Comparison of the McGrath®MAC video laryngoscope with direct Macintosh laryngoscopy for novice laryngoscopists in children without difficult intubation: A randomised controlled trial.
BACKGROUND
Airway management and tracheal intubation are routinely performed in paediatric anaesthesia and yet are associated with preventable adverse events. The McGrath®MAC is a video laryngoscope with a curved blade similar to the Macintosh blade, which has not been previously described in first intention paediatric tracheal intubation. We aimed to compare direct laryngoscopy to the McGrath®MAC video laryngoscope among novice laryngoscopists.


METHODS
Six paediatric anaesthesia residents with novice skills in paediatric laryngoscopy were randomly assigned to perform tracheal intubation using either direct Macintosh laryngoscopy (DL) or the McGrath®MAC video laryngoscope (MM) as the first attempted device in children weighing between 10 and 20kg without difficult intubation.


RESULTS
Our study enrolled 132 children between August 2013 and April 2015. The time to intubation was shorter in the DL group (n=67) compared to the MM group (n=65) with 42s (35-50) versus 48s (43-58) P=0.002. The time to best view was similar between the two groups (10s [7-16] versus 10s [8-15]; P=0.50). The tube passage time was shorter with DL (29s [25-35] versus 35s [30-45]; P=0.0002) and either Cormak & Lehane grade or Percentage Of Glottis Opening (POGO) scores were similar between groups. Minor reversible respiratory adverse events were similar between groups: 12 in the DL group (17.9%) versus 12 in the MM group (18.5%).


CONCLUSIONS
McGrath®MAC video laryngoscopy, when performed by a novice laryngoscopist on easy-to-intubate children, is associated with longer intubation times.
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France. Electronic address: antoine.giraudon@chu-bordeaux.fr.
Antoine
A
Giraudon
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
Maryline
M
Bordes-Demolis
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
Barbara
B
Blondeau
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
Nadia
N
Sibai de Panthou
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
Nathan
N
Ferrand
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
Maeva
M
Bello
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
Victoria
V
Dahlet
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
François
F
Semjen
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
Matthieu
M
Biais
Anaesthesia and Critical Care Department 3, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, Bordeaux 33076, France.
Karine
K
Nouette-Gaulain
D058109:Airway Management; D000776:Anesthesiology / Q000193:education*; D002675:Child, Preschool; D023381:Endpoint Determination; D005260:Female; D005931:Glottis / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000379:methods*; D020704:Laryngoscopes / Q000009:adverse effects; D007828:Laryngoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008348:Manikins
Curved blades; Internship and residency; Laryngoscopes; Paediatric; Tracheal intubation; Video laryngoscopes