title: A comparison of the Airtraq®, McGrath®, and Macintosh laryngoscopes for difficult paediatric intubation: A manikin study.
abstract: BACKGROUND
  The efficacy of devices for difficult intubation in paediatric patients, especially with a Cormack-Lehane grade 4 view, has yet to be established. We compared intubating parameters among three devices (the Airtraq®, McGrath®, and Macintosh laryngoscopes).
  
  
  METHODS
  This study is a randomised cross-over trial. Participants were 20 anaesthetists. Each device was tested three times using a paediatric manikin with a Cormack-Lehane grade 4 view. The order to use each device was randomised by a computer-generated random sequence. The primary endpoint was the rate of successful intubation. Secondary endpoints included the time taken to intubate, percentage of glottic opening score, and severity of potential dental trauma.
  
  
  RESULTS
  The successful intubation rates of the Airtraq®, McGrath®, and Macintosh laryngoscopes were 100%, 72%, and 45%, respectively. The risk ratio of the success rates of Airtraq® compared with McGrath® and Macintosh laryngoscopes were 1.40 (95% CI; 1.19-1.64, P < 0.001) and 2.22 (95% CI; 1.68-2.94, P < 0.001), respectively. The modified Cormack-Lehane grade and percentage of the glottic opening score were better for the Airtraq® than for the other devices. The dental trauma score was lower for the Airtraq® than for the other devices. There were no significant differences in the intubation time among the groups.
  
  
  CONCLUSIONS
  The Airtraq® had higher success rate, had better visibility, and was associated with less dental trauma than the other devices in a difficult paediatric intubation model with a Cormack-Lehane grade 4 view.
authors.affiliation: Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Owada
authors.affiliation: Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan.|Department of Anaesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Takahiro
authors.identifier: http://orcid.org/0000-0003-0613-511X
authors.initials: T
authors.lastname: Mihara
authors.affiliation: Department of Anaesthesiology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
authors.forename: Gaku
authors.initials: G
authors.lastname: Inagawa
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Asakura
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Anaesthesiology, Kanagawa Children's Medical Centre, Yokohama, Japan.
authors.forename: Koui
authors.initials: K
authors.lastname: Ka
mesh_terms: D002648:Child; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes / Q000009:adverse effects*; D008348:Manikins; D018677:Tooth Injuries / Q000209:etiology*