Usefulness of Airway Scope for intubation of infants with cleft lip and palate–comparison with Macintosh laryngoscope: a randomized controlled trial

Abstract

BackgroundAirway Scope (AWS) with its plastic blade does not require a head-tilt or separate laryngoscopy to guide intubations. Therefore, we hypothesized that its use would reduce the intubation time (IT) and the frequency of airway complication events when compared with the use of Macintosh Laryngoscope (ML) for infants with cleft lip and palate (CLP).MethodsThe parents of all patients provided written consents; we enrolled 40 infants with CLP (ASA-PS 1). After inducing general anesthesia using sevoflurane and rocuronium, we performed orotracheal intubations using either AWS (n = 20) or ML (n = 20), randomly. We define the duration between manual manipulation using cross finger for maximum mouth opening and the first raising motion of the chest following intubation by artificial ventilation as “IT;” further, the measured IT as primary outcomes. Airway complications were considered secondary outcomes. Moreover, we looked for associations between IT and the patient’s characteristics: extensive clefts, age, height, and weight. We used the Mann–Whitney test and Fisher’s exact probability test for statistical analysis; p < 0.05 was considered as statistically significant.ResultsThe mean IT was 31.5 ± 8.3 s in AWS group and 26.4 ± 8.9 s in ML group. Statistical significant difference was not found in IT between the two groups. The IT of AWS group was statistically related to extensive clefts. Airway complications were detected in ML group.ConclusionAWS could be useful for intubation of infants with CLP; it required IT similar to that required using ML, with a lower rate of airway complications.Trial registrationUMIN-CTR Registration number UMIN000024763.Registered 8 November 2016.

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

“…Meta-analyses of randomized controlled trials comparing video-assisted laryngoscopy with direct laryngoscopy in patients with predicted difficult airways reported improved laryngeal views, a higher frequency of successful intubations, a higher frequency of first attempt intubations, and fewer intubation maneuvers with video-assisted laryngoscopy (Category A1-B evidence); [249][250][251][252][253][254][255][256][257][258][259] findings for time to intubation were equivocal (Category A1-E evidence). 250,[253][254][255][258][259][260][261]### Randomized controlled trials comparing video-assisted laryngoscopy with awake laryngoscopy with a flexible intubation scope reported equivocal findings for laryngeal view, visualization time, first attempt intubation success, and time to intubation (Category A2-E evidence). [262][263][264][265] Randomized controlled trials comparing channel-guided videolaryngoscopes with non-channel-guided videolaryngoscopes reported equivocal findings for laryngeal view, intubation success, first attempt intubation, time to intubation, and needed intubation maneuvers (Category A3-E evidence).…”

Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis

“…A further 202 studies were excluded for the following reasons: non-RCT (n = 56), manikin study (n = 41), case report (n = 33), review or meta-analysis (n = 22), different outcomes (n = 16), use of a flexible fiberscope (n = 11), use of a laryngeal mask (n = 7), observational study design (n = 7), adult patients (n = 4), guidelines (n = 3), and resuscitation research (n = 3). The remaining 34 articles met the inclusion criteria and contained the data necessary for the planned analysis ( Figure S3 ) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

“…Patients included in these studies were aged 0 to 10 years. Based on pre-intubation airway assessment, 26 of 34 studies included patients with a normal airway [ 15 , 16 , 17 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 46 , 47 ], and 3 included patients with a difficult airway [ 35 , 36 , 45 ]. Five studies did not provide information on airway status [ 18 , 19 , 21 , 34 , 44 ].…”

Unexpected difficult airway due to an undiagnosed congenital lingual thyroglossal duct cyst in a neonate without stridor: A case report

“…In addition, its blade is made of polycarbonate resin and airway complications such as bleeding from the pharynx with this device are lower compared with those seen when using a Macintosh laryngoscope. 18 …”