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A comparison of McGrath MAC, AIRWAY SCOPE®, and AceScope® video laryngoscopes in novice healthcare providers: a randomized crossover simulation study

BMC Anesthesiology volume 25, Article number: 212 (2025) Cite this article

Abstract

Background

Video laryngoscopes are widely used for tracheal intubation, particularly in challenging airway scenarios. The McGrath MAC, AIRWAY SCOPE®, and AceScope® are popular video laryngoscopes with different design features. This study aimed to compare the effectiveness and usability of these three devices in novice healthcare providers during simulated tracheal intubation scenarios employing a manikin.

Methods

Sixty novice healthcare providers, including nurses and pharmacists, were enrolled in this randomized crossover study. Participants performed tracheal intubation using the McGrath MAC, AIRWAY SCOPE, and AceScope in both normal airway and cervical spine immobilization models. Primary outcomes were intubation success rate and time to intubation. Secondary outcomes included user preferences, device ease of use, and the incidence of dental injuries.

Results

The AIRWAY SCOPE demonstrated the shortest intubation time in both normal airway and cervical spine immobilization models (14.90 ± 1.76 s and 23.80 ± 2.43 s, respectively), followed by the McGrath MAC and AceScope. All devices exhibited high success rates, and there were no significant differences in perceived difficulty among the three video laryngoscopes. The incidence of dental injuries was generally comparable among the devices. However, in the cervical spine immobilization model, the AceScope demonstrated a significantly higher rate of dental injuries compared to the McGrath MAC (p < 0.05), highlighting a potential concern for clinical practice.

Conclusions

The AIRWAY SCOPE was the most efficient video laryngoscope in terms of intubation time, followed by the McGrath MAC and AceScope. However, all devices showed high success rates and no significant differences in perceived difficulty. Further research is needed to validate these findings in clinical settings and investigate the impact of device-specific features on intubation outcomes and dental injury incidence.

Trial registration

Registration number: jRCT1030240598 (https://jrct.niph.go.jp/re/reports/detail/91422) The registration date of the clinical trial is January 8, 2025.UMIN000050394.

Peer Review reports

Introduction

Video laryngoscopes have significantly improved tracheal intubation by providing enhanced airway visualization, particularly in difficult airway scenarios. Recent guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) emphasize the necessity of thorough airway assessment and the utilization of advanced airway management devices, including video laryngoscopes, to optimize perioperative airway management [1].

While previous studies have evaluated the efficacy of McGrath MAC and AIRWAY SCOPE® (Pentax Corporation, Tokyo, Japan) in various clinical scenarios, limited data exist on their comparative performance when used by novice healthcare providers [2]. Furthermore, the AceScope, a newly developed video laryngoscope integrating design elements from both devices, has not been extensively studied in this population. This study is the first to systematically compare these three video laryngoscopes in novice users, assessing their impact on procedural efficiency, intubation success rates, and ease of use. By focusing on this underexplored aspect, our findings may contribute to optimizing device selection and training strategies in airway management education.

The McGrath MAC (Aircraft Medical Ltd, Scotland, United Kingdom) and are two widely used video laryngoscopes that have demonstrated efficacy in facilitating tracheal intubation across various clinical settings [3, 4, 5, 6]. The McGrath MAC has been shown to provide superior glottic visualization and higher intubation success rates in both routine and difficult airway scenarios, making it a preferred device among both novice and experienced clinicians [3, 4, 5]. Notably, previous studies have reported that the McGrath MAC significantly reduces intubation time and enhances first-attempt success rates compared to direct laryngoscopy, particularly in simulated difficult airways [3, 4, 5]. The AIRWAY SCOPE, incorporating an integrated guide rail system and disposable blade, has been particularly advantageous in scenarios involving limited mouth opening or restricted neck mobility, demonstrating high success rates even in patients with challenging airway anatomy. Clinical studies have reported a first-attempt intubation success rate 100% with the AIRWAY SCOPE in patients with restricted neck movement, outperforming conventional direct laryngoscopy [6]. These devices have established a standard in video laryngoscopy, against which newer devices, such as the AceScope® (IMI Co., Ltd., Seoul, Korea), are now being evaluated [7, 8].

The AceScope is a novel video laryngoscope that integrates the enhanced glottic visualization of the McGrath MAC with the AIRWAY SCOPE’s disposable blade and guide rail system [7, 8]. It features an improved angle adjustment mechanism for optimized glottic exposure, a lightweight design to reduce operator fatigue, and an ergonomically positioned monitor to enhance usability. These refinements are intended to improve maneuverability and facilitate intubation, particularly for novice healthcare providers. However, despite its innovative design, limited clinical evidence exists regarding the comparative effectiveness and usability of the AceScope relative to other established video laryngoscopes [7, 8].

