GlideScope® cobalt video laryngoscope versus direct Miller laryngoscope for lateral position-tracheal intubation in neonates with myelodysplasia: A prospective randomized study

Abstract

Background and objective: Anesthesiologists encounter difficulties during laryngoscopy and tracheal intubation of neonates with myelodysplasia. Tracheal intubation in lateral position in such cases deemed profitable but not easy because of the compromised laryngeal view. We compared GlideScope video laryngoscope (GVL) versus conventional Miller direct laryngoscope (DL) for tracheal intubation in laterally positioned neonates with myelodysplasia.

Materials and methods: Sixty neonates scheduled for elective surgical repair of meningeocele or meningeomyelocele under general anesthesia were allocated randomly for endotracheal intubation using GVL or DL. Percentage of glottis opening (POGO) scores, time to best glottis view (TBGV), endotracheal tube passage time (TPT), intubation time (IT), intubation attempts, and overall success rate of intubation were recorded.

Results: TBGV was significantly shorter in GVL group (median = 6.8 s, range = 3.5-28.2 s) in comparison with DL group (median = 8.4 s, range = 4.8-32.7 s) (P = 0.01); however, TPT and IT were comparable. POGO scores were significantly higher with GVL group than DL group (median = 93.8, range = 45-100 and median = 82.4, range 10-100, respectively) (P = 0.001). Overall success of intubation was the same; however, three patients in GVL group required a second attempt for intubation in comparison with five patients in DL group. One patient in DL group required a third attempt.

Conclusion: In laterally positioned neonates, GVL is easier than DL with a similar intubation time, comparable time required for tube passage, better views of the glottis, shorter times to obtain the best glottic view, and high success rate as compared with DL. GlideScope seems to be an effective approach for endotracheal intubation of laterally positioned neonates with myelodysplasia.

Keywords: Cobalt video laryngoscope; direct laryngoscope; neonates; tracheal intubation.

Figure 1

The consort diagram illustrating patients flow through the study

Figure 2

Time to best glottis view in seconds represented by Box and whisker plots. The horizontal solid line inside the box gives the median time and the upper and lower limits of the box correspond to the 25^th and 75^th quartiles. The horizontal limits of the whiskers correspond to the 5^th and 95^th percentiles

Figure 3

Intubation time in seconds represented by Box and whisker plots. The horizontal solid line inside the box gives the median time and the upper and lower limits of the box correspond to the 25^th and 75^th quartiles. The horizontal limits of the whiskers correspond to the 5^th and 95^th percentiles

Figure 4

Endotracheal tube passage time in seconds represented by Box and whisker plots. The horizontal solid line inside the box gives the median time and the upper and lower limits of the box correspond to the 25^th and 75^th quartiles. The horizontal limits of the whiskers correspond to the 5^th and 95^th percentiles