Comparison of Indirect Video Laryngoscopes in Children Younger than Two Years of Age: a Randomized Trainee Evaluation Study.

BACKGROUND Gaining proficiency with various airway management tools is an important goal for anesthesiology training. Indirect video laryngoscopes facilitate tracheal intubation in adults, but it is not clear whether these findings translate to children. This study evaluates the total time to successful intubation when performed by anesthesiology trainees using GlideScope Cobalt® video laryngoscopy (GlideScope), Storz DCI® video laryngoscopy (Storz), or direct laryngoscopy (Direct) in children <2 years old with normal airway anatomy. METHODS Sixty-five children presenting for elective surgery were randomly assigned to undergo tracheal intubation using GlideScope, Storz, or Direct. Laryngoscopists were anesthesiology trainees in clinical anesthesia year ≥2 who had proven basic proficiency with each laryngoscope on an infant airway manikin. Total time to successful intubation (TTSI, seconds), rate of successful intubation on first laryngoscopy attempt, and the change in intubation time from manikin to clinical settings were recorded. An intubation time difference >10 seconds was defined as clinically significant. RESULTS TTSI was longer for Storz (42.1; 34.0 to 59.0) than for Direct (21.5; 17.0 to 34.3; p=0.002). We were not able to demonstrate a difference >10 seconds between the GlideScope and the other laryngoscopes. Median manikin intubation time was <10 seconds and increased significantly in the clinical setting for all laryngoscopes (all p <0.0001). CONCLUSIONS Anesthesiology trainees completed manikin tracheal intubation rapidly with all laryngoscopes studied, but required a clinically significant longer time to tracheally intubate children <2 years. Our findings suggest in vivo training should be included to facilitate proficiency with device-specific intubation techniques.