Video laryngoscopes are widely utilized for tracheal intubation, particularly among novice healthcare providers, making their usability in this population clinically relevant. Studies indicate that novice users face a steeper learning curve with video laryngoscopy than with direct laryngoscopy, highlighting the need for intuitive device design [9, 10]. This study evaluates whether the AceScope’s novel features improve usability, reduce procedural errors, and accelerate proficiency acquisition in airway management, with potential implications for medical education and training [7, 8].

This study aims to evaluate and compare the performance of the AceScope, McGrath MAC, and AIRWAY SCOPE in terms of intubation success rate and time to intubation in simulated tracheal intubation scenarios performed by novice healthcare providers using a manikin model. Additionally, user preferences and device usability will be assessed as secondary outcomes in both simulated normal and difficult airway conditions. Given the increasing reliance on video laryngoscopy in contemporary airway management, this study seeks to provide valuable insights into whether the AceScope offers distinct advantages over established video laryngoscopes, potentially influencing future clinical practice and airway management training protocols [7, 8].

Materials and methods

After obtaining approval from the Ethics Committee of Hitachi General Hospital (Approval No. 2023-22, Clinical Research Registry No. jRCT1030240598), written informed consent was secured from 60 nurses and pharmacists lacking prior tracheal intubation experience to participate in this randomized crossover study. The novices received verbal and demonstrative instruction from a board-certified anesthesiologist in Japan on the utilization of three types of video laryngoscopes (McGrath MAC, AIRWAY SCOPE, and AceScope). A malleable stylet was inserted into the endotracheal tube (ETT) and bent into a “field hockey stick” shape for intubation with the McGrath MAC [9, 10]. In this study, two types of airway management simulators, the Laerdal Airway Management Trainer (Laerdal Medical, Stavanger, Norway), were prepared: a “normal airway model” that allowed subjects to freely and arbitrarily adjust the simulator’s inherent head extension angle, and a “Cervical Spine Immobilization Model,” which was a custom-made difficult airway version created by the principal investigator [11, 12]. The latter involved modifying the Laerdal Airway Management Trainer by securing an adult-sized cervical spine protection collar (Philadelphia Collar, Ossur, Reykjavík, Iceland) tightly around the simulator’s neck, thereby completely restricting head extension. This modification simulated a difficult airway scenario where manual in-line stabilization was applied, mimicking clinical conditions in patients with cervical spine injuries. Subsequently, participants were provided with five minutes of free training time for each device. Previous research has established that a brief training period, such as five minutes, is adequate for novice operators to attain fundamental proficiency in video laryngoscopy [13, 14]. This timeframe was selected due to its practicality in clinical settings and its prior validation in comparable studies. Following the five minutes training session, participants were required to perform tracheal intubation within two minutes using each device. Each participant was allowed up to three attempts per device. Failure to achieve successful tracheal intubation with at least one device within three attempts resulted in exclusion from the study. A randomized sequence of the six intubation scenarios was generated using a web-based randomization tool (https://www.random.org), ensuring that each value appeared once without duplication. An independent physician, uninvolved in the tracheal intubation demonstrations, conducted the randomization to ensure unbiased allocation and enhance study reproducibility. The scenarios included: (1) intubation with McGrath MAC in a normal airway model, (2) intubation with McGrath MAC in a cervical immobilization model, (3) intubation with AIRWAY SCOPE in a normal airway model, (4) intubation with AIRWAY SCOPE in a cervical immobilization model, (5) tracheal intubation using AceScope in a normal airway model, and (6) tracheal intubation using AceScope in a cervical immobilization model. During tracheal intubation scenarios, participants were allowed to request assistance from a supervising anesthesiologist at their discretion, beginning 30 s after initiating the procedure [15].

In this study, intubation assistance was defined as any external intervention provided by the supervising anesthesiologist to facilitate tracheal intubation. Assistance was classified into three categories based on the nature and degree of intervention:

Device Hold: The anesthesiologist stabilized the video laryngoscope alongside the participant to optimize glottic visualization and improve device control.

Device Replacement: If the participant failed to obtain an adequate glottic view, the anesthesiologist removed and reinserted the device, after which the participant resumed control and continued the intubation attempt.

Head Repositioning: The anesthesiologist manually adjusted the participant’s head position (e.g., head extension) to optimize airway alignment while the participant continued to manipulate the video laryngoscope independently.

