The relationship between years of anesthesia experience and first-time intubation success rate with direct laryngoscope and video laryngoscope in infants: a retrospective observational study

Abstract

Purpose Studies in adults have reported that video laryngoscope is more useful than direct laryngoscope when training less experienced anesthesiologists. However, whether this is true for infants remains unclear. Therefore, this study aimed to evaluate whether the use of video laryngoscope would result in smaller differences in success rate according to anesthesiologists’ expertise than those in direct laryngoscope. Methods Medical records and video recordings from the operating room of patients aged < 1 year who underwent non-cardiac surgery between March 2019 and September 2021 were reviewed. Tracheal intubations between April 8, 2020, and June 20, 2021, were excluded due to the shortage of video laryngoscope blades during the COVID-19 pandemic. Rates of first-time tracheal intubation success were compared by years of anesthesia experience and initial intubation device. Results In total, 125 of 175 tracheal intubations were analyzed (direct laryngoscope group, n = 72; video laryngoscope group, n = 53). The first-time tracheal intubation success rate increased with years of experience as an anesthesiologist in the direct laryngoscope group (odds ratio OR 1.70, 95% confidence interval CI 1.15, 2.49; P = 0.0070), but not the video laryngoscope group (OR 0.99, 95% CI 0.74, 1.35; P = 0.99). Conclusion The differences in success rate according to the anesthesiologists’ years of experience were non-significant when using video laryngoscope in infants, compared to those in direct laryngoscope. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-022-03106-y.

Comparison of the intubation time between McGRATHTM MAC size 1 and size 2 blades for infants: an observational study

“…However, more time for intubation was required for the use of video laryngoscopes because more time is required for the tube to pass through the glottis [6,7]. Reports comparing video laryngoscope models have not discovered a video laryngoscope model evidently advantageous for use in children [11][12][13]. Few studies have used McGRATH™ MAC on infants, especially since blade size 1, which is considered an appropriate size for infants, recently became available.…”

“…The time required for tracheal intubation was de ned as the period from the entry of the tracheal intubation device into the oral cavity to its complete exit from the oral cavity upon considering the teeth or gums for the oral cavity boundary line, as in our previous report [11]. If multiple tracheal intubations were performed, the time required for intubation was measured using the time of the last tracheal intubation as the nal time point.…”

“…To standardize performance, we used the following de nitions. If the size of the ETT was changed because the ETT was too large, the next attempt was considered the rst-time tracheal intubation [11].…”

The Clinical Usability Evaluation of an Attachable Video Laryngoscope in the Simulated Tracheal Intubation Scenario: A Manikin Study

“…However, the learning curve involved in using a video laryngoscope correctly and developing the skills to maximize the likelihood of successful primary intubation still requires an adjustment during training. Doglioni et al reported that the learning curve of clinicians performing neonatal intubation with direct laryngoscopy has not been fully described but may require more than 100 attempts to become proficient for primary intubation [ 13 ], and Uchinami et al reported that the learning curve for VL compared to direct laryngoscopy was potentially shorter [ 14 ].…”

Video laryngoscopy as the standard of care for pediatric intubation—the time is now

“…Anesthesiologists demonstrate higher first attempt success rates with direct laryngoscopy as their experience increases, whereas this trend is not observed with video laryngoscopy ( 21 ). This suggests a potentially shorter learning curve for video laryngoscopy compared to direct laryngoscopy ( 24 ).…”