Comparison of ease of intubation with Airtraq®, Miller, Macintosh laryngoscope blades in children: A prospective randomised trial

Aims and Objectives In children, the airway often presents unique anatomical challenges that can make intubation difficult, particularly when attempting to align the line of sight with the laryngeal inlet. However, video laryngoscopes offer several advantages over traditional direct laryngoscopy by eliminating the need for precise alignment, thereby facilitating easier and more successful intubation. The primary objective of the study was to compare the ease of intubation with Airtraq®, Miller, and Macintosh laryngoscope blades. The secondary objectives were to compare the mean intubation time, Cormack-Lehane (CL) grade, percentage of glottis opening (POGO), number of intubation attempts, and haemodynamic response between Airtraq®, Miller, and Macintosh laryngoscope blades of appropriate sizes in children undergoing elective surgeries under general anaesthesia. Material and Methods 75 paediatric patients of American Society of Anesthesiologists physical status I and between 2 and 10 years of age were consecutively enroled and randomly allocated to one of the three groups: group A (Airtraq®, n = 25), group B (Miller, n = 25), and group C (Macintosh, n = 25). Patients were intubated with one of the three devices, viz. Airtraq®, Miller, and Macintosh laryngoscope blades, and the ease of intubation, mean intubation time, CL grade, POGO score, number of intubation attempts, and haemodynamic responses were noted. Results The ease of intubation was better with Airtraq® compared to Miller and Macintosh laryngoscope blades (p-value = 0.001). The mean intubation time [mean ± standard deviation (SD)] for Airtraq® (41.52 ± 6.63 seconds) [95% confidence interval (CI): 38.78, 44.26] was significantly greater than for Miller and Macintosh laryngoscope blades, 33.12 ± 6.77 seconds (95% CI: 24.78, 31.78) and 28.28 ± 8.48 seconds (95% CI: 30.32, 35.92), respectively, p-value <0.05, though the POGO score was more for Airtraq® [mean ± SD (86% ± 10)] (95% CI 81.87, 90.13) compared to Miller blade (72% ± 12.25) (95% CI 66.94, 77.06) p-value <0.05. The POGO score with Airtraq® was more than with Macintosh blade, though statistically insignificant (95% CI 76.52, 85.08) (p-value = 0.290). The modified CL grading was better with Airtraq® compared with Miller and Macintosh (p-value = 0.020), with no significant difference in the haemodynamic response between the three blades. The number of first and second attempts at intubation was 56% and 44% for Airtraq and 88% and 12% for Miller blade, respectively. Intubation was successful in the first attempt for the Macintosh blade group. Conclusion Even though the ease of intubation and glottic visualisation was better with the Airtraq® compared to Miller and Macintosh blades in children, the time taken for intubation was more with the Airtraq® when compared to Miller and Macintosh laryngoscope blades.