A new twist in the pediatric difficult airway

Lillie, Edwardina Mary Mae Alexandra; Harding, Louise; Thomas, Mark

doi:10.1111/pan.12538

Cited by 8 publications

(6 citation statements)

References 3 publications

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“…Regarding the primary endpoint ("time to intubate") and the "time to ventilate", no significant differences were observed between the conventional Miller laryngoscope, the C-MAC 1 Miller and the Glidescope 1 Core™. However, the Glidescope 1 Core™ enabled a significantly shorter "time to vocal cords" (p < 0.001, 7 [4][5][6][7][8][9][10][11] vs. 12 [7][8][9][10][11][12][13][14][15][16][17][18], Glidescope 1 Core™ vs. Miller laryngoscope; p < 0.01, 7 [4][5][6][7][8][9][10][11] vs. 10 [7-15], Glidescope 1 Core™ vs. C-MAC 1 Miller) and significantly improved the Cormack and Lehane grade (p < 0.001, 1 Core™ vs. C-MAC 1 Miller). Post-hoc comparison revealed no significant differences for the handling and the difficulty of tracheal intubation.…”

Section: Anesthetists With Limited Previous Experiencementioning

confidence: 99%

“…Due to different blade sizes, these devices can also be used for the management of a difficult airway in infants and newborns [8,9]. In addition, VLs, including the C-MAC 1 [10], the Airtraq 1 [11], the McGrath MAC™ [12] and the Glidescope 1 [13] have been successfully used in pediatric patients with PRS. In a randomized multi-institutional crossover study, Fiadjoe and colleagues even reported comparable first-attempt intubation success of Glidescope 1 Cobalt video laryngoscopy and fiberoptic bronchoscopy when used in a Pierre Robin manikin [14].…”

Section: Introductionmentioning

confidence: 99%

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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: Anesthetists With Limited Previous Experiencementioning

confidence: 99%

Section: Introductionmentioning

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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“…Nevertheless, this study has some limitations. First, the effect of twisting the tube into the spiral shape was expected to be more pronounced in difficult intubation cases or for younger infants requiring a small sized blade (blade # 0 or blade # 1), as reported in previous cases 16 . In this study, however, infants without airway anomalies were recruited, and the proportion of infants less than 3 kilograms was small.…”

Section: Discussionmentioning

confidence: 77%

“…Previously, there has been a report of tracheal tube twisting that was successfully used in difficult GlideScope intubation cases 16 . Twisting the tube shaft into a spiral shape seems to provide a sufficient angle that allows the tracheal tube tip to be placed at the center of the laryngeal inlet.…”

mentioning

confidence: 99%

The usefulness of endotracheal tube twisting in facilitating tube delivery to glottis opening during GlideScope intubation in infants: randomized trial

Min

Shin

et al. 2020

Sci Rep

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Despite an excellent view of the glottis, technical difficulties with endotracheal tube delivery remains in GlideScope intubation. We evaluated whether a spiral-shape twisted tube can facilitate placement of the tracheal tube tip at the center of glottis opening compared to conventional tube for GlideScope intubation in infants. eighty-six infants were randomly placed in either the conventional tube group (group C) or the twist tube group (group T). In group T, the shaft of the tube was manually twisted into a loose spiral shape. the primary outcome was the initial center location of the tube tip at the glottis opening, and the secondary outcome was total tube handling time. The initial center location rate of the tube tip at the glottis opening was significantly higher in group T than in group C (88% [38/43] vs. 47% [20/43], P < 0.001). In addition, total tube handling time (sec) was significantly shorter in group T than in group C (15.4 ± 4.7 vs. 18.2 ± 5.3, P = 0.012). In this study, the spiral shape twist tube successfully improved the rate of initial center location of the tube tip at glottis opening and facilitated tube delivery in GlideScope intubation in infants.

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“…One further option is available for difficult intubation in children using the GlideScope ® . It is known that twisting the stylet into a spiral or a cork-screw shape and rotating it while intubation makes it simpler [ 3 ]. Although this maneuver can overcome the difficult angulation, the tracheal tube has to be rotated 180°.…”

Section: Discussionmentioning

confidence: 99%

Difficult Intubation in Pediatric Patient with a Large Lymphangioma at the Tongue Base

Lim

Park

Song

2015

Journal of Lifestyle Medicine

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Lymphangioma is a congenital malformation of lymphatic system and often involves the oral cavity. When lymphangioma is located on the mouth floor and enlarges, it can compress the airway and make intubation difficult. The GlideScope® video laryngoscope is sometimes used in routine intubation, but is most commonly used in difficult or failed intubation. We report a pediatric patient with a difficult intubation due to a large tongue base mass. The airway was compromised due to limited intraoral space, large mass at the tongue base, and glottis distortion. Oral approach was not successful with the Macintosh laryngoscope. In this case, a rigid stylet was made to match the GlideScope® curve and the endo-tracheal tube was inserted through the glottis under GlideScope® guidance. We believe that, even in pediatric patients, a rigid stylet is necessary when intubation at a sharp posterior angulation to the trachea is difficult during GlideScope® approach.

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A new twist in the pediatric difficult airway

Cited by 8 publications

References 3 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

The usefulness of endotracheal tube twisting in facilitating tube delivery to glottis opening during GlideScope intubation in infants: randomized trial

Difficult Intubation in Pediatric Patient with a Large Lymphangioma at the Tongue Base

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