Abstract
BackgroundAirway Scope (AWS) with its plastic blade does not require a head-tilt or separate laryngoscopy to guide intubations. Therefore, we hypothesized that its use would reduce the intubation time (IT) and the frequency of airway complication events when compared with the use of Macintosh Laryngoscope (ML) for infants with cleft lip and palate (CLP).MethodsThe parents of all patients provided written consents; we enrolled 40 infants with CLP (ASA-PS 1). After inducing general anesthesia using sevoflurane and rocuronium, we performed orotracheal intubations using either AWS (n = 20) or ML (n = 20), randomly. We define the duration between manual manipulation using cross finger for maximum mouth opening and the first raising motion of the chest following intubation by artificial ventilation as “IT;” further, the measured IT as primary outcomes. Airway complications were considered secondary outcomes. Moreover, we looked for associations between IT and the patient’s characteristics: extensive clefts, age, height, and weight. We used the Mann–Whitney test and Fisher’s exact probability test for statistical analysis; p < 0.05 was considered as statistically significant.ResultsThe mean IT was 31.5 ± 8.3 s in AWS group and 26.4 ± 8.9 s in ML group. Statistical significant difference was not found in IT between the two groups. The IT of AWS group was statistically related to extensive clefts. Airway complications were detected in ML group.ConclusionAWS could be useful for intubation of infants with CLP; it required IT similar to that required using ML, with a lower rate of airway complications.Trial registrationUMIN-CTR Registration number UMIN000024763.Registered 8 November 2016.
Highlights
Airway Scope (AWS) with its plastic blade does not require a head-tilt or separate laryngoscopy to guide intubations
Based on the mean outcome of our pilot study including seven individuals for each group taken as 21 s in Macintosh Laryngoscope (ML) group and as 31 s in AWS group, we calculated effect size 1.00 using Cohen’s d first and subsequently the sample size keeping α error as 5%, and power of the study as 80% (1-β errors). the minimum sample size calculated was 34 (17 in each group) using G*Power 3.1.9.2
A Φ3.5 mm tracheal tube of Halyard micro cuff® was used in all patients as a first choice; the ML group patients were intubated with No 1 blade; the AWS group patients were intubated with AWS with NK PBLADE ITL-PL®
Summary
Airway Scope (AWS) with its plastic blade does not require a head-tilt or separate laryngoscopy to guide intubations. Ali et al [4] had compared intubation time for pediatric patients between pediatric Airtraq® and conventional Macintosh laryngoscope They calculated the sample size on the bases of the mean outcome of intubation time required 30 s of the former and 40 s with a standard deviation of 8 s of the latter keeping α error 5% and power as 95% (1-β errors); the calculated sample size was 34 (17 in each group). They concluded that Pediatric Airtaq® takes shorter time to intubate with less frequent complication than conventional laryngoscope in children
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