Comparison of time to intubate and intubation conditions with CMAC Miller blade size 1 and CMAC Macintosh blade size 2 in pediatric patients-A prospective randomized controlled study

Abstract

BackgroundIntubating conditions with CMAC Miller and Macintosh blade have not been compared. AimThe primary aim was an evaluation of intubation time with a CMAC Miller blade & Macintosh blade in children. The secondary aim was an evaluation of the best glottic view time, ease of blade insertion & intubation, maneuvers and complications. MethodsA total of 160 children aged 1–4 years were included. After anesthesia, intubation was attempted with either a CMAC Miller blade size 1 (group Mil) or Macintosh blade size 2 (group Mac) by a second year resident. Intubation time, best glottic view time, procedure time, Cormack-Lehane (CL) grade, percentage of glottis opening (POGO) score, ease of blade insertion and intubation were noted. ResultsThe demographic data was comparable. Mean time for intubation (22.73 ± 9.06 vs 23 ± 8.34 s) (p = 0.84), best glottic view (11.79 ± 7.97 vs 12.66 ± 5.93 s) (p = 0.43) and procedure (28.54 ± 9.57 vs 29.24 ± 10 s) (p = 0.65) was comparable between group Mil and group Mac respectively. Ease of intubation was significantly more in group Mac (p = 0.02). The need for cheek retraction during intubation was significantly more in group Mil (p=<0.0001). The ease of blade insertion, intubation attempts, CL grading, POGO score and complications were comparable. ConclusionThe mean time for intubation was comparable with a CMAC Miller blade size 1 and Macintosh blade size 2 in 1–4 years old children. Significantly more children required cheek retraction during intubation with a Miller blade.