Department of Anesthesiology, Saitama Medical University Hospital, Moroyama, Saitama 350-0495, Japan.
Department of Anesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan.
J Clin Anesth. 2018 May;46:25-32. doi: 10.1016/j.jclinane.2017.12.030. Epub 2018 Mar 26.
The McGrath laryngoscope is a novel self-contained videolaryngoscope with a single-use blade. There are several anecdotal reports that the McGrath is superior to the Macintosh laryngoscope for tracheal intubation. However this remains controversial.
Meta-analysis and systematic review.
Operating room or intensive care unit.
A comprehensive literature search was conducted to identify clinical trials that met our inclusion criteria. To qualify, studies had to be prospective randomized trials comparing tracheal intubation between the McGrath and the Macintosh in an adult population. We extracted data on success rate, glottic visualization during intubation, and intubation time from the studies identified. In subgroup analysis, we assessed the influence on each of these parameters which included airway condition (normal or difficult) and operator (novice or experienced). We then conducted a trial sequential analysis (TSA).
Fourteen articles met our inclusion criteria. The McGrath offered better glottic visualization than the Macintosh (risk ratio, 1.34; 95% confidence interval (CI), 1.25-1.45). However, the McGrath required longer intubation time (mean difference, 10.1s; CI, 2.74-17.5) and demonstrated similar success rate of tracheal intubation (risk ratio, 1.00; CI, 0.95-1.05) compared to the Macintosh. TSA showed that total sample size reached the required information size (RIS) in glottic visualization and success rate. However, only 15.1% of the RIS was achieved in intubation time. In the subgroup analysis for airway condition and operator experience level, there were no subgroup differences in both glottic visualization and intubation time.
Our meta-analysis suggests that the McGrath is superior to the Macintosh in terms of glottic visualization (GRADE: moderate). However, it significantly extends intubation time (GRADE: very low) and its success rate (GRADE: very low) for tracheal intubation is not excellent. TSA suggests that further studies are necessary to confirm the results of intubation time.
麦氏喉镜是一种新型的、自带一次性刀片的、独立的视频喉镜。有一些传闻报告称，麦氏喉镜在气管插管方面优于麦克林（Macintosh）喉镜。然而，这一点仍存在争议。
荟萃分析和系统评价。
手术室或重症监护病房。
进行了全面的文献检索，以确定符合我们纳入标准的临床试验。符合条件的研究必须是前瞻性随机试验，比较成人人群中使用麦氏喉镜和麦克林喉镜进行气管插管的情况。我们从确定的研究中提取了成功率、插管期间声门可视化和插管时间的数据。在亚组分析中，我们评估了气道条件（正常或困难）和操作者（新手或经验丰富）对每个参数的影响。然后，我们进行了试验序贯分析（TSA）。
有 14 篇文章符合我们的纳入标准。麦氏喉镜比麦克林喉镜提供了更好的声门可视化（风险比，1.34；95%置信区间（CI），1.25-1.45）。然而，麦氏喉镜需要更长的插管时间（平均差值，10.1s；CI，2.74-17.5），并且与麦克林喉镜相比，气管插管的成功率相似（风险比，1.00；CI，0.95-1.05）。TSA 显示，总样本量达到了声门可视化和成功率的所需信息量（RIS）。然而，仅在插管时间方面，达到了 RIS 的 15.1%。在气道条件和操作者经验水平的亚组分析中，声门可视化和插管时间方面没有亚组差异。
我们的荟萃分析表明，在声门可视化方面，麦氏喉镜优于麦克林喉镜（GRADE：中度）。然而，它显著延长了插管时间（GRADE：非常低），其气管插管的成功率（GRADE：非常低）并不理想。TSA 表明，需要进一步的研究来证实插管时间的结果。