Participants who were unable to complete tracheal intubation within two minutes were permitted to request assistance. This structured assistance framework was designed to evaluate the usability and clinical applicability of each video laryngoscope under simulated conditions. All instances of intubation assistance were systematically recorded by independent observers. The frequency and type of assistance provided were analyzed to assess device usability, operator performance, and procedural efficiency. The number of instances in which the assistant provided aid was recorded. However, assistants were not allowed to touch the ETT. Upon completing all six scenarios, participants rated the ease of tracheal intubation for each device on a visual analog scale, with 0 signifying “extremely easy” and 10 denoting “extremely difficult.”

The primary endpoint in this study was the duration of successful tracheal intubation. Intubation time was defined as the interval from the blade’s entry between the teeth until the ETT was connected to the bag-valve mask and the model lung inflated [13, 16]. The tracheal intubation procedures were recorded laterally, focusing on the participants’ hand movements. A high-resolution video recording was conducted using an iPhone 13 Pro (Apple Inc., Cupertino, CA, USA) to ensure precise documentation of the intubation process. The position of the ETT tip was verified by the principal investigator following each intubation. Failure of intubation was defined as a time delay exceeding 120 s or inflation of the model stomach without inflating the model lung when utilizing the bag-valve mask. Secondary endpoints included the frequency of assistance required for successful intubation and the incidence of dental injuries (audible maxillary teeth clicking sounds) [17].

Sample size calculations for this study were based on previous research comparing video laryngoscopes [13, 16, 18]. Assuming an average intubation time of 40 s with a standard deviation of 10 s, a sample size of 7 participants per group was determined to be necessary for detecting a minimum difference of 10 s in intubation time between groups, with a statistical power of 0.80 and an alpha level of 0.05. To account for potential dropouts and ensure an adequate sample size for each of the three devices, the study aimed to enroll 60 novice healthcare providers, comprising both nurses and pharmacists.

Statistical analysis

Statistical analyses were conducted using Stata version 17.1 (StataCorp, College Station, TX, USA). Data normality was assessed using the Shapiro-Wilk test. As intubation time data were normally distributed, they were presented as means ± standard deviations. Differences in intubation time among devices were analyzed using repeated measures analysis of variance (ANOVA), followed by post-hoc tests with Bonferroni correction. Primary outcome measures included intubation times for each device in every scenario. Secondary outcome measures encompassed user preferences and ease of use for each device based on visual analog scale scores, the incidence of dental injuries, and the frequency of assistance required during intubation procedures. These outcomes were analyzed using descriptive statistics, such as means and standard deviations for continuous variables and proportions for categorical variables. The statistical significance of differences in outcomes among devices was determined using ANOVA or chi-square tests, as appropriate. Post-hoc comparisons were performed using Bonferroni-corrected pairwise comparisons, with a significance level set at p < 0.05. All statistical tests were two-tailed.

Results

The study involved 60 healthcare professionals with a median age of 32 years (interquartile range: 26–42 years), consisting of 35% males and 65% females, and including 71.7% nurses and 28.3% pharmacists. Novice operators performed tracheal intubation with each device, and a repeated measures ANOVA was conducted on the intubation times for the three groups among 55 participants. Prior to the study, all fifty-five participants successfully completed tracheal intubation in all six scenarios after receiving a 5-minute demonstration and 15 min of hands-on training (5 min per device). Five participants were excluded due to difficulties handling the devices in the cervical spine immobilization model: three were unable to independently perform tracheal intubation using AceScope, and two were unable to independently perform tracheal intubation using McGrath MAC.

In the normal airway model, the analysis revealed a significant effect of the device on intubation time (F(2, 54) = 8.358, p = 0.0002). The mean intubation times (SD) for the McGrath MAC, AIRWAY SCOPE, and AceScope groups were 18.67 (1.44), 14.90 (1.76), and 24.16 (2.49) seconds, respectively. Post-hoc comparisons using the Bonferroni correction demonstrated significant differences in intubation time between the McGrath MAC and AIRWAY SCOPE groups (p < 0.05), and between the AIRWAY SCOPE and AceScope groups (p < 0.05), but not between the McGrath MAC and AceScope groups (p > 0.05). In the cervical spine immobilization model, the repeated measures ANOVA indicated a significant effect of the device on intubation time (F(2, 57) = 7.04, p = 0.0007). The mean intubation times (SD) for the McGrath MAC, AIRWAY SCOPE, and AceScope groups were 26.33 (2.06), 23.80 (2.43), and 33.38 (2.50) seconds, respectively, with significant differences in intubation time among all three groups (McGrath MAC vs. AIRWAY SCOPE: p < 0.05, McGrath MAC vs. AceScope: p < 0.05, AIRWAY SCOPE vs. AceScope: p < 0.05) (Fig. 1 and 2).

