Journal of Clinical and Diagnostic Research. 2022 Mar, Vol-16(3): UC05-UC10 5 5 DOI: 10.7860/JCDR/2022/53696.16070 Original Article Anaesthesia Section Comparative Evaluation of King Vision Video Laryngoscope, McCoy and Macintosh Laryngoscopes in Patients Scheduled for Mucormycosis Surgery: A Randomised Clinical Trial INTRODUCTION Mucormycosis is an aggressive angio-invasive infection of immunocompromised patients [1]. The estimated prevalence of mucormycosis in India is nearly 70 times that of worldwide data, at a median of 0.2 cases per 100,000 persons [2]. Rhino-Orbital Cerebral Mucormycosis (ROCM) is the frequently encountered variant, invading hard palate, paranasal sinuses, orbit and brain. An anaesthesiologist may encounter difficult mask ventilation and endotracheal intubation as a result of fungal debris in the oropharyngeal region, epiglottitis and supraglottic oedema [3]. Anaesthesiologists have many devices in their arsenal to manage a difficult airway, ranging from direct laryngoscopy with gum elastic bougie, lighted stylet, mcCoy laryngoscope, intubating laryngeal mask airway, fiber optic bronchoscope and various video laryngoscopes. There is an ongoing quest for new devices to facilitate optimal difficult airway management. McCoy improves glottic visualisation by virtue of its hinged tip which elevates epiglottis, requiring less neck movement and external laryngeal manipulation [4]. The KVVL with a light emitting diode and camera as part of the blade which may be a standard- non channeled requiring the use of a stylet to direct the tube, or a channeled, blade incorporating a guide channel for Endotracheal Tube (ETT) towards glottis [5]. Conventional macintosh laryngoscope is the gold standard for endotracheal intubation. It is the most ubiquitously used device despite vast advances in anaesthesia. There are similar researches in literature, pertaining to the aforementioned three devices, in predicted difficult, normal as well as simulated airway scenarios. Several studies observed that video laryngoscopes perform better than others [4,6-10] in aiding endotracheal intubation. Studies that outline the management of airways that are made challenging due to various infective pathologies including mucormycosis have been published [3,11]. However, a comparison of intubation devices to evaluate their relative performance in this subgroup of patients has been lacking. Therefore, this study aimed at comparing KVVL, mcCoy, macintosh in patients with ROCM undergoing surgical debridement at the study institute, with the aim to ascertain the relative performance of one over the other. Primary outcome MICHELL GULABANI 1 , VIBHOR GUPTA 2 , RICHA CHAUHAN 3 , SUMAN CHOUDHARY 4 , ASHOK KUMAR SAXENA 5 , PRERNA VASUDEV 6 Keywords: Airway, Anaesthesia, Glottis, Haemodynamics, Intratracheal ABSTRACT Introduction: Mucormycosis, an aggressive fungal infection may result in a difficult airway owing to its inflammation. King Vision Video Laryngoscope (KVVL) is a useful addition to a difficult airway armamentarium. McCoy laryngoscope with hinged tip is well-known equipment of difficult airway cart. Conventional Macintosh laryngoscope dominates in anaesthesia practice. Standard, existing and contemporary devices were compared in difficult airways resulting from mucormycosis. Aim: To compare the relative performance of KVVL, McCoy, and Macintosh laryngoscopes based on the ease of intubation and haemodynamic response in patients with mucormycosis. Materials and Methods: The present study was a randomised clinical trial done during June-August 2021 on 90 consenting patients of 18-65 years age, belonging to either sex with microbiologically confirmed mucormycosis undergoing debridement surgery. Group A was intubated with a non channeled KVVL, while group B had McCoy and group C had Macintosh laryngoscope. Primary outcome parameters were Cormack Lehane (CL) grade, time from laryngoscopy to successful intubation, number of attempts, any adjuncts or optimisation maneuvers, and any mucosal injury. Secondary outcome parameters were Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Blood Pressure (MBP) measured on arrival, before induction, after induction, and at 1, 2, 3, 5, and 7 minutes after intubation. Comparison of quantitative variables not normally distributed were analysed using Kruskal Wallis test. Post-hoc analysis by Dunn's multiple pairwise comparison test. Friedman test followed by pairwise comparison was done to compare haemodynamic parameters within each group. Chi-square test was used for qualitative variables. The p-value ≤0.05 was considered to be statistically significant. Results: CL grade was lowest in group B (1.83±0.38) against group A (1.93±0.25), group C (2.13±0.35) with p-value of 0.029. Time from laryngoscopy to successful intubation was the least in group B (19.5±3.98) against group A (26.07±9.8), group C (21.33±3.74) with p-value of 0.002. No significant difference was there in the number of attempts, airway adjuncts/optimisation maneuvers, mucosal injury. Haemodynamic variables were comparable. Conclusion: McCoy laryngoscope was found to perform best in difficult airways resulting from mucormycosis. It was most effective for glottic visualisation, with the shortest time to successful intubation and, haemodynamic parameters were comparable to KVVL and Macintosh laryngoscopes.