The efficacy of GlideScope® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry

Abstract

During difficult tracheal intubation in children, direct laryngoscopy is an overly used technique with a low chance of success. GlideScope use was associated with a higher chance of success with no increased risk of complications. GlideScope use in children with difficult tracheal intubation has a lower success rate than in adults with difficult tracheal intubation. Children weighing less than 10 kilograms had lower success rates with either device. Attempts should be minimized with either device to decrease complications.

Emerging trends, techniques, and equipment for airway management in pediatric patients

“…Although the greater angulation of a hyperangulated videolaryngoscope blade will generally facilitate a view of the glottis, this acute distal blade angulation together with the inherent anatomic complexities of such patients can introduce difficulty in converting an adequate view to a successful intubation . In an analysis from the Pediatric Difficult Intubation Registry (PeDI‐R), the rate of successful intubation with a GlideScope® hyperangulated (GVL) blade given a Cormack‐Lehane grade 1 or 2a view was 64%, while in patients less than 10 kg, it was 53% . Thus, in infants, nearly 50% of attempts failed despite having an adequate view of the laryngeal inlet.…”

“…The familiar structure of the blade and lack of angulation is expected to decrease technical complications compared with a hyperangulated blade . The ability to convert from a direct to indirect technique within the same airway attempt may minimize attempts, and thus, complications, as the need for multiple intubation attempts, have been associated with increased rates of hypoxemia even in otherwise healthy neonates and infants …”

“…Although VL with hyperangulated blades provides improved glottic visualization and has higher first‐pass success rates in children who are difficult to intubate than traditional DL, difficulty may still be encountered in guiding the ETT through the glottic opening and into the trachea . Successful combination of VL with a hyperangulated blade and flexible video laryngotracheobronchoscopy (flexible scope) has been described in adults with anticipated difficult intubations using the flexible scope as a dynamic stylet .…”

Comparative evaluation of CMAC and Truview picture capture device for endotracheal intubation in neonates and infants undergoing elective surgeries: A prospective randomized control trial

“…VLs have an upcoming role in pediatric airway management but their efficacy has only been demonstrated in a handful of case reports and studies . A recent multicentric pediatric difficult intubation registry demonstrated significantly better success rates with VLs including CMAC and Truview as compared to conventional laryngoscopes . However, the intubation success rates with pediatric VLs were much lower than those of adults and they emphasized the need for studies comparing the efficacy of different VLs in children …”

“…[8][9][10][11] A recent multicentric pediatric difficult intubation registry demonstrated significantly better success rates with VLs including CMAC and Truview as compared to conventional laryngoscopes. 12 However, the intubation success rates with pediatric VLs were much lower than those of adults and they emphasized the need for studies comparing the efficacy of different VLs in children. 12 The Truview picture capture device (Truview-PCD ® ) videolaryngoscope (Truphatek International Ltd, Netanya, Israel) has a specially profiled steel blade with 48°deflection to provide a wide and magnified view of the larynx, whereas CMAC Videolaryngscope (Karl Storz GmbH & Co. KG, Tuttlingen, Germany) has a camera providing an 80°angled view ( Figure 1).…”