Fig. 1
figure 1

Comparison of three video laryngoscope models and their corresponding disposable plastic blades. a: A collective view of the three video laryngoscopes, arranged from left to right: McGrath MAC, AceScope, and AIRWAY SCOPE. b: The disposable plastic blades compatible with each of the three video laryngoscopes, displayed from left to right: McGrath MAC blade (size #3, blade effective length 114 mm), AceScope blade (size #3, blade effective length 133.4 mm), and AIRWAY SCOPE blade (Depth 95 mm, Height 134 mm, Width 52 mm)

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Fig. 2
figure 2

Six box-and-whisker plots illustrating intubation times in seconds for six scenarios involving McGrath MAC, AIRWAY SCOPE, and AceScope video laryngoscope in normal airway and cervical immobilization models. Scenario (1) intubation with McGrath MAC in a normal airway model, (2) intubation with McGrath MAC in a cervical immobilization model, (3) intubation with AIRWAY SCOPE in a normal airway model, (4) intubation with AIRWAY SCOPE in a cervical immobilization model, (5) tracheal intubation using AceScope in a normal airway model, and (6) tracheal intubation using AceScope in a cervical immobilization model. In the normal airway model, significant differences were observed between McGrath MAC and AIRWAY SCOPE (p < 0.05) and AIRWAY SCOPE and AceScope (p < 0.05), but not between McGrath MAC and AceScope (p > 0.05). In the cervical spine immobilization model, significant differences in intubation time were found among all three groups (McGrath MAC vs. AIRWAY SCOPE: p < 0.05, McGrath MAC vs. AceScope: p < 0.05, AIRWAY SCOPE vs. AceScope: p < 0.05)

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Table 1 presents the outcomes of the study, examining the success rates for intubation, the necessity for intubation assistance, and the incidence of dental injuries (quantified by the number of clicks) for each scenario. In this study, all three video laryngoscopes—McGrath MAC, AIRWAY SCOPE, and AceScope—were utilized for tracheal intubation in both normal airway and cervical spine immobilization models. In scenario 4, a single case of esophageal intubation occurred, while in scenario 6, there were two instances of esophageal intubation and time up.

Table 1 Outcomes of a study investigating endotracheal intubation scenarios utilizing various videolaryngoscopes
Full size table

Participants assessed the difficulty of tracheal intubation using each device on a visual analog scale (VAS), and no significant differences in VAS ratings were observed among the devices (Fig. 3). No significant differences in dental injury incidence were found among the McGrath MAC, AIRWAY SCOPE and AceScope in both normal and cervical spine immobilization models, except for a notable difference in dental injury rate between the AceScope and McGrath MAC in scenario 6 (23.6%, p = 0.04) (Table 1).

Fig. 3
figure 3

the box-and-whisker plots delineating the perceived ease of use for the McGrath MAC, AIRWAY SCOPE, AceScope video laryngoscopes, as assessed by 60 participants employing a Visual Analog Scale (VAS). Upon completion of all six scenarios, the participants evaluated the facility of tracheal intubation for each of the three devices utilizing a VAS, where a score of 0 signified “extremely easy” and 10 indicated “highly challenging”. The comparative analysis revealed no statistically significant differences among the three devices concerning their ease of use. McGrath MAC: Median VAS score = 6 (IQR: 4–8), AIRWAY SCOPE: Median VAS score = 7 (IQR: 5–9), AceScope: Median VAS score = 6 (IQR: 4–8)

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Discussion

This study aimed to compare the effectiveness and usability of McGrath MAC, AIRWAY SCOPE, and AceScope video laryngoscopes during simulated tracheal intubation scenarios in novice healthcare providers. Our results demonstrated significant differences in intubation times among the three devices in both normal and cervical spine immobilization models. In the normal airway model, the AIRWAY SCOPE had the shortest intubation time, followed by the McGrath MAC and AceScope. In the cervical spine immobilization model, intubation times were significantly longer, with the AIRWAY SCOPE remaining the fastest, followed by the McGrath MAC and AceScope.

These findings suggest that the AIRWAY SCOPE may be more efficient than the other two devices, particularly in challenging airway situations. This could be attributed to the AIRWAY SCOPE’s unique design, which features a disposable blade and guide rail system that facilitates smooth endotracheal tube insertion [19, 20]. Previous studies have also reported the AIRWAY SCOPE’s superiority in terms of intubation time compared to other video laryngoscopes [21, 22, 23, 24]. While the AIRWAY SCOPE demonstrated the shortest intubation time, the differences, although statistically significant, may not necessarily impact clinical outcomes in scenarios where rapid intubation is not critical. Previous studies have also indicated that differences in intubation time of less than 10–15 s may not translate into clinically relevant benefits, particularly in controlled settings [25, 26, 27]. However, in emergent situations requiring immediate airway management, even small differences in intubation time may contribute to improved patient safety, particularly in cases of hypoxia or hemodynamic instability. Further studies evaluating these factors in real-world clinical settings are warranted.

