Evolution of videolaryngoscopy in pediatric population

Gupta, Anju; Sharma, Ridhima; Gupta, Nishkarsh

doi:10.4103/joacp.joacp_7_19

Cited by 15 publications

(18 citation statements)

References 80 publications

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“…Evidence also shows that difficult laryngoscopy (Cormack Lehane grade 3) incidence is 4.7% among infants compared to 0.7% among older children (9,10). Desaturation is also rapid in the pediatric age group.…”

Section: There Are Various Advantages and Disadvantages Ofmentioning

confidence: 99%

A Comparative Study of Video Laryngoscopy to Direct Laryngoscopy for Endotracheal Intubation in Pediatric Patients

2023

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Background: Direct laryngoscopy is the standard method for intubation in pediatric patients. The introduction of video laryngoscopy brought a paradigm shift in managing pediatric airways. Objectives: We compared the tracheal intubation technique between direct and video laryngoscopy with McIntosh Blade 2 in pediatric patients 2 - 8 years of age requiring airway management. The glottic view and the first pass success rate were compared and analyzed. Methods: An observational cross-sectional study was conducted with 120 children between 2 - 8 years with normal airways. They were divided into video laryngoscopy (Group V) and direct laryngoscopy (Group D). The primary outcome measures included time taken for intubation, number of attempts required, Cormack-Lehane glottic view, use of optimization maneuvers, the requirement of tube repositioning, and hemodynamic parameters before and after intubation. Results: The time taken for intubation was longer in the video laryngoscopy group ( group D, 24.28 sec vs. group V, 27.65 seconds (P = 0.01). The Cormack-Lehane glottic view was grade 1 in all the patients in the video laryngoscopy group, while only 35 children showed grade 1 in the direct laryngoscopy group. (P < 0.001). We observed a significant increase in both heart rate and mean arterial pressure in the video laryngoscopy group at 1, 3, 5, and 10 min after intubation ((P < 0.001, P < 0.05). Conclusions: The time taken for intubation was more in group V, but the glottic view was much better, and the requirement for external maneuvers was also less. Pressure response to intubation was more in group V compared to group D.

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Section: There Are Various Advantages and Disadvantages Ofmentioning

confidence: 99%

A Comparative Study of Video Laryngoscopy to Direct Laryngoscopy for Endotracheal Intubation in Pediatric Patients

2023

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“…Also important to successful intubation is airway visualisation. Several videolaryngoscope manufacturers produce paediatric‐sized blades [ 25 ], enabling improved visibility among team members during intubation. Whilst the incidence of difficult laryngoscopy (Cormack–Lehane grade ≥ 3) is higher in infants compared with older children [ 21 , 22 ], a 2018 Cochrane meta‐analysis of videolaryngoscopy‐assisted intubation in neonates concluded there was insufficient evidence to recommend its use for neonatal intubation [ 26 ].…”

Section: Update On ‘Doing the Basics Well’mentioning

confidence: 99%

“…Also important to successful intubation is airway visualisation. Several videolaryngoscope manufacturers produce paediatricsized blades [25], enabling improved visibility among team members during intubation. Whilst the incidence of difficult These patients are often more severely unwell than general critical care patients and require early and aggressive resuscitation due to associated morbidity and mortality [42].…”

Section: Engelhardt Et Al Reported a Low Incidence Of Difficultmentioning

confidence: 99%

State‐of‐the‐art management of the acutely unwell child

et al. 2022

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Children make up around one-fifth of all emergency department visits in the USA and UK, with an increasing trend of emergency admissions requiring intensive care. Anaesthetists play a vital role in the management of paediatric emergencies contributing to stabilisation, emergency anaesthesia, transfers and non-technical skills that optimise team performance. From neonates to adolescents, paediatric patients have diverse physiology and present with a range of congenital and acquired pathologies that often differ from the adult population. With increasing centralisation of paediatric services, staff outside these centres have less exposure to caring for children, yet are often the first responders in managing these high stakes situations. Staying abreast of the latest evidence for managing complex low frequency emergencies is a challenge. This review focuses on recent evidence and pertinent clinical updates within the field. The challenges of maintaining skills and training are explored as well as novel advancements in care.

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“…[ 4 ] A videolaryngoscope (VL) has recently been investigated as a pivotal tool for difficult airway scenario management by a paediatric anaesthesiologist. [ 5 ] There exists substantial literature insinuating a better glottic visualisation in adults and older children. Albeit, the data referring to the time to intubation (TTI) and intubation success rate in infants is negligible and inconclusive.…”

Section: Introductionmentioning

confidence: 99%

Comparison of C-MAC Miller blade video laryngoscope with conventional Miller blade in infants undergoing elective surgery- A prospective randomised trial

et al. 2023

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Background and Aims: Endotracheal intubation (ET) in infants is considered a challenging task over the decades. Infants have short safe apnoea time, and this difficulty has been vanquished to some extent by using the videolaryngoscopes (VLs), but there exists a dearth of research particularly in this vulnerable subset. Therefore, this trial was conducted to evaluate intubation times obtained with C-MAC VL and conventional Miller laryngoscopes in infants. Methods: A total of 80 infants aged between 1 month and 1 year with American Society of Anesthesiologists physical status I-II requiring ET were randomised in two groups; the C-MAC VL or Miller laryngoscope ML. Anaesthesia was induced with sevoflurane 1–8% and atracurium 0.5 mg/kg IV. The primary outcome was evaluated as the total time taken to intubate. Secondary outcomes were time to achieve best glottic view (TBGV), tube insertion time (TIT), percentage of glottic opening (POGO) score, number of attempts and intubation difficulty score (IDS). Results: The median (interquartile range) of time taken for ET was less in VL; 22.5 (20.75–26) compared to ML; 26 (21.75–31). TBGV was achieved early in VL group than the ML group (6.03 ± 1.33s/7.88 ± 2.44) respectively (P-value < 0.001). POGO was better in VL (99.12 ± 4.795s) compared to ML (85.50 ± 31.13s). IDS was less in the VL group (0.07 ± 0.27) than in ML (0.70 ± 1.14). Other parameters, such as the number of attempts, bougie usage, adverse effects and TIT, were comparable across the two groups. Conclusion: When compared to the ML group, the C-MAC VL group exhibited a decreased intubation time, early TBGV, better POGO score, reduced IDS and subjective intubation difficulty. As a result, we consider VL to be a more efficacious device for intubating the trachea in infants.

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Evolution of videolaryngoscopy in pediatric population

Cited by 15 publications

References 80 publications

A Comparative Study of Video Laryngoscopy to Direct Laryngoscopy for Endotracheal Intubation in Pediatric Patients

A Comparative Study of Video Laryngoscopy to Direct Laryngoscopy for Endotracheal Intubation in Pediatric Patients

State‐of‐the‐art management of the acutely unwell child

Comparison of C-MAC Miller blade video laryngoscope with conventional Miller blade in infants undergoing elective surgery- A prospective randomised trial

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