Comparison of the MultiViewScope Stylet Scope and the direct laryngoscope with the Miller blade for the intubation in normal and difficult pediatric airways: A randomized, crossover, manikin study

Abstract

Background Managing difficult pediatric airway is challenging. The MultiViewScope (MVS) Stylet Scope is reported to be useful in difficult pediatric airway. In this randomized crossover study, we compared the effectiveness of the MVS Stylet Scope to a standard direct laryngoscope with Miller #1 blade in simulated normal and difficult airways. Methods Fifteen expert anesthesiologists and Fifteen anesthesiology residents participated in the study. Participants were asked to perform intubation with the Airsim Baby manikin first, and then with the Airsim Pierre Robin manikin. Participants in each group used the intubation devices in a randomized order. The primary outcome was the time of successful intubation. The secondary outcomes were the force exerted on the incisors during intubation, Cormack–Lehane scale, the difficulty of intubation. Results There were no differences between MVS Stylet Scope and Direct laryngoscope in the time of successful intubation by the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved the force exerted on the incisors during intubation in the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved Cormack–Lehane scale, and the difficulty of intubation with difficult pediatric airway situation in both expert anesthesiologists and anesthesiology residents. Conclusions Although less forces on the incisors and improved view of glottis were observed with the MVS Stylet Scope, MVS Stylet Scope did not shorten the time of intubation. The results of this study mean that the MVS Stylet Scope may be a less invasive airway devise than the direct laryngoscope with the Miller blade in the pediatric airway management. For the next step, we need to evaluate the MVS Stylet Scope in the real patients as an observational 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

“…This might be due to the greater angulation of the LoPro S1 blade, which offers a ‘view around the corner’ and enables optimal glottis visualization via the camera, without the need to align the oral, pharyngeal and tracheal axes [ 19 ]. In a randomized crossover manikin-based study, Godai and colleagues could demonstrate that the MultiViewScope Stylet Scope, a video laryngoscope system including a handle with integrated monitor and a rigid, angulated stylet scope, improved the force exerted on the incisors during tracheal intubation, the Cormack and Lehane glottic view and the difficulty of tracheal intubation in a simulated difficult pediatric airway when used by expert anesthesiologists and anesthesiology residents [ 20 ]. The nonangulated C-MAC ® Miller also improved glottic exposure in our simulated Pierre Robin sequence compared to the conventional Miller laryngoscope.…”

“…Although manikins do not fully resemble human structures, the use of anatomically correct manikins has proven to be a reliable surrogate for the clinical context [ 28 ]. The airway of the AirSim ® Pierre Robin X manikin has been designed in accordance with real computed tomography data and has been evaluated in clinical studies repeatedly [ 14 , 20 , 29 ]. In addition, clinical investigations such as the comparison of different intubation devices in infant PRS patients are hardly feasible due to the low incidence and ethical aspects.…”

An approach to difficult airway in infants: Comparison of GlideScope® Spectrum LoPro, GlideScope® Spectrum Miller and conventional Macintosh and Miller blades in a simulated Pierre Robin sequence performed by 90 anesthesiologists

“…Subjective evaluation of view and handling revealed significantly better results for the two video-based laryngoscopes compared to the conventional ones. These results could be explained by the fact that hyperangulated airway devices enable easy “view around the corner” without the need for force to align the oral, pharyngeal and tracheal axes to see the vocal cords [ 15 , 20 , 21 ].…”

“…However, training on a manikin can never fully reflect a life-like experience. Manikins like this have been used in several investigations before [ 15 , 21 , 23 , 24 , 26 ]. Studies on patients are limited due to the small incidence of PRS and ethical aspects.…”

A test prototype of a novel flexible video laryngoscope and preliminary verification in a difficult airway management simulator

“…The study was conducted immediately after practice, and each intubation was conducted only once. Tooth loss, esophageal intubation, and attempts requiring more than 90 s were recorded as intubation failure [ 19 ]. Participants performed intubation in the difficult airway management simulator in the neutral position with intermediate mouth opening first and then in the neutral position with difficult mouth opening.…”