A comparison of Truview infant EVO2 laryngoscope with the Miller blade in neonates and infants

Singh, Ranju; Singh, Preetvanti; Vajifdar, Homay

doi:10.1111/j.1460-9592.2009.02929.x

Cited by 56 publications

(32 citation statements)

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“…Multiple airway devices have been developed to improve the success and safety of intubation, however, reports of their use in neonates has been limited to case reports [38][39][40] observational studies [41] and small pilot randomized trials [42,43]. Clinical use of some technologies has been limited by the small size of the mouth and airway of the neonate.…”

Section: Alternative Methods Of Intubating Neonatesmentioning

confidence: 99%

Improving neonatal intubation safety: A journey of a thousand miles

Sawyer

Foglia

Hatch

et al. 2017

NPM

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Abstract. Neonatal intubation is one of the most common procedures performed by neonatologists, however, the procedure is difficult and high risk. Neonates who endure the procedure often experience adverse events, including bradycardia and severe oxygen desaturations. Because of low first attempt success rates, neonates are often subjected to multiple intubation attempts before the endotracheal tube is successfully placed. These factors conspire to make intubation one of the most dangerous procedures in neonatal medicine. In this commentary we review key elements in the journey to improve neonatal intubation safety. We begin with a review of intubation success rates and complications. Then, we discuss the importance of intubation training. Next, we examine quality improvement efforts and patient safety research to improve neonatal intubation safety. Finally, we evaluate new tools which may improve success rates, and decrease complications during neonatal intubation.

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Section: Alternative Methods Of Intubating Neonatesmentioning

confidence: 99%

Improving neonatal intubation safety: A journey of a thousand miles

Sawyer

Foglia

Hatch

et al. 2017

NPM

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“…In 2006, the Truphatek TruView EVO2 system (Truphatek International Limited, Netanya, Israel) was introduced for adult airway management (17), and in 2009, the device began to be used in pediatric anesthesia (18). The TruView system is a device with an integrated optical lens system and a unique blade tip angulation that provides an optimal line of sight, allowing a view of the glottis via the prismatic lens without having to align the oral, pharyngeal, and tracheal axes (Figure 2).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the TruView infant EVO2 PCD™ and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways

Mutlak¹,

Rolle

Rosskopf³

et al. 2014

Clinics

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OBJECTIVE:Videolaryngoscopy has mainly been developed to facilitate difficult airway intubation. However, there is a lack of studies demonstrating this method's efficacy in pediatric patients. The aim of the present study was to compare the TruView infant EVO2 and the C-MAC videolaryngoscope with conventional direct Macintosh laryngoscopy in children with a bodyweight ≤10 kg in terms of intubation conditions and the time to intubation.METHODS:In total, 65 children with a bodyweight ≤10 kg (0-22 months) who had undergone elective surgery requiring endotracheal intubation were retrospectively analyzed. Our database was screened for intubations with the TruView infant EVO2, the C-MAC videolaryngoscope, and conventional direct Macintosh laryngoscopy. The intubation conditions, the time to intubation, and the oxygen saturation before and after intubation were monitored, and demographic data were recorded. Only children with a bodyweight ≤10 kg were included in the analysis.RESULTS:A total of 23 children were intubated using the C-MAC videolaryngoscope, and 22 children were intubated using the TruView EVO2. Additionally, 20 children were intubated using a standard Macintosh blade. The time required for tracheal intubation was significantly longer using the TruView EVO2 (52 sec vs. 28 sec for C-MAC vs. 26 sec for direct LG). However, no significant difference in oxygen saturation was found after intubation.CONCLUSION:All devices allowed excellent visualization of the vocal cords, but the time to intubation was prolonged when the TruView EVO2 was used. The absence of a decline in oxygen saturation may be due to apneic oxygenation via the TruView scope and may provide a margin of safety. In sum, the use of the TruView by a well-trained anesthetist may be an alternative for difficult airway management in pediatric patients.

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“…They showed a statistically, but not clinically signifi cant difference in intubation time (18.18 s in the Truview group; 16.3 s in the Miller group) and an improved view of the glottis in the Truview group [ 37 ].…”

Section: Truviewmentioning

confidence: 97%

Anesthesia Challenges for the Difficult and Critical Neonatal Airway

Fiadjoe

Isserman

McCloskey

2014

Disorders of the Neonatal Airway

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The larynx descends as children grow and is most cranially positioned in the neonate [ 1 ]. The high cervical position of the larynx is often described as being "anterior" because of the view obtained with direct laryngoscopy. Because of the high location of the glottis, straight blades are thought to offer better exposure of the larynx because of the ability to elevate the base of the tongue. Despite this, some clinicians prefer curved blades and use them successfully. Other consequences of the high location of the neonate's glottis include the tendency for laryngeal masks to become dislodged and inadvertent compression of the airway in the neck during bag-mask ventilation.The tongue in the neonate is relatively large and may obstruct the airway by adhering to the palate; relief can be obtained by opening the mouth or by applying continuous positive airway pressure (CPAP), to the airway via a bagmask device. An oral airway is rarely needed to open the airway of a neonate. The neonatal epiglottis is relatively short. This allows one to elevate the tip by simply placing the straight laryngoscope blade in the vallecula much like how a curved blade is used. The glossoepiglottic ligament located in the vallecula should be engaged with the tip of the straight blade in order to gain adequate glottic exposure. The vocal cords in the neonate are slanted rostrally as compared to the vocal cords in the adult. This can cause diffi culties in passing an endotracheal tube because the tip is already directed in an upward fashion to the anteriorly located larynx causing it to have a greater chance of being hung up at the anterior commissure or anterior tracheal wall. Classically, it has been taught the neonatal airway is funnel shaped, but a recent study suggests it may be tubular much like the adult airway [ 2 ]. Traditionally teaching is that the narrowest part of the neonatal/pediatric airway is at the cricoid ring and not at the vocal cords like the adult airway.Normal cardiopulmonary physiology can also make the management of the neonatal airway diffi cult.In the operating room (OR), the initial approach to a patient with a diffi cult airway is to perform an inhalational induction with a volatile anesthetic agent to allow for spontaneous ventilation. This can be done successfully in a neonate; however, the response is different due to differences in physiology. Theoretically, uptake of the volatile anesthetic can be delayed due to the relatively higher cardiac output; however, the higher minute ventilation and increased proportion of cardiac output to the brain in the neonate can actually increase the rate of induction. The faster rate of induction and effects on the neonatal brain subsequently leads to a faster decrease in respiratory function as compared to older children and adults (Fig. 1a ).Neonates are also more prone to develop hypoxia during the process of securing the airway due to differences in lung volumes and metabolic rate as compared to children and adults. In neonates, the functional residual capacity is ap...

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A comparison of Truview infant EVO2 laryngoscope with the Miller blade in neonates and infants

Abstract: In this study, we found that in neonates and infants, the tracheal intubation using Truview infant EVO2 blade took almost as much time as miller blade and provided improved laryngoscopic view as compared to the Miller blade.

Cited by 56 publications

References 9 publications

Improving neonatal intubation safety: A journey of a thousand miles

Improving neonatal intubation safety: A journey of a thousand miles

Comparison of the TruView infant EVO2 PCD™ and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways

Anesthesia Challenges for the Difficult and Critical Neonatal Airway

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