Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis.

STUDY OBJECTIVE: Videolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity.

DESIGN: Systematic review, Meta-analysis SETTING: Operating room, Obesity patients MEASUREMENTS: Data on success rate, intubation time, and glottic visualisation during tracheal intubation were extracted from the identified studies. In a subgroup analysis, we also compared the parameters for videolaryngoscopes with a tracheal tube guide channel and those without a tracheal tube guide channel. Data from individual trials were combined, and the DerSimonian and Laird random-effect model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) as well as the corresponding 95% confidence intervals (CI).

MAIN RESULTS: Eleven articles describing 13 trials met the inclusion criteria. The performance of videolaryngoscopes was superior to that of the Macintosh laryngoscope for all outcomes. (Success rate; RR=1.11, 95% CI 1.04 to 1.18, p=0.001, I2 =63%, Intubation time; WMD=-16.1, 95% CI -31.1 to -1.10, p=0.04, I2 =97%, Glottic visualisation; RR=1.19, 95% CI 1.09 to 1.30, p<0.0001, I2 =76%) In the subgroup analysis, the performance of both types of videolaryngoscopes (with and without a tracheal tube guide channel) was superior to that of the Macintosh laryngoscope, except for intubation time with the videolaryngoscopes without a tracheal tube guide channel.

CONCLUSIONS: Videolaryngoscopes were superior to the Macintosh laryngoscope for tracheal intubation in adults with obesity. (GRADE score: low or very low.).