Comparison of Bullard laryngoscope and short-handled Macintosh laryngoscope for orotracheal intubation in pediatric patients with simulated restriction of cervical spine movements

Abstract

Aim: To compare time to intubation, time to optimal laryngoscopy, best laryngeal view, and success rate of intubation with pediatric Bullard laryngoscope and short-handled Macintosh laryngoscope in children being intubated with neck stabilization.

Background: Securing airway of a patient with restricted cervical spine movement has been a challenge faced by anaesthesiologists around the world. Macintosh laryngoscope with manual inline stabilization is most commonly used. Bullard laryngoscope is also useful in this situation as minimal neck movement occurs with its use.

Methods: Forty patients, ASA I or II, aged 2-10 years, were enrolled in this prospective, controlled, and randomized study. Patients were randomly allocated to one of two groups: Group MB (first laryngoscopy using short-handled Macintosh laryngoscope followed by pediatric Bullard laryngoscope) and Group BM (first laryngoscopy using pediatric Bullard laryngoscope followed by short-handled Macintosh laryngoscope) with manual inline stabilization after induction of anesthesia and paralysis. Trachea was intubated orally using the second equipment.

Results: Laryngeal view when obtained was always Grade 1 with Bullard laryngoscope (38/38) when compared to Macintosh laryngoscope [Grade 1 (10/40)]. The mean time to laryngoscopy (and intubation) was shorter with Macintosh laryngoscope [15.53 s (38.15 s)] than Bullard laryngoscope [35.21 s (75.71 s)], respectively. Success rate of intubation was higher with Macintosh laryngoscope (100%) when compared to Bullard laryngoscope (70%).

Conclusions: Laryngoscopy and intubation is faster using a short-handled Macintosh laryngoscope with a higher success rate compared to pediatric Bullard laryngoscope in pediatric patients when manual inline stabilization is applied.