Related Experiment Video For Awake orotracheal intubation
Updated: May 31, 2026
The Flexible Rhino-Laryngoscope for Awake Nasotracheal Intubation
Published on: August 2, 2024
Awake orotracheal intubation using the C-MAC D-Blade in cancer patients with predicted difficult airway: A
D Abdellatif Elebedy1, A Medhat Mohasseb1, E Mohamed Mokbel1
1Departamento de Anestesia, Cuidados Intensivos Quirúrgicos y Manejo del Dolor, Facultad de Medicina, Universidad de Mansoura, Mansoura, Egypt.
Background And Aims:
Managing difficult airways in cancer patients remains a significant challenge for anesthetists worldwide due to the risk of serious complications. Therefore, this study aimed to evaluate the feasibility of awake orotracheal intubation using the C-MAC D-Blade in cancer patients with predicted difficult airways undergoing elective surgery under general anesthesia.
Method:
We enrolled 180 cancer patients with difficult airways, as assessed by the El-Ganzouri Risk Index. Awake orotracheal intubation was performed using the C-MAC D-Blade, with topical local anesthesia and sedation. The primary outcome was the first-attempt intubation success rate. Secondary outcomes included the total intubation time, hemodynamic changes, patient responses, complications, and the ease of the procedure, assessed by both anesthesiologists and patients using a visual analog scale (VAS).
Results:
First-attempt intubation was successful in 89.4% of patients (n = 161), 8.3% (n = 15) required a second attempt, and 2.2% (n = 4) required a third attempt. No failed intubations were recorded. The mean intubation time with its standard deviation was 40.8 ± 9.01 s. At one and two minutes after intubation, heart rate and mean arterial blood pressure increased significantly from baseline values (P < .001). Tooth damage occurred in three patients, bleeding gums in seven patients, and tissue edema in four patients. The median VAS score for both anesthesiologists and patient satisfaction was 9, indicating high procedural feasibility. Additionally, a statistically significant positive correlation was observed between the number of intubation attempts and cough severity (P = .001).
Conclusion:
Awake video-laryngoscopic intubation using the C-MAC D-Blade achieved a high first-attempt success rate (89.4%) with minimal complications in cancer patients with predicted difficult airways. These results suggest it is a safe and effective option when careful assessment, adequate topical anesthesia, and appropriate sedation are ensured, although comparative studies are needed to better define its role.
Clinical Trial Registry:
Registered at clinicaltrial.gov registry system (clinical trial identifier: PACTR202408730457046).
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