Comparison of Airtraq™, McCoy™ and Macintosh laryngoscopes for endotracheal intubation in patients with cervical spine immobilisation: A randomised clinical trial

BACKGROUND AND AIMS: The study aimed at comparing the performance of the novel optical Airtraq™ laryngoscope with the McCoy™ and conventional Macintosh laryngoscopes for ease of endotracheal intubation in patients with neck immobilisation using manual inline axial cervical spine stabilisation (MIAS) technique. METHODS: Ninety consenting American Society of Anaesthesiologist's physical status I–II patients, aged 18–60 years, scheduled for various surgeries requiring tracheal intubation were randomly assigned into three groups of thirty each to undergo intubation with Macintosh, Airtraq™, or McCoy™ laryngoscope with neck immobilisation by MIAS technique. The ease of intubation based on Intubation difficulty scale (IDS) score, Cormack-Lehane grade of glottic view, optimisation manoeuvres and impact on haemodynamic parameters were recorded. Statistical analysis was performed with ANOVA and Bonferroni correction for post hoc tests. RESULTS: All patients in three groups had a comparable demographic profile and were successfully intubated. The Airtraq™ laryngoscope significantly reduced the IDS (mean − 0.43 ± 0.81) as compared with both McCoy™ (mean − 1.63 ± 1.49, P = 0.001) and Macintosh laryngoscope (mean −2.23 ± 1.92, P < 0.001) and improved the Cormack-Lehane glottic view (77% grade 1 view and no patients with grade 3 or 4 view). There were less haemodynamic variations during laryngoscopy with the Airtraq™ compared to the Macintosh laryngoscope, but there was not between the Airtraq™ and McCoy™ laryngoscope groups. CONCLUSION: In patients undergoing endotracheal intubation with cervical immobilisation, Airtraq™ laryngoscope was superior to the McCoy™ and Macintosh laryngoscopes, with greater ease of intubation and lower impact on haemodynamic variables.