A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

Peyton, James; Park, Raymond; Staffa, Steven J.; Sabato, Stefano; Templeton, T. Wesley; Stein, Mary Lyn; Garcia‐Marcinkiewicz, Annery; Kiss, Edgar; Fiadjoe, John E.; Ungern-Sternberg, Britta von; Chiao, Franklin; Olomu, Patrick; Zurakowski, David; Kovatsis, Pete G.; Sommerfield, David; Holmes, Chris E.; Ravula, Niroop; Jette, Christine; Mireles, Sam; Matava, Clyde; Whyte, Simon; Vega, Eduardo; Yang, Lei; Echeverry-Marin, Piedad; Pérez‐Pradilla, Carolina; Starker, Elizabeth; Zieg, Jennifer; Szolnoki, Judit; Lee, Angela; Heitmiller, Eugenie S.; Rehman, Mohamed A.; Zamora, Lillian; Fernández, A. Díaz; Meserve, Jonathan R.; Bhattacharya, Solmaletha; Reynolds, Paul I.; Lewis, Ian C.; Haydar, Bishr; Therrian, Megan; Sarmiento, Linare; Richtsfeld, Martina; Belani, Kumar G.; Robertson, Sara; Sathyamoorthy, Kumar; Schrock, Charles; Graaff, Jurgen de; Soneru, Codruta; Singh, Neeta; Taicher, Brad M.; Castro, Pilar; Perez, N. Ricardo Riveros; Stricker, Paul A.; Lockman, Justin L.; Gálvez, Jorge A.; Isserman, Rebecca S.; Struyk, Brian; Ward, C. F.; Hsu, Grace; Nishisaki, Akira; Kodavatiganti, Ramesh; Ramos, Luis; Scheu, Eric; Bruins, Benjamin B.; Goldfarb, Tally; Szmuk, Peter; Jain, Ranu; Matuszczak, Maria; Polaner, David M.; Hunyady, Ágnes; Bösenberg, Adrian; Tham, See Wan; Low, Daniel; Rosas, Guelay Bilen; Lee, Lisa; Iyah, Ihab; Dalesio, Nicholas M.; Greenberg, R.

doi:10.1016/j.bja.2020.08.010

Cited by 52 publications

(54 citation statements)

References 23 publications

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“…This is in line with the findings of Park and colleagues who analyzed data from the pediatric difficult intubation registry and found that in children weighing less than 10 kg, the likelihood of successful intubation when using the Glidescope 1 in the setting of a Cormack-Lehane grade 1 or 2a views was only 53% [23]. In addition, in a retrospective observational study, analyzing data submitted by 28 institutions into the pediatric difficult intubation registry from March 2017 to January 2020, Peyton and colleagues could demonstrate that in infants weighing less than 5 kg, video laryngoscopy with standard Macintosh and Miller blades was associated with a significantly greater success rate than video laryngoscopy with non-standard blades [24]. Zhang and colleagues also showed that in pediatric patients less than 6 years of age more than half of all endotracheal intubations with the Glidescope 1 VL were associated with technical difficulties.…”

Section: Plos Onementioning

confidence: 99%

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

et al. 2021

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Background Video laryngoscopy is an effective tool in the management of difficult pediatric airway. However, evidence to guide the choice of the most appropriate video laryngoscope (VL) for airway management in pediatric patients with Pierre Robin syndrome (PRS) is insufficient. Therefore, the aim of this study was to compare the efficacy of the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a nonangulated Miller blade (C-MAC® Miller) and a conventional Miller laryngoscope when used by anesthetists with limited and extensive experience in simulated Pierre Robin sequence. Methods Forty-three anesthetists with limited experience and forty-three anesthetists with extensive experience participated in our randomized crossover manikin trial. Each performed endotracheal intubation with the Glidescope® Core™ with a hyperangulated blade, the C-MAC® with a Miller blade and the conventional Miller laryngoscope. “Time to intubate” was the primary endpoint. Secondary endpoints were “time to vocal cords”, “time to ventilate”, overall success rate, number of intubation attempts and optimization maneuvers, Cormack-Lehane score, severity of dental trauma and subjective impressions. Results Both hyperangulated and nonangulated VLs provided superior intubation conditions. The Glidescope® Core™ enabled the best glottic view, caused the least dental trauma and significantly decreased the “time to vocal cords”. However, the failure rate of intubation was 14% with the Glidescope® Core™, 4.7% with the Miller laryngoscope and only 2.3% with the C-MAC® Miller when used by anesthetists with extensive previous experience. In addition, the “time to intubate”, the “time to ventilate” and the number of optimization maneuvers were significantly increased using the Glidescope® Core™. In the hands of anesthetists with limited previous experience, the failure rate was 11.6% with the Glidescope® Core™ and 7% with the Miller laryngoscope. Using the C-MAC® Miller, the overall success rate increased to 100%. No differences in the “time to intubate” or “time to ventilate” were observed. Conclusions The nonangulated C-MAC® Miller facilitated correct placement of the endotracheal tube and showed the highest overall success rate. Our results therefore suggest that the C-MAC® Miller could be beneficial and may contribute to increased safety in the airway management of infants with PRS when used by anesthetists with limited and extensive experience.

