Background We analysed data from the Paediatric Difficult Intubation Registry examining the use of direct laryngoscopy and GlideScope ® videolaryngoscopy. Methods Data collected by a multicentre, paediatric difficult intubation registry from 1295 patients were analysed. Rates of success and complications between direct laryngoscopy and GlideScope videolaryngoscopy were analysed. Results Initial (464/877 = 53% vs 33/828 = 4%, Z-Test = 22.2, P < 0.001) and eventual (720/877 = 82% vs. 174/828 = 21%, Z-Test = 25.2, P < 0.001) success rates for GlideScope were significantly higher than direct laryngoscopy. Children weighing <10 kg had lower success rates with the GlideScope than the group as a whole. There were no differences in complication rates per attempt between direct laryngoscopy and GlideScope. The direct laryngoscopy group had more complications associated with the greater number of attempts needed to intubate. There were no increased risks of hypoxia or trauma with GlideScope use. Each additional attempt at intubation with either device resulted in a two-fold increase in complications (odds ratio: 2.0, 95% confidence interval: 1.5-2.5, P < 0.001). Conclusions During difficult tracheal intubation in children, direct laryngoscopy is an overly used technique with a low chance of success. GlideScope use was associated with a higher chance of success with no increased risk of complications. GlideScope use in children with difficult tracheal intubation has a lower success rate than in adults with difficult tracheal intubation. Children weighing less than 10 kilograms had lower success rates with either device. Attempts should be minimized with either device to decrease complications.
Bibliographical noteFunding Information:
Supported by internal funding from the Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA and the Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
© The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
- airway management
- difficult intubation
- intratracheal intubation