In terms of secondary outcomes, our study found that novice users reported similar levels of difficulty using three different video laryngoscopes based on their assessments using a visual analog scale (VAS). However, it should be noted that healthcare providers with varying levels of experience may have different experiences with these devices. Notably, the AceScope’s user-friendly design may make it easier to use, underscoring the importance of appropriate training and practical experience in increasing healthcare providers’ confidence and comfort when using these devices [28, 29].

The incidence of dental injuries was comparable among the McGrath MAC, AIRWAY SCOPE, and AceScope in both normal airway and cervical spine immobilization models, with the exception of a significant difference between the AceScope and McGrath MAC in scenario 6. The higher dental injury incidence associated with the AceScope in scenario 6 may be attributed to its blade design, which requires a more pronounced lifting force for adequate glottic visualization [17]. Additionally, novice users unfamiliar with the device’s handling may have applied excessive force, leading to unintended maxillary contact. Previous studies have reported similar trends with video laryngoscopes featuring rigid blades and unfamiliar handling mechanics [30, 31]. Strategies such as extended training, alternative insertion angles, or modified blade designs may help mitigate this risk. Future investigations assessing the impact of operator experience on dental injury rates will be valuable in further clarifying this issue. While the differences in dental injury rates observed in this study were minimal, further investigation into the factors contributing to these discrepancies may help identify strategies to reduce dental injury risk during intubation [32].

The AceScope is a novel video laryngoscope that combines the most advantageous features of the McGrath MAC and AIRWAY SCOPE, providing a lightweight design that facilitates ease of use and maneuverability [7, 8]. Although the AceScope demonstrated longer intubation times in both normal and cervical spine immobilization models compared to the other devices, it is crucial to consider that the differences may not be clinically significant, given that all devices achieved high first-attempt success rates exceeding 90% in both models (Fig. 2). This finding suggests that, despite variations in intubation time, all three video laryngoscopes are effective for airway management in novice users. Notably, the AIRWAY SCOPE demonstrated the highest first-attempt success rate across all scenarios, aligning with its previously reported advantages in glottic visualization and guided endotracheal tube insertion. Future studies should further explore how device-specific features influence success rates, particularly in challenging airway conditions. The AceScope’s blade shape is similar to that of the McGrath MAC, and its guide rail system is reminiscent of the unique feature of the AIRWAY SCOPE. These design features may potentially facilitate smooth endotracheal tube insertion and optimal glottic visualization. However, additional investigation is necessary to assess the effects of these characteristics on intubation outcomes. It is worth noting that the AceScope’s longer intubation times may result from its unique design, which may require novices to adjust to a new technique, leading to longer intubation times. Subsequent studies should evaluate the effectiveness of the AceScope among providers with varying levels of experience to determine whether it offers any distinct advantages over the other two video laryngoscopes. Overall, the AceScope’s innovative design warrants further investigation to determine its potential role in airway management strategies.

This study has some limitations that should be acknowledged. Firstly, the use of a manikin model may not fully represent the complexities and challenges of intubating human subjects, particularly in difficult airway scenarios [12, 17, 19, 22, 24, 33, 34]. Therefore, the generalizability of our findings to clinical practice should be approached cautiously. Secondly, the study only involved novice healthcare providers, and the results may not be applicable to experienced providers [12, 35]. Future studies should examine the performance of these devices among providers with varying levels of experience to determine their effectiveness across a broader spectrum of healthcare professionals.

In conclusion, our findings demonstrate that the AIRWAY SCOPE was the most efficient video laryngoscope in terms of intubation time, both in normal airway and cervical spine immobilization models, followed by the McGrath MAC and AceScope. However, all devices exhibited high success rates, and there were no significant differences in perceived difficulty among the three video laryngoscopes. Further research is needed to validate these findings in clinical settings and investigate the impact of device-specific features on intubation outcomes, as well as dental injury incidence.

Data availability

The data that support the findings of this study are not publicly available due to restrictions related to patient privacy and confidentiality. However, de-identified data supporting the results of this manuscript is available from the corresponding author (Musashi Yahagi, musasum0710@yahoo.co.jp) upon reasonable request and with the approval of the institutional ethics review board of Hitachi General Hospital.

References

  1. Lamperti M, Romero CS, Guarracino F, Cammarota G, Vetrugno L, Tufegdzic B, Lozsan F, Macias Frias JJ, Duma A, Bock M, Ruetzler K, Mulero S, Reuter DA, La Via L, Rauch S, Sorbello M, Afshari A. Preoperative assessment of adults undergoing elective noncardiac surgery: updated guidelines from the European society of anaesthesiology and intensive care. Eur J Anaesthesiol. 2025;42(1):1–35. Epub 2024 Nov 2. PMID: 39492705.

