M, Grundmann U. Flexible fiberoptic versus Parker Flex-It, Truflex and hockey stick formed stylet as an intubation guide with the videolaryngoscope McGRATH Series 5 in a simulated airway: 19AP5-10. Eur J Anaesthesiol 2012;29:241.

16. Reus E, Liening K, Wrobel M, Grundmann U. Evaluation of the success rate of the intubation with the videolaryngoscope McGrath® in combination with the direction giving Truflex TM stylet versus a hockeystick formed stylet in a simulated airway: 19AP5-8. Eur J Anaesthesiol 2011; 28:236–7.

17. Reus E, Grundmann U, Liening K, Wrobel M. Parker Flex-It intubation stylet versus a 90-degree curved stylet during intubation with the McGrath videolaryngoscope performed by novices: a manikin study with 5 airway scenarios. J Clin Anesth 2013;25:624-8.