Effect of head position on laryngeal visualisation with the McGrath MAC videolaryngoscope in paediatric patients

Kim, Eun‐Hee; Lee, Ji Hyun; Song, In Kyung; Kim, Jin‐Tae; Kim, Bo Rim; Kim, Hee‐Soo

doi:10.1097/eja.0000000000000448

Cited by 19 publications

(19 citation statements)

References 30 publications

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“…We found that the time to intubation was 24 seconds in the group with support under the shoulder, and the time to intubation was 31 seconds in the group without support under the shoulder. The times in our study were longer than those of Kim et al, but the cause of this difference may be that the age group and the video laryngoscope were different in our study. Additionally, these authors defined the tracheal intubation time as the time between when the researcher picked up and put down the McGrath Video Laryngoscope.…”

Section: Discussioncontrasting

confidence: 77%

“…In our study, it was found that the placement of a folded towel under the shoulders, considering the alignment of the external auditory canal and sternum in the horizontal plane, increases visualization of the glottis opening. In a study by Kim et al, these authors investigated the effects of head position on laryngeal visualization using the McGrath Mac Video Laryngoscope in children aged 3‐7 years. These authors found a better POGO score and a shorter time to intubation in the group in which the external auditory canal and sternal notch were aligned in the horizontal plane by supporting the head with a pillow.…”

Section: Discussionmentioning

confidence: 99%

“…Kim et al found that the time to intubation was 15 seconds in the group that had support of the head with a pillow, and the time to intubation was 17 seconds in the group without support. We found that the time to intubation was 24 seconds in the group with support under the shoulder, and the time to intubation was 31 seconds in the group without support under the shoulder.…”

Section: Discussionmentioning

confidence: 99%

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The effect of placement of a support under the shoulders on laryngeal visualization with a C‐MAC Miller Video Laryngoscope in children younger than 2 years of age

Gencay

Begeç

Özgül

et al. 2019

Pediatric Anesthesia

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Background:We aimed to evaluate glottis visualization and time to intubation in children younger than 2 years of age during laryngoscopy performed with a C-MAC Miller Video Laryngoscope in a position determined by placing a folded towel under the shoulders to align the oral-pharyngeal and laryngeal axes in the horizontal plane. Methods: Ninety-six children younger than 2 years of age, who were classified by the American Society of Anesthesiologists as having a physical status I or II and who were scheduled for elective surgery necessitating endotracheal intubation under general anesthesia, were included in the study. All patients were intubated with a C-MAC Miller Video Laryngoscope. The children intubated by placing a folded towel under the shoulders were categorized as Group 1 (n = 48), and the children intubated without placement of a folded towel were categorized as Group 2 (n = 48). The percentage of glottis opening and Cormack-Lehane Scores, values of visual analogue scale to determine the ease of using a C-MAC Miller Video Laryngoscope, time to intubation, number of intubation attempts, optimization procedures and complications were recorded for all children.Results: There was a statistically significant difference between Group 1 (mean ± SD; 97.71 ± 4.24) and Group 2 (mean ± SD; 94.17 ± 7.09) in terms of the percentage of glottis opening scores (P = 0.004). The mean difference in the percentage of glottis opening scores (95% confidence interval) between the groups was 3.54 (1.17-5.90). Conclusion:We showed that a folded towel placed under the shoulders in children younger than 2 years of age improves glottis visualization provides ease of use of the C-MAC Miller Video Laryngoscope. Therefore, we think that the placement of a folded towel under the shoulders during the use of a C-MAC Miller Video Laryngoscope may be useful for airway management in children younger than 2 years of age. K E Y W O R D S airway management, infant, laryngoscopy, patient position | 815 KOYLU GENCAY Et AL.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The effect of placement of a support under the shoulders on laryngeal visualization with a C‐MAC Miller Video Laryngoscope in children younger than 2 years of age

Gencay

Begeç

Özgül

et al. 2019

Pediatric Anesthesia

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“…We calculated the sample size based on the POGO score using PASS software (version 15.0; NCSS, LLC, Kaysville, UT, USA). Assuming that a 20% difference in POGO score was clinically important (standard deviation of 35%) [ 30 ], we determined that 28 pairs were required in each sequence for two-sided testing in this 2 × 2 crossover study, with 95% power and an alpha level of 5%. Therefore, we enrolled 32 participants in each sequence group, assuming a dropout rate of 10%.…”