    Article  PubMed  Google Scholar 

  2. Sansone P, Giaccari LG, Bonomo A, Gargano F, Aurilio C, Coppolino F, Passavanti MB, Pota V, Pace MC. Comparison of McGrath videolaryngoscope versus macintosh laryngoscope in tracheal intubation: an updated systematic review. J Clin Med. 2023;12(19):6168. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/jcm12196168. PMID: 37834812; PMCID: PMC10573091.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Szarpak L, Truszewski Z, Czyzewski L, Gaszynski T, Rodríguez-Núñez A. A comparison of the McGrath-MAC and macintosh laryngoscopes for child tracheal intubation during resuscitation by paramedics. A randomized, crossover, manikin study. Am J Emerg Med. 2016;34(8):1338–41. Epub 2015 Nov 23. PMID: 26712571.

    Article  PubMed  Google Scholar 

  4. Korkut S, Szarpak L, Evrin T, Smereka J, Katipoğlu B, Gorczyca D. Comparison of the McGrath MAC EMS videolaryngoscope with a conventional laryngoscope for standard and difficult airway intubation: A randomized, Cross-over, simulation trial. Eurasian J Emerg Med. 2019;18(4):211–7. https://doiorg.publicaciones.saludcastillayleon.es/10.4274/eajem.galenos.2019.02360.

    Article  Google Scholar 

  5. Komatsu R, Kamata K, Sessler DI, Ozaki M. A comparison of the airway scope and McCoy laryngoscope in patients with simulated restricted neck mobility. Anaesthesia. 2010;65(6):564–8. Epub 2010 Apr 12. PMID: 20412151.

    Article  CAS  PubMed  Google Scholar 

  6. Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: a Cochrane systematic review and meta-analysis update. Br J Anaesth. 2022;129(4):612–23. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.bja.2022.05.027. Epub 2022 Jul 9. PMID: 35820934; PMCID: PMC9575044.

    Article  PubMed  PubMed Central  Google Scholar 

  7. IMI Corporation. AceScope. IMI corporation, www.imimed.co.jp/medical/product/vent_related/acescope/

  8. Jo WY, Choi JH, Kim J, Shin KW, Choi S, Park HP, Oh H. Cervical spine motion during videolaryngoscopic intubation using a Macintosh-style blade with and without the anterior piece of a cervical collar: a randomized controlled trial. Can J Anaesth. 2024 Oct 14. English. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s12630-024-02849-4. Epub ahead of print. PMID: 39402414.

  9. Wakabayashi R, Shiko Y, Kodaira T, Shiroshita Y, Otsuka H, Baba K, Hishinuma N. Efficacy of stylet angulation at the holding position during tracheal intubation with a videolaryngoscope: a randomized controlled trial. Sci Rep. 2021;11(1):20713. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41598-021-00115-x. PMID: 34671041; PMCID: PMC8528812.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kim YJ, Hur C, Yoon HK, Lee HC, Park HP, Oh H. Effects of external laryngeal　manipulation on cervical spine motion during videolaryngoscopic intubation under　manual In-Line stabilization: A randomized crossover trial. J Clin Med. 2021 Jun　30;10(13):2931. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/jcm10132931. PMID: 34208825; PMCID: PMC8268206.

  11. Geraghty LE, Dunne EA, Ní Chathasaigh CM, Vellinga A, Adams NC, O’Currain EM, McCarthy LK, O’Donnell CPF. Video versus direct laryngoscopy for urgent intubation of newborn infants. N Engl J Med. 2024;390(20):1885–94. https://doiorg.publicaciones.saludcastillayleon.es/10.1056/NEJMoa2402785. Epub 2024 May 5. PMID: 38709215.

    Article  PubMed  Google Scholar 

  12. Aghamohammadi H, Massoudi N, Fathi M, Jaffari A, Gharaei B, Moshki A. Intubation learning curve: comparison between video and direct laryngoscopy by inexperienced students. J Med Life. 2015;8(Spec Iss 4):150–3. PMID: 28316722; PMCID: PMC5319281.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Nalubola S, Jin E, Drugge ED, Weber G, Abramowicz AE. Video versus direct laryngoscopy in novice intubators: A systematic review and Meta-Analysis. Cureus. 2022;14(9):e29578. https://doiorg.publicaciones.saludcastillayleon.es/10.7759/cureus.29578. PMID: 36312614; PMCID: PMC9595268.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kaplan HS, Üney İH. The effects of McGrath® MAC video laryngoscope-assisted education on the endotracheal intubation practices of undergraduate anesthesia medicine students: A randomized, controlled attempt. East J Med. 2021;26(1):80–5. https://doiorg.publicaciones.saludcastillayleon.es/10.5505/ejm.2021.75768.

