Comparison of Direct and Video Assisted Views of the Larynx during Routine Intubation in Infants and Children

Abstract

Purpose: Video assisted laryngoscopy has been rapidly incorporated into the anesthesiologist's arsenal for challenging adult airway management. The development of pediatric video airway equipment presents an opportunity to expand upon the previous reliance on direct laryngoscopy alone. This study utilized the Storz DCI ® Video Laryngoscope which consists of a standard straight 0 and 1 blade combined with a 2.8 mm fiberoptic light bundle built into the left side of the blade. Method:The ease of use, best direct and video-assisted glottic view was documented for 50 infants and children less than 2 years of age. Direct laryngoscopy was performed with the naked eye (direct view). The best views obtained with and without external laryngeal manipulation were graded by the laryngoscopist without looking at the video monitor. The views on the video monitor, located in front of the intubator and to the right of the patient, were simultaneously graded independently by another pediatric anesthesiologist.Results: Fifty infants and children, ages ranging from one day to 22 months, were enrolled in the study. There were 37 males, and 13 females. The average age was 10.5 months. ASA physical status ranged from I to III, with the vast majority of patients being either class I or II. The grade of laryngeal view on the video monitor was significantly improved when compared with that of direct laryngoscopy (p<0.05). Conclusion:In our study the view on the monitor screen was, on average, one grade better than the direct view. In only one instance was the view obtained with the video laryngoscope worse than that obtained under direct vision. The magnified view provided by the video laryngoscope allows for better visualization of airway structures in difficult airways and further help in facilitating securing the airway.