![]() Multiple international airway management guidelines emphasise the importance of limiting the number of tracheal intubation attempts. Reported first-pass tracheal intubation success rates using direct laryngoscopy in this setting range from 44% to 87%. When performing elective tracheal intubation in the operating theatre, direct laryngoscopy with a Macintosh blade is commonly used. ![]() Practitioners may consider using this device as first choice for tracheal intubation. This study demonstrates that using McGrath videolaryngoscopy compared with direct laryngoscopy improves first-pass tracheal intubation success in patients having elective surgery. Cormack and Lehane grade ≥ 3 was observed more frequently with direct laryngoscopy (84/1039, 8%) compared with McGrath (8/1053, 0.7% p < 0.001) No significant difference in tracheal intubation-associated adverse events was observed between groups. This resulted in a relative risk (95%CI) of unsuccessful tracheal intubation at first attempt of 0.34 (0.26–0.45 p < 0.001) for McGrath compared with direct laryngoscopy. First-pass tracheal intubation success was higher with the McGrath (987/1053, 94%), compared with direct laryngoscopy (848/1039, 82%) absolute risk reduction (95%CI) was 12.1% (10.9–13.6%). In this multicentre randomised trial, 2092 adult patients without predicted difficult airway requiring tracheal intubation for elective surgery were allocated randomly to either videolaryngoscopy with a Macintosh blade (McGrath) or direct laryngoscopy. We hypothesised that using videolaryngoscopy for routine tracheal intubation would result in higher first-pass tracheal intubation success compared with direct laryngoscopy. Before completion of this study, there was insufficient evidence demonstrating the superiority of videolaryngoscopy compared with direct laryngoscopy for elective tracheal intubation.
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