    Article  Google Scholar 

  15. Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2018;275(3):679–90. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00405-017-4838-7. Epub 2017 Dec 19. PMID: 29255970.

    Article  PubMed  Google Scholar 

  16. Roh GU, Kwak HJ, Lee KC, Lee SY, Kim JY. Randomized comparison of McGrath MAC　videolaryngoscope, Pentax Airway Scope, and Macintosh direct laryngoscope for　nasotracheal intubation in patients with manual in-line stabilization. Can J Anaesth. 2019;66(10):1213–1220. English. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s12630-019-01409-5.Epub 2019 May 29. PMID: 31144258.

  17. Oh JY, Lee JH, Kim YY, Baek SM, Jung DW, Park JH. A comparative study of glottis visualization according to the method of lifting the epiglottis in video laryngoscopy: indirect and direct lifting methods. Anesth Pain Med (Seoul). 2021;16(2):196–200. https://doiorg.publicaciones.saludcastillayleon.es/10.17085/apm.20073. Epub 2021 Apr 8. PMID: 33845551; PMCID: PMC8107246.

    Article  PubMed  Google Scholar 

  18. Komasawa N, Hattori K, Mihara R, Minami T. Direct laryngoscopy training is important for videolaryngoscopy skill acquisition. Br J Anaesth. 2017;118(2):269–70. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/bja/aew458.

    Article  CAS  PubMed  Google Scholar 

  19. Guo N, Wen X, Wang X, Yang J, Zhou H, Guo J, Su Y, Zhang T. Comparison of outcomes between video laryngoscopy and flexible fiberoptic bronchoscopy for endotracheal intubation in adults with cervical neck immobilization: A systematic review and meta-analysis of randomized controlled trials. PLoS ONE. 2024;19(11):e0313280. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/journal.pone.0313280. PMID: 39546549; PMCID: PMC11567517.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Belze O, Coppere Z, Ouattara J, Thion LA, Paqueron X, Devys JM, Ma S, Kennel T, Fischler M, Le Guen M. Influence of videolaryngoscopy using McGrath Mac on the need for a helper to perform intubation during general anaesthesia: a multicentre randomised video-no-video trial. BMJ Open. 2022;12(1):e049275. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmjopen-2021-049275. PMID: 34980609; PMCID: PMC8724720.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Goto T, Koyama Y, Kondo T, Tsugawa Y, Hasegawa K. A comparison of the force applied on oral structures during intubation attempts between the Pentax-AWS airwayscope and the macintosh laryngoscope: a high-fidelity simulator-based study. BMJ Open. 2014;4(10):e006416. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmjopen-2014-006416. PMID: 25296656; PMCID: PMC4194748.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kotera A, Irie H, Iwashita S, Taniguchi J, Kasaoka S, Kinoshita Y. Comparison of the conventional Macintosh laryngoscope, the Pentax Airwayscope, and the McGrath MAC video laryngoscope under restricted cervical motion: a manikin study. Acute Med Surg., Asai T, Enomoto Y, Okuda Y. Airway scope for difficult intubation. Anaesthesia 2007; 62:199.

  23. Teoh WH, Saxena S, Shah MK, Sia AT. Comparison of three videolaryngoscopes: pentax airway scope, C-MAC, glidescope vs the macintosh laryngoscope for tracheal intubation. Anaesthesia. 2010;65(11):1126–32. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1365. Epub 2010 Sep 30. PMID: 20883502.

    Article  CAS  PubMed  Google Scholar 

  24. Kim JK, Kim JA, Kim CS, Ahn HJ, Yang MK, Choi SJ. Comparison of tracheal intubation with the airway scope or Clarus video system in patients with cervical collars. Anaesthesia. 2011;66(8):694–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1365-2044.2011.06762.x. Epub 2011 May 13. PMID: 21564045.

    Article  CAS  PubMed  Google Scholar 

  25. Tsai P, Chen B. Hemodynamic responses to endotracheal intubation comparing the Airway Scope®, Glidescope®, and Macintosh laryngoscopes. Internet J Anesthesiol. 2009;24(2).

  26. Kim JG, Ahn C, Kim W, Lim TH, Jang BH, Cho Y, Shin H, Lee H, Lee J, Choi KS, Na MK, Kwon SM. Comparison of video laryngoscopy with direct laryngoscopy for intubation success in critically ill patients: a systematic review and bayesian network meta-analysis. Front Med (Lausanne). 2023;10:1193514. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/fmed.2023.1193514. PMID: 37358992; PMCID: PMC10289197.

