Pediatric Videolaryngoscopy

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Excerpt

The article published in a recent issue of Pediatric Critical Care Medicine by Balaban and Tobias (1) describing videolaryngoscopy in neonates, infants, and children was of interest to us. However, we noted the several issues in this article that were needed to be clarified and supplemented.
First, the authors described that the available videolaryngoscopes are classified into two categories: Macintosh type (nonguided) and tube (guide) channel type. In fact, the GlideScope, Truview PCD, and UEScope VL300 videolaryngoscopes included in this article are often called as “angulated devices.” They are characterized by a larger blade curve than the Macintosh type videolaryngoscopes. The large blade curvature can provide an improved laryngeal view on the monitor with minimal movement of the patient’s head and neck for alignment of three airway axes. Furthermore, the Storz videolaryngoscope and UEScope are available with the two reusable Miller blades (sizes 0 and 1) for pediatric use. Thus, the currently available videolaryngoscopes should be classified into four groups: Macintosh, tube channel, angulated, and Miller types (2).
Second, the manufacturer of the McGrath MAC videolaryngoscopes is Aircraft Medical (Edinburgh, United Kingdom), rather Covidien Products (Medtronic, Minneapolis, MN). In February 2012, furthermore, the two Intlock blades for pediatric use were developed for the Pentax Airway Scope; the Intlock blade for neonates and the Intlock blade for infants (3).
Third, the authors provided some erroneous information regarding UEScope videolaryngoscopes. There are commercially reusable and disposable UEScope devices available for pediatric patients. The trade names of reusable and disposable devices are VL300 and TTC, respectively. The UEScope videolaryngoscopes have no pediatric Macintosh blades. There are three reusable angulated blades (sizes 1–3), two reusable Miller blades (sizes 0 and 1), and one disposable angulated blade (size 2) for use in pediatric patients (http://www.ueworld.com/product.html, accessed March 29, 2017). However, the angled blade design of UEScope is significantly different from those of the videolaryngoscopes with sharply angulated blades, such as GlideScope videolaryngoscope. The upwards angle of UEScope angulated blade is about 40°, which is larger than Macintosh laryngoscope but less than GlideScope videolaryngoscope. This feature of UEScope videolaryngoscope is designed for improvement of intubation performance and for use in the normal and difficult airways (2). Furthermore, there have been several randomized controlled trials comparing the performance of angulated UEScope videolaryngoscope and Macintosh laryngoscope for orotracheal intubation in pediatric patients with normal and difficult airways. These studies show that compared with Macintosh laryngoscope, UEScope videolaryngoscope provides an improved laryngeal view, a higher success rate at the first attempt, a shorter intubation time, and fewer complications (4–6). In addition, there are reports about successful use of this videolaryngoscope in neonates, infants, and children (7, 8).

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