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Section: Plos Onementioning

confidence: 99%

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

et al. 2021

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“…8,9,11,20 VLs with blades similar to conventional DL blades like McGrath MAC and C-MAC Miller are potentially easier to use as compared to nonstandard blades due to greater familiarity. 10 McGrath MAC and C-MAC VLs used in our study achieved high first attempt success in a reasonable timeframe with minimal hypoxemia, unlike previous studies evaluating airway management in neonates and infants. 4,19 The optimal laryngeal views can be obtained in children <2 years of age during DL with Miller size-1 blade either by directly lifting the epiglottis or placing the laryngoscope tip into the vallecula.…”

Section: Intubation In Neonates and Infants Is Difficult Due To Anatomical And Physiological Reasons A Recent Retrospective Analysis Hasmentioning

confidence: 70%

“…The videolaryngoscope (VL) is a well-established tool in the armory of an anesthesiologist for adults and has shown promise in pediatric airway management. [8][9][10] Previous literature has documented lower intubation success rates with VLs in children as compared to adults and has highlighted the necessity for studies to ascertain the efficacy of various VLs in children. 11 A recent multicenter registry has concluded that conventional blade VLs are more effective than the hyperangulated blade VLs in infants.…”

Section: Introductionmentioning

confidence: 99%

“…11 A recent multicenter registry has concluded that conventional blade VLs are more effective than the hyperangulated blade VLs in infants. 10 The C-MAC Miller sizes "0" and "1" (Karl Storz GmbH & Co. KG, Tuttlingen, Germany) have a straight blade with an 80° angled view camera that provides improved intubating conditions in infants and neonates. [12][13][14] McGrath MAC ® VL (McGrath; Medtronic, Minneapolis, USA) is exceptionally lightweight, with a disposable Macintosh type blade, and an integrated monitor attached to its handle.…”

Section: Introductionmentioning

confidence: 99%

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Comparative efficacy of C‐MAC^® Miller videolaryngoscope versus McGrath^® MAC size “1” videolaryngoscope in neonates and infants undergoing surgical procedures under general anesthesia: A prospective randomized controlled trial

Gupta

Singh

Gupta

et al. 2021

Pediatric Anesthesia

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Background: Various anatomical and physiological factors make intubation in infants challenging. C-MAC videolaryngoscope shows better results as compared to the conventional direct laryngoscopy for intubation in infants. McGrath MAC size-1 with a disposable Macintosh type blade has recently been introduced for use in infants and has not been formally evaluated in this population. Aims: This study aims to evaluate the intubation characteristics of C-MAC Miller and McGrath MAC in neonates and infants with the primary objective to compare the time with the two devices. Methods: After informed consent from the parents, 140 neonates and infants scheduled for surgical procedures were randomized to undergo intubation with either C-MAC Miller or McGrath MAC after standard general anesthesia. The two devices were compared in terms of total intubation time, Percent of Glottic Opening score, Cormack Lehane grades, time to glottis view, intubation difficulty score, overall success rate, first attempt success rate, and complications. Results: The median glottic view time (6 s [4-9] vs. 6 s [4-9]; p = .40) and intubation time (27 s [25.5-28] vs. 27 s [24.5-29.5]; p = .87) were similar. The mean difference (95% CI) in time to tracheal intubation and time to glottic view was 0.49 s [−3.1 to 2.1]and −1.7 s [−3.8 to 0.47], respectively. However, the Percent of Glottic Opening score, Cormack Lehane grades, and subjective intubation difficulty were significantly better with C-MAC. The first attempt success rates, overall success rates (100% vs. 97.5%), and intubation difficulty scores were comparable. There were two failed intubations with McGrath which were successfully intubated with C-MAC. Conclusion:The C-MAC Miller blade showed similar intubation timings, success rates, and intubation difficulty score as compared to McGrath MAC in neonates and infants, though the former provided superior glottic views. Both the videolaryngoscopes may be safely used in infants and neonates for routine intubation scenarios.

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“…Of note, at the time of this case, our institution did not have access to straight videolaryngoscope blades. The manufacturer now does produce paediatric straight blades which, according to emerging data, may have a greater success rate in children under 5 kg [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 presenting with spontaneous massive pneumomediastinum in a three‐month‐old child

Sinclair

Sharieff

Gaskell

et al. 2021

Anaesthesia Reports

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Summary A three‐month‐old child presented to our district general hospital with acute respiratory distress. He was found to have massive spontaneous pneumomediastinum and extensive surgical emphysema overlying the neck. Tracheal intubation using the GlideScope® was difficult, and the patient’s trachea was ultimately intubated with a direct laryngoscope. Computed tomography revealed bilateral lung consolidation and reverse transcriptase‐polymerase chain reaction swab was positive for SARS‐CoV‐2. There was no other precipitating factor to explain the presence of pneumomediastinum. The patient was treated with pleural and mediastinal drains, required five days of mechanical ventilation on a paediatric intensive care unit and subsequently made a full recovery. We outline our initial differential diagnosis, airway management plan, and propose a mechanism for the development of spontaneous pneumomediastinum in this case. We suggest that clinicians should consider pneumomediastinum as a potential cause of surgical emphysema, particularly in the context of COVID‐19, even in infants. To our knowledge, this is the first reported case of COVID‐19 in this age group with spontaneous pneumomediastinum as the presenting feature.

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A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

Cited by 52 publications

References 23 publications

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

Comparative efficacy of C‐MAC^® Miller videolaryngoscope versus McGrath^® MAC size “1” videolaryngoscope in neonates and infants undergoing surgical procedures under general anesthesia: A prospective randomized controlled trial

COVID‐19 presenting with spontaneous massive pneumomediastinum in a three‐month‐old child

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A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

Cited by 52 publications

References 23 publications

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study

Comparative efficacy of C‐MAC® Miller videolaryngoscope versus McGrath® MAC size “1” videolaryngoscope in neonates and infants undergoing surgical procedures under general anesthesia: A prospective randomized controlled trial

COVID‐19 presenting with spontaneous massive pneumomediastinum in a three‐month‐old child

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Product

Resources

About

Comparative efficacy of C‐MAC^® Miller videolaryngoscope versus McGrath^® MAC size “1” videolaryngoscope in neonates and infants undergoing surgical procedures under general anesthesia: A prospective randomized controlled trial