Divya Jain1, Swati Mehta1, Komal Gandhi1, Suman Arora1, Badal Parikh1, Muneer Abas2. 1. Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India. 2. Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Abstract
BACKGROUND:Endotracheal intubationin lateral position in infants is a challenge. This difficulty may be surmounted to some extent by using videolaryngoscopes but the routine use of these devices as a tool to secure the airway in lateral position remains unevaluated. Therefore, we conducted a prospective, randomized controlled trial to compare the intubation conditions achieved with the CMAC videolaryngoscope and the Miller Laryngoscopein lateral position in infants. We hypothesized that CMAC videolaryngoscope would provide a better laryngoscopic view and reduce the time to intubation compared to the Miller blade. METHODS:Sixty-four children aged <1 year, belonging to American Society of Anesthesiologists physical status I-III requiring endotracheal intubation were randomized to undergo tracheal intubation with either the Miller laryngoscope (n = 32) or the CMAC videolaryngoscope (n = 32) in left lateral position. Anesthesia was induced with sevoflurane or thiopentone 5-8 mg/kg IV and atracurium 0.5 mg/kg IV. Total time taken to intubate was assessed as the primary outcome. Laryngoscopic view, intubation difficulty score, success rate of tracheal intubation, number of attempts, maneuvers used, and any airway complications were recorded as secondary outcomes. RESULTS: The difference in the mean time to intubate (95% confidence interval) between the Miller and CMAC group was 6.1 (1.7-10.4) seconds. Furthermore, the CMAC videolaryngoscope provided a better laryngoscopic view compared to the conventional Miller blade. In addition, the Intubation Difficulty Scale score was less in the CMAC videolaryngoscope group. CONCLUSION: The CMAC videolaryngoscope decreases the time taken to intubate and reduces the intubation difficulty when compared to the Miller laryngoscope. Therefore, the CMAC videolaryngoscope may be more useful device when intubating the trachea of infants in the lateral position.
RCT Entities:
BACKGROUND: Endotracheal intubation in lateral position in infants is a challenge. This difficulty may be surmounted to some extent by using videolaryngoscopes but the routine use of these devices as a tool to secure the airway in lateral position remains unevaluated. Therefore, we conducted a prospective, randomized controlled trial to compare the intubation conditions achieved with the CMAC videolaryngoscope and the Miller Laryngoscope in lateral position in infants. We hypothesized that CMAC videolaryngoscope would provide a better laryngoscopic view and reduce the time to intubation compared to the Miller blade. METHODS: Sixty-four children aged <1 year, belonging to American Society of Anesthesiologists physical status I-III requiring endotracheal intubation were randomized to undergo tracheal intubation with either the Miller laryngoscope (n = 32) or the CMAC videolaryngoscope (n = 32) in left lateral position. Anesthesia was induced with sevoflurane or thiopentone 5-8 mg/kg IV and atracurium 0.5 mg/kg IV. Total time taken to intubate was assessed as the primary outcome. Laryngoscopic view, intubation difficulty score, success rate of tracheal intubation, number of attempts, maneuvers used, and any airway complications were recorded as secondary outcomes. RESULTS: The difference in the mean time to intubate (95% confidence interval) between the Miller and CMAC group was 6.1 (1.7-10.4) seconds. Furthermore, the CMAC videolaryngoscope provided a better laryngoscopic view compared to the conventional Miller blade. In addition, the Intubation Difficulty Scale score was less in the CMAC videolaryngoscope group. CONCLUSION: The CMAC videolaryngoscope decreases the time taken to intubate and reduces the intubation difficulty when compared to the Miller laryngoscope. Therefore, the CMAC videolaryngoscope may be more useful device when intubating the trachea of infants in the lateral position.