Video-laryngoscopy in pediatric anesthesia improves glottis visualization but prolongs intubation time and increases failure.

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• Yu Sun, Yi Lu, Yan Huang, and Hong Jiang.
• Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
• Paediatr Anaesth. 2014 Oct 1; 24 (10): 1056-65.

BackgroundWe reviewed the updated literature and performed a meta-analysis based on randomized controlled trials in children to compare the clinical efficacy between video laryngoscopes (VLs) and direct laryngoscopes (DLs).MethodsWe searched articles published in English matching the key words 'video laryngoscope (including Airtraq, GlideScope, Storz, TruView, AWS, Bullard, McGrath)' AND 'direct laryngoscope' AND 'children (including pediatric, infant, neonate)' in PubMed, Ovid, Google Scholar, and the Cochrane Library databases. Only prospective randomized controlled trials (RCTs), which compared the use of VLs and DLs in children, were included. The relative risk (RR), weighted mean difference (WMD), and their corresponding 95% confidence interval (95% CI) were calculated using the quality effects model of the metaxl 1.3 software for outcome data.ResultsFourteen studies were included in this meta-analysis. Although VLs improved the glottis visualization in most children either with normal airways or with potentially difficult intubations, the time to intubation (TTI) was prolonged in comparison to DLs (WMD: 4.9 s; 95% CI: 2.6-7.1). Subgroup analysis showed the GlideScope (WMD: 5.2 s; 95% CI: 2.0-8.5), TruView (WMD: 5.1 s; 95% CI: 0.7-9.5), Storz (WMD: 6.4 s; 95% CI: 4.8-8.1), and Bullard (WMD: 37.5 s; 95% CI: 21.0-54.0) rather than Airtraq (WMD: 0.6 s; 95% CI: -7.7-8.9) prolonged TTI. Although the success rate of the first attempt (RR: 0.96; 95% CI: 0.92-1.00) and associated complications (RR: 1.11; 95% CI: 0.39-3.16) were similar in both groups, VLs were associated with a higher incidence of failure (RR: 6.70; 95% CI: 1.53-29.39).ConclusionThis meta-analysis demonstrates that although VLs improved glottis visualization in pediatric patients, this was at the expense of prolonged TTI and increased failures. However, further studies are needed to clarify the efficacy and safety of VLs in hands of nonexperts and in children with airway problems.© 2014 John Wiley & Sons Ltd.

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