A comparative study of the efficacy of the McGrath (Registered Trademark) X-blade vs the C-MAC Videolaryngoscope in patients with simulated difficult airways

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Videolaryngoscopes have been listed as part of the initial approach to intubation in international airway algorithms and guidelines, such as the 2013 ASA Practice Guidelines for Management of the Difficult Airway. Furthermore, meta-analyses of RCTs comparing video-assisted laryngoscopy with direct laryngoscopy in patients with simulated difficult airways report improved laryngeal views and a higher frequency of successful intubations. The McGrath X-blade, which is recently launched in June 2014, has been advocated to be useful in difficult airway situations. In addition, it is small and easily transportable for many clinical settings for tracheal intubation. Methodology - Our null hypothesis is that McGrath X-blade attachment is as efficacious as the C-MAC Videolaryngoscope in tracheal intubation of patients with simulated difficult airways. We aim to recruit 210 patients between 21 to 80 years old, ASA I to III to receive either CMAC or McGrath X-blade for intubation during elective operations. The primary outcome will be first-pass success (FPS). Secondary outcomes include overall intubation success, number of intubation attempts, total time to intubation (TTI), Cormack & Lehane grade, cardiorespiratory and intubation-related adverse events. Importance of proposed research to science or medicine If the McGrath X-blade video laryngoscope is shown to be better in efficacy to the C-MAC Videolaryngoscope in simulated difficult airway, it will be a useful portable airway adjunct in difficult airway situations, especially those occurring in remote locations e.g. radiology suites, general ward, ICUs, where access to difficult intubation equipment may be limited. Potential benefits & risks Risks to participants are no greater than what they would experience coming for a standard general anaesthetic and tracheal intubation. General risks related to tracheal intubation included sore throat, hoarseness of voice. Uncommon risks include dental injuries and rare but severe risks include hypoxia, increased blood pressure and heart rates.