Endotracheal intubation criteria and stress response: Airtraq versus macintosh laryngoscopes – A prospective randomized controlled trial

Background: Airtraq® is a single-use video laryngoscope used to facilitate tracheal intubation in both expected and unexpected difficult airways. Aims: We hypothesized that Airtraq laryngoscope would facilitate better intubation criteria and lower stress response to laryngoscopy in comparison to the Macintosh laryngoscope. Materials and Methods: In this randomized, single-blinded, prospective study, 70 adult patients were randomly assigned to be intubated with either Airtraq (Group AT) or Macintosh (Group M) laryngoscope (35 patients in each). The primary outcomes involved intubation time, first-attempt success rate, time to best laryngoscopic view, and percentage of glottic opening (POGO) score. Other recorded parameters involved the hemodynamic and intraocular pressure (IOP) responses to laryngoscopy and intubation and complications during and after laryngoscopy and after extubation. Serum samples were collected before anesthesia induction and 2 min after intubation and analyzed for epinephrine, cortisol, and glucose. Results: Group AT had significantly higher POGO score and significantly shorter intubation time and time to best laryngoscopic view than Group M (P < 0.001). The first-attempt success rate was 97.1% in Group AT and 94.3% in Group M (P = 0.55). Postoperatively, laryngospasm and sore throat were encountered in 2.9% of Group M patients compared to 0% in Group AT (P = 1.00). The heart rate, mean arterial pressure, IOP, serum epinephrine, and cortisol were significantly increased in Group M than Group AT. Conclusion: In comparison to the Macintosh laryngoscope, Airtraq conferred significantly better intubation criteria and lesser stress response to laryngoscopy and intubation.