Comparison of Glidescope Video Laryngoscopy and Direct laryngoscopy for Tracheal intubation in Neonates

This clinical study from China sought to answer the question whether the routine use of a glidescope improved tracheal intubation times (TTIs) in neonates. 70 neonates (less than 28 days age), ASA 1or 2, scheduled to undergo surgery under general anaesthesia were randomised in to the direct laryngoscopy (DL) or Glidescope (GS) groups. Macintosh blade 1 was used in the DL group and Cobalt blade 1 was used in the GS group. After initial laryngoscopy following gas induction and assessment of Cormack and Lehane (C &L) grading, the neonates were intubated with an appropriate sized ETT with either DL or with GS. TTI was recorded in each group and defined as the time frame between when the blade was placed between the lips to when ETCO2 was detected from the endotracheal tube regardless of the number of intubation attempts. All intubations were performed by consultant anaesthetists with significant experience.

71% of the neonates had a C&L grade 1 view on initial assessment, 14% had a grade 2 view, 13% grade 3 and 1% had a grade 4 view. Any adverse events, immediate and up to 24 hrs post intubation, were noted. The study showed that there were no significant overall differences in the TTIs between the 2 groups. However, subgroup analysis showed that in neonates with C&L grading of 3 and 4, the TTIs was reduced by almost 40%. GS also improved the glottic view compared to the DL use. Additionally, only one case required a third attempt at intubation which was successful after using the GS over the DL. The authors have however commented that the lack of use of muscle relaxant in this study may have contributed to increasing the C&L grade and the potential advantage shown in this study for the GS may be negated with muscular paralysis on board.

Take home message:

Whilst there are many studies that exist in the adult and older paediatric patients looking at benefits the use of videolaryngoscopy in improving intubation times, there is limited data in neonates for the use of Glidescopes. This study does allude to the benefits of videolaryngoscopy in neonates who are potentially difficult intubations in the operating theatre. Further studies may be required to discern whether this benefit will translate in to the less controlled emergency or resuscitation scenarios, where time to intubation may be even more critical, with less experienced personnel at hand.

Reviewed by: Dr. Priya Sreedharan