It is not clear whether indirect laryngoscopes are superior to direct laryngoscopes for nasotracheal intubation and which laryngoscopes are better for nasotracheal intubation. We sought to undertake a ranking of the effectiveness of intubation devices in patients undergoing nasotracheal intubation. We conducted a systematic review and network meta-analysis (NMA). We searched electronic databases for prospective randomized studies comparing different tracheal intubation devices in patients undergoing nasotracheal intubation. The primary outcome was intubation time. The secondary outcomes were first-attempt success rate, glottic visualization, use of Magill forceps, and the use of external laryngeal manipulation. We used DerSimonian and Laird random-effects models for statistical analysis. We performed frequentist network meta-analysis and generated network plots and network league tables. We included 22 studies comparing 10 types of devices. With the Macintosh direct laryngoscope as reference, six indirect laryngoscopes significantly reduced intubation time relative to the Macintosh laryngoscope. In the ranking of intubation time, the C-MAC® D-Blade (Karl Storz SE first submitted 20 July 2023.
Hoshijima et al. (Tue,) studied this question.