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Updated: Jul 16, 2025
Author Spotlight: Advancing Awake Nasotracheal Intubation with Flexible Video Rhino-Laryngoscopes
Published on: August 2, 2024
McGrath® versus Macintosh laryngoscopes on hemodynamic response to intubation in elderly patients: a randomized
Salma Ketata1, Mahdi Fourati1, Rahma Derbel1
1Department of Anesthesiology and Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia.
Introduction:
laryngoscopy and tracheal intubation induce catecholaminergic release. Our study aimed to evaluate the hemodynamic impact of orotracheal intubation by McGrath® compared to the Macintosh laryngoscope in the elderly.
Methods:
we conducted a prospective randomized clinical trial that included elderly patients proposed for a scheduled surgery under general anesthesia with orotracheal intubation and divided into 2 groups: patients who were intubated using the McGrath® (group V) and patients who were intubated using the Macintosh direct laryngoscope (group M). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure (MAP), were recorded before induction of anesthesia (baseline), and at 1 min, 3 min, and 5 min after intubation. Our outcomes were the increase of SBP (∆ SBP), MAP (∆ MAP), and HR (∆ HR) between the two groups, during the 5 minutes following the start of the orotracheal intubation, intubation time and the incidence of its related complications.
Results:
sixty patients were included and randomized into 2 groups of 30. The average age of our sample was 70±6 years with a sex ratio of 1.22. Most of the patients were operated on for orthopedic, urologic, or abdominal surgery. There were no statistically significant differences between the two groups in terms of demographic characteristics and the duration of anesthesia (p> 0.05). The intubation time was significantly increased in group M (p≤0.001). There was a significant difference in SBP, MAP, and HR values at 1 min after orotracheal intubation compared with the baseline values in Group V(P<0,05) and Group M (p < 0.05). There was a significant increase in the first minute after tracheal intubation in terms of SBP (151±42 vs 134.5±26 mmHg, p=0.012), MAP (114±4 vs 102±17 mmHg, p=0.015), DBP (89±32 vs 84±16 mmHg, p=0.01), and HR (99.5±10 vs 94.5±2 b/min, p=0.008) when group M was compared to group V. The ∆SBP was significantly different between group M (∆SBP = 36.2±23.5mmHg) and group V (∆SBP= 30.77±21.6mmHg) (p = 0.005). There were 4 ventricular arrhythmias in group M versus zero in group V (p <0.0001). The postoperative sore throat was significantly decreased in group M vs V (p=0.036).
Conclusion:
the McGrath® videolaryngoscope decreased the hemodynamic fluctuations due to endotracheal intubation in elderly patients.
Insights
The McGrath® videolaryngoscope significantly reduced hemodynamic fluctuations during tracheal intubation in elderly patients compared to the Macintosh laryngoscope. This device also lowered the incidence of ventricular arrhythmias and postoperative sore throat.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Cardiovascular Physiology
Background:
- Tracheal intubation is known to trigger catecholamine release, leading to hemodynamic instability.
- Assessing the impact of different laryngoscope devices on hemodynamic responses is crucial for patient safety, especially in elderly populations.
Purpose of the Study:
- To compare the hemodynamic effects of orotracheal intubation using the McGrath® videolaryngoscope versus the traditional Macintosh laryngoscope in elderly patients.
- To evaluate intubation time and complication rates associated with each device.
Main Methods:
- A prospective randomized clinical trial involving elderly patients undergoing scheduled surgery requiring orotracheal intubation.
- Patients were randomized into two groups: McGrath® videolaryngoscope (Group V) and Macintosh laryngoscope (Group M).
- Hemodynamic parameters (HR, SBP, DBP, MAP) were recorded at baseline and at 1, 3, and 5 minutes post-intubation.
Main Results:
- The McGrath® group (V) showed significantly lower increases in systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate (HR) at 1 minute post-intubation compared to the Macintosh group (M).
- Intubation time was significantly longer with the Macintosh laryngoscope (p≤0.001).
- The incidence of ventricular arrhythmias was significantly higher in the Macintosh group (4 vs 0), and postoperative sore throat was less frequent with the McGrath® device (p=0.036).
Conclusions:
- The McGrath® videolaryngoscope effectively mitigates hemodynamic fluctuations associated with endotracheal intubation in the elderly.
- This device may offer advantages in reducing cardiovascular stress and complications during airway management in this patient population.
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