Comparison of the performance of four laryngoscopes in a high-fidelity simulator using normal and difficult airway

Novel laryngoscopes may demonstrate advantages over the traditional Macintosh laryngoscope for difficult airways. Our study compared Glidescope laryngoscope, Bonfils fibrescope, and CTrach intubating laryngeal mask airway with the Macintosh laryngoscope in a simulated normal and difficult airway, considering the additional effect of previous intubation experience.

Twenty-two non-anaesthetists, 21 trainees, and 20 consultant anaesthetists attempted tracheal intubation of a Laerdal SimMan manikin, comparing a normal with a difficult airway scenario for each intubation device. The time taken to view the vocal cords and time to intubate were recorded. Also success rate and ease of use for each device were scored, alongside scope preference for each scenario.

Time to intubate was significantly shorter with the Macintosh compared with all three novel devices. All the devices had a high first-attempt success rate, but the Glidescope had a 100% first time successful intubation for all participants in both a normal and a difficult airway. Non-anaesthetists took significantly longer time to intubate compared with consultant anaesthetists, but there was no difference between trainee and consultant anaesthetists. Higher proportions of participants found the Glidescope easy to use, compared with other devices. For the normal airway, the Macintosh was the preferred device, but for the difficult airway, the Glidescope was favoured.

In this study, the Macintosh laryngoscope outperformed the other devices. However, the Glidescope was considered easy to use regardless of previous experience and was the preferred device for the simulated difficult airway.