Available online 14 June 2022
Highlights•Direct Macintosh and Miller blade are widely used for endotracheal intubation in children and compared for intubating conditions and time for intubation.
•Videolaryngoscopes have been compared with direct laryngoscopes for intubating conditions and time for intubation.
•Pediatric videolaryngoscopes blade have different designs. CMAC videolaryngoscope has pediatric Miller blade and Macintosh blade.
•CMAC videolaryngoscope Miller size 1 and Macintosh size 2 blade provide comparable time for best glottic view, time for intubation and attempts for intubation in children aged 1–4 years.
•Cheek retraction was required for intubation with CMAC Miller blade in higher number of cases in comparison to CMAC Macintosh blade.
AbstractBackgroundIntubating conditions with CMAC Miller and Macintosh blade have not been compared.
AimThe primary aim was an evaluation of intubation time with a CMAC Miller blade & Macintosh blade in children. The secondary aim was an evaluation of the best glottic view time, ease of blade insertion & intubation, maneuvers and complications.
MethodsA total of 160 children aged 1–4 years were included. After anesthesia, intubation was attempted with either a CMAC Miller blade size 1 (group Mil) or Macintosh blade size 2 (group Mac) by a second year resident. Intubation time, best glottic view time, procedure time, Cormack-Lehane (CL) grade, percentage of glottis opening (POGO) score, ease of blade insertion and intubation were noted.
ResultsThe demographic data was comparable. Mean time for intubation (22.73 ± 9.06 vs 23 ± 8.34 s) (p = 0.84), best glottic view (11.79 ± 7.97 vs 12.66 ± 5.93 s) (p = 0.43) and procedure (28.54 ± 9.57 vs 29.24 ± 10 s) (p = 0.65) was comparable between group Mil and group Mac respectively. Ease of intubation was significantly more in group Mac (p = 0.02). The need for cheek retraction during intubation was significantly more in group Mil (p=<0.0001). The ease of blade insertion, intubation attempts, CL grading, POGO score and complications were comparable.
ConclusionThe mean time for intubation was comparable with a CMAC Miller blade size 1 and Macintosh blade size 2 in 1–4 years old children. Significantly more children required cheek retraction during intubation with a Miller blade.
KeywordsCMAC
Video laryngoscope
Miller blade
Macintosh blade
Children
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