COMPARATIVE STUDY OF MACINTOSH AND MIDLINE APPROACH OF MILLER BLADE INTUBATION IN CHILDREN

Abstract

INTRODUCTION: In children problems related to Airway are among the most common perioperative critical incidents. Airway management, both knowledge and training are mandatory in children. Due to different anatomy with different proportion and angulation children airway is not a miniature replica of adult airway. Epiglottis is large, floppy and omega-shaped in children. The tonsils and adenoids appear in the second year of life reach their largest size by 4–7 years. There are many studies but till date there in no any study has been done to compare Miller, Macintosh laryngoscope blades in paediatric patients. However trial was going on with the primary aim to compare glottic visualisation using Intubation Difficulty Score (IDS); secondary aim to compare ease of intubation using Cormack Lehane grade. AIM: The aim of this study is to find a laryngoscope blade that provides best laryngoscopic and intubation conditions in children. 

MATERIALS AND METHODS: This is prospective study which is carried out in the department of anaesthesia at Prakash Institute of Medical Science and Research Urun-Islampur Maharashtra, during the period of 1 year. All paediatric patients which undergoing circumcisions were included in this study. Total 50 paediatric patients were included in this study with single-blind, parallel group, randomised controlled clinical trial was conducted different age group. Children with anticipated difficult airways, planned for oral surgeries, having severe cardiovascular disease any abnormal liver and/or renal function, having asthma, pneumothorax, hydrothorax or grossly impaired pulmonary function were excluded in this study. All the airway equipment including the emergency cart was kept ready. Baseline data were recorded for all the patients.

RESULT: Total 50 patients were included in this study.  In different age group there was no significant difference (P>0.05) in patients. Better Cormack–Lehane view (P = 0.002) is good and it has significantly obtained with Miller blade when compared with the other blades. Regarding the duration of laryngoscopy or intubation, between the groups there was no difference in the total time to intubate the trachea successfully.

CONCLUSION: In conclusion Miller blade may be considered superior to Macintosh blade in terms of glottis visualization, ease of intubation with normal airways. Styletted  ETT significantly reduces time for intubation and time for procedure in comparison to non styletted ETT.

KEYWORDS:  Children, Macintosh laryngoscope blade, Macintosh laryngoscope blade