The C-MAC Videolaryngoscope: First Experiences with a New Device for Videolaryngoscopy-Guided Intubation

Abstract

We studied the efficacy of the C-MAC® (Karl Storz, Tuttlingen, Germany), a new portable videolaryngoscope, in 60 patients during routine induction of anesthesia. It was possible to insert the blade (Size 3) of the C-MAC and to get a view of the glottis on the first attempt in all patients. Tracheal intubation also was successful in all 60 patients; 52 patients were intubated on the first attempt, 6 on the second, and 2 on the third. In 8 patients (13%), a gum elastic bougie guide was required. A Cormack-Lehane Class 1 view of the glottis was seen in 30 patients without external manipulation and in 45 with external manipulation, Class 2a view in 22 without and 12 with, Class 2b in 2 without, and Class 3 in 2 without manipulation. The median time taken for tracheal intubation was 16 s (range, 6–58 s). In addition, we describe our experience with 3 patients in whom we had unexpected difficulty with direct laryngoscopy with a conventional Macintosh laryngoscope (Cormack-Lehane Class 3, 4, and 4, respectively). These patients' airways were successfully managed on the first attempt when using the C-MAC Size 4 blade (improvement to Cormack-Lehane Class 1, 2a, and 2b, respectively) in a modified manner by uploading the epiglottis, which is known as “straight blade technique.”

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Tracheal intubation using direct laryngoscopy is successful in the majority of patients, even when a line-of-sight view of the glottis is not possible. Although poor glottic visualization is encountered between 1% and 9% of attempts,1,2 success can generally be achieved with additional force, external laryngeal manipulation, or the use of gum elastic bougies and stylets. However, poor glottic exposure is more likely to require prolonged or multiple intubation attempts and, subsequently, may be associated with complications such as oxygen desaturation or airway and dental injuries. In recent years, videolaryngoscopy has begun to play an important role in the management of patients with an unanticipated difficult or failed laryngoscopic intubation.3 Some videolaryngoscopes (e.g., GlideScope® and McGrath®) do not provide visualization of the tip of the blade and, therefore, demand a tube stylet to guide the endotracheal tube through the glottis. 

 The C-MAC® videolaryngoscope (Karl Storz, Tuttlingen, Germany) is a new videolaryngoscope using a modified Macintosh blade, which may be a useful alternative both for routine and difficult airway management and for educational purposes. In this study, we describe for the first time the use of the C-MAC videolaryngoscope for tracheal intubation in 60 patients during routine induction of anesthesia. 

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