Section: Methodsmentioning

confidence: 99%

Effects of head-elevated position on tracheal intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway: a prospective randomized crossover study

et al. 2022

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Background The head-elevated laryngoscopy position has been described to be optimal for intubation, particularly in obese patients and those with anticipated difficult airways. Horizontal alignment of the external auditory meatus and sternal notch (AM-S) can be used as endpoints for optimal positioning. Thus, we aligned the head-elevated position with the AM-S in the horizontal plane and evaluated its effect on laryngeal visualization and ease of intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway. Methods Sixty-four patients were included in this prospective, crossover, randomized controlled trial. A cervical collar was used to restrict neck movement and mouth opening. The head-elevated position was achieved by raising the back section of the operation room table and ensuring that the end point was horizontally aligned with the AM-S (table-ramp method). The laryngeal view was randomly assessed in both head-flat and head-elevated positions based on the percentage of glottic opening (POGO) score and modified Cormack–Lehane (MCL) grade. External laryngeal manipulation was not permitted when laryngeal visualization was scored. The trachea was intubated only once (in the second position). The ease of intubation was assessed based on the need for optimization maneuvers, intubation difficulty scale (IDS) scores and time to intubation. Results The mean table-ramp angle required to achieve the horizontal alignment of AM-S was 17.5 ± 4.1°. The mean POGO score improved significantly in the head-elevated position (59.4 ± 23.8%) when compared with the head-flat position (37.5 ± 24%) (P < 0.0001). MCL grade 1 or 2a was achieved in 56 (85.9%) and 28 (43.7%) of patients in the head-elevated and head-flat positions, respectively (P < 0.0001). Optimization maneuvers for intubation were required in 7 (21.9%) and 17 (53.1%) patients in the head-elevated and head-flat positions, respectively (P < 0.0001). The IDS scores and time to intubation did not differ significantly between the two positions. Conclusion In the head-elevated position, aligning the AM-S in the horizontal plane consistently improved laryngeal visualization without worsening the view when the McGrath MAC videolaryngoscope was used in patients with simulated difficult airways. It also improved the ease of intubation, which reduced the need for optimization maneuvers. Trial registration This trial was registered with www.clinicaltrials.gov, NCT04716218, on 20/01/2021.

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“…Thyroidectomy is challenging not only because of the thyroid pathology to be operated on but also because of the anatomic characteristics of young children [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Children are more likely to have recurrent laryngeal nerve (RLN) injury than adults [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Optimal Monitoring Technology for Pediatric Thyroidectomy

Zhang

Sun

Kim

et al. 2022

Cancers

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This retrospective study aimed to describe, firstly, characteristics and outcomes of the intraoperative neural monitoring technology in the pediatric population, and secondarily the recurrent laryngeal nerve complication rate. Thirty-seven patients (age <18 years) operated on from 2015 to 2021 by conventional open thyroid surgery were included. Twenty-four (64.9%) total thyroidectomies and 13 (35.1%) lobectomies were performed. Seven central and six lateral lymph node dissections completed 13 bilateral procedures. Histology showed malignancy in 45.9% of the cases. The differences between the electromyographic profiles of endotracheal tubes or electrodes for continuous monitoring were not statistically significant. In our series of young patients, both adhesive (even in 4- or 5-year-olds) and embedded endotracheal tubes were used, while in patients 3 years old or younger, the use of a more invasive detection method with transcartilage placement recording electrodes was required. Overall, out of 61 total at-risk nerves, 5 (8.2%) recurrent laryngeal nerves were injured with consequent intraoperative loss of the signal; however, all these lesions were transient, restoring their normal functionality within 4 months from surgical procedure. To our knowledge, this is the first study of intraoperative neural monitoring management in a cohort of Italian pediatric patients.

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Effect of head position on laryngeal visualisation with the McGrath MAC videolaryngoscope in paediatric patients

Abstract: http://cris.nih.go.kridentifier:KCT0001443.

Cited by 19 publications

References 30 publications

The effect of placement of a support under the shoulders on laryngeal visualization with a C‐MAC Miller Video Laryngoscope in children younger than 2 years of age

The effect of placement of a support under the shoulders on laryngeal visualization with a C‐MAC Miller Video Laryngoscope in children younger than 2 years of age

Effects of head-elevated position on tracheal intubation using a McGrath MAC videolaryngoscope in patients with a simulated difficult airway: a prospective randomized crossover study

Optimal Monitoring Technology for Pediatric Thyroidectomy

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