    Article  PubMed  Google Scholar 

  27. Hirabayashi Y. Airway Scope: initial clinical experience with novice personnel. Can J Anaesth. 2007;54(2):160-1. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/BF03022021. Erratum in: Can J Anaesth. 2007;54(5):406. PMID: 17272261.

  28. Madziala M, Smereka J, Dabrowski M, Leung S, Ruetzler K, Szarpak L. A comparison of McGrath MAC® and standard direct laryngoscopy in simulated immobilized cervical spine pediatric intubation: a manikin study. Eur J Pediatr. 2017;176(6):779–86. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s00431-017-2909-9. Epub 2017 Apr 21. PMID: 28429117; PMCID: PMC5432598.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli GL, Nabecker S, Theiler LG. Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. Br J Anaesth. 2016;116(5):670-9. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/bja/aew058. PMID: 27106971.

  30. Tan Y, Loganathan N, Thinn KK, Liu EHC, Loh NW. Dental injury in anaesthesia: a tertiary hospital’s experience. BMC Anesthesiol. 2018;18(1):108. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-018-0569-6. PMID: 30111288; PMCID: PMC6094905.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Russotto V, Lascarrou JB, Tassistro E, Parotto M, Antolini L, Bauer P, Szułdrzyński K, Camporota L, Putensen C, Pelosi P, Sorbello M, Higgs A, Greif R, Grasselli G, Valsecchi MG, Fumagalli R, Foti G, Caironi P, Bellani G, Laffey JG, Myatra SN, INTUBE Study Investigators. Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study. Br J Anaesth. 2023;131(3):607–16. Epub 2023 May 17. PMID: 37208282.

    Article  PubMed  Google Scholar 

  32. Aoi Y, Inagawa G, Nakamura K, Sato H, Kariya T, Goto T. Airway scope versus　macintosh laryngoscope in patients with simulated limitation of neck movements. J Trauma. 2010;69(4):838– 42. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/TA.0b013e3181c4529e. PMID: 20179653.

  33. Murakami Y, Ueki R, Niki M, Hirose M, Shimode N. Three-day tracheal intubation manikin training for novice Doctors using macintosh laryngoscope, McGRATH MAC videolaryngoscope and pentax airwayscope. Med (Baltim). 2021;100(4):e23886. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/MD.0000000000023886. PMID: 33530183; PMCID: PMC7850776.

    Article  Google Scholar 

  34. Malik MA, Maharaj CH, Harte BH, Laffey JG. Comparison of Macintosh, Truview EVO2, glidescope, and airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth. 2008;101(5):723–30. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/bja/aen231. Epub 2008 Sep 9. PMID: 18784069.

    Article  CAS  PubMed  Google Scholar 

  35. Teoh WH, Shah MK, Sia AT. Randomised comparison of Pentax AirwayScope and Glidescope for tracheal intubation in patients with normal airway anatomy. Anaesthesia. 2009;64(10):1125-9. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1365-2044.2009.06032. x. PMID: 19735405.

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Acknowledgements

The authors would like to express their gratitude to Professor Makoto Tanaka (M.D. Dean, College of Medicine, School of Health Sciences Professor and Chairman Department of Anesthesiology Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, JAPAN) for his valuable guidance and support.

Funding

Support was provided solely from institutional and departmental sources.

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Authors and Affiliations

  1. Department of Anesthesiology, Hitachi General Hospital, 2-1-1 Jonan-cho, Hitachi, 317-0077, Ibaraki, Japan

    Musashi Yahagi, Kyuma Omi & Yuichi Yaguchi

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  1. Musashi Yahagi
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  3. Yuichi Yaguchi
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Contributions

Y.Y. and M.Y. designed the study. Y.Y. and K.O. performed the data collection and analysis. M.Y. wrote the manuscript draft. Both authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Musashi Yahagi.

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Ethics approval and consent to participate

This study was approved by the Ethics Committee of Hitachi General Hospital (approval number 2023-22) and registered as a clinical trial with the registration number jRCT1030240598 (https://jrct.niph.go.jp/re/reports/detail/91422) The registration date of the clinical trial is January 8, 2025. Informed consent was obtained from all individual participants included in the study.

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Not Applicable.

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The authors declare no competing interests.

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Yahagi, M., Omi, K. & Yaguchi, Y. A comparison of McGrath MAC, AIRWAY SCOPE®, and AceScope® video laryngoscopes in novice healthcare providers: a randomized crossover simulation study. BMC Anesthesiol 25, 212 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12871-025-03094-y

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Keywords

BMC Anesthesiology

ISSN: 1471-2253

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