Aspiration of gastric contents is a recognised complication during all phases of anaesthesia. The risk of this event becomes more likely with repeated attempts at tracheal intubation. There is a lack of clinical data on the effectiveness of videolaryngoscopy relative to direct laryngoscopy rapid sequence intubation in the operating theatre. We hypothesised that the use of a videolaryngoscope during rapid sequence intubation would be associated with a higher first pass tracheal intubation success rate than conventional direct laryngoscopy. In this multicentre randomised controlled trial, 1000 adult patients requiring tracheal intubation for elective, urgent or emergency surgery were allocated randomly to airway management using a McGrath™ MAC videolaryngoscope (Medtronic, Minneapolis, MN, USA) or direct laryngoscopy. Both techniques used a Macintosh blade. First-pass tracheal intubation success was higher in patients allocated to the McGrath group (470/500, 94%) compared with those allocated to the direct laryngoscopy group (358/500, 71.6%), odds ratio (95%CI) 1.31 (1.23–1.39); p < 0.001. This advantage was observed in both trainees and consultants. Cormack and Lehane grade ≥ 3 view occurred less frequently in patients allocated to the McGrath group compared with those allocated to the direct laryngoscopy group (5/500, 1% vs. 94/500, 19%, respectively; p < 0.001). Tracheal intubation with a McGrath videolaryngoscope was associated with a lower rate of adverse events compared with direct laryngoscopy (13/500, 2.6% vs. 61/500, 12.2%, respectively; p < 0.001). These findings suggest that the McGrath videolaryngoscope is superior to a conventional direct laryngoscope for rapid sequence intubation in the operating theatre.

中文翻译：

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手术室中用于快速顺序插管的 McGrath 视频喉镜与直接喉镜的比较：一项多中心随机对照试验

胃内容物误吸是麻醉各个阶段公认的并发症。如果反复尝试气管插管，这种事件的风险就会变得更大。缺乏关于手术室中视频喉镜相对于直接喉镜快速插管的有效性的临床数据。我们假设在快速顺序插管期间使用视频喉镜比传统的直接喉镜具有更高的首次通过气管插管成功率。在这项多中心随机对照试验中，1000 名需要气管插管进行择期、紧急或紧急手术的成年患者被随机分配至使用 McGrath™ MAC 视频喉镜（美敦力，明尼苏达州明尼阿波利斯市，美国）或直接喉镜进行气道管理。两种技术都使用 Macintosh 刀片。与分配到直接喉镜组的患者 (358/500, 71.6%) 相比，分配到 McGrath 组的患者首次气管插管成功率更高 (470/500, 94%)，比值比 (95%CI) 1.31 ( 1.23–1.39）； p < 0.001。在学员和顾问中都观察到了这一优势。与分配到直接喉镜检查组的患者相比，分配到 McGrath 组的患者中 Cormack 和 Lehane ≥ 3 级视图的发生频率较低（分别为 5/500，1% vs. 94/500，19%；p < 0.001）。与直接喉镜检查相比，使用 McGrath 视频喉镜进行气管插管的不良事件发生率较低（分别为 13/500、2.6% 和 61/500、12.2%；p < 0.001）。这些发现表明，在手术室进行快速插管时，McGrath 视频喉镜优于传统的直接喉镜。