The C-MAC video laryngoscope helps presbyopic anesthetists to overcome difficulty in neonatal and infantile intubation: a randomized controlled trial.

Background: Endotracheal intubation (ETI) is a life-saving procedure that must be accurately carried on to guard against complications. Presbyopia leads to difficulty in viewing close objects and may obstacle proper intubation even with the best hands.

Purpose: This study supposed that the use of video-laryngoscope (VL) may provide better intubation conditions for presbyopic anesthetists and targets to evaluate the neonates and infants' intubation success rates (ISR) by anesthetists aged ≥ 45 years using the C-MAC VL compared to the standard laryngoscope (SL).

Methods: Thirty-one neonates with an age of 18.2 ± 5.2 days and a body weight of 4.5 ± 0.3 kg and 103 infants aged 8.6 ± 1 months and weighing 9.4 ± 1.5 kg were randomly categorized into the SL group that received ETI using the SL and the VL group had intubated using the C-MAC (Karl Storz, Germany) VL with the standard Miller blade and flexible Stylet (2 mm PORTEX stylet; Smiths Medical International Ltd., UK) to strengthen the endotracheal tube (ETT) and adjust its curvature as C-shaped. The study outcomes included the frequency of successful intubation and the number of intubation attempts.

Results: The ISR was significantly (P < 0.001) higher with significantly (P = 0.0037) lower frequency of using assistance maneuvers with VL. The mean score of the anesthetist's difficulty rating was significantly (P < 0.001) higher with SL (2.7 ± 2) than with VL (1.27 ± 1.27). Times for the full intubation process were significantly (P < 0.001) shorter with VL than SL. The 1st attempt success rate was significantly (P = 0.0195) higher with VL than SL (86.6% vs. 67.2%). The frequency of maneuver-related complications was insignificantly (P = 0.116) reduced with the use of VL (4.5%) than with SL (12%). The ISR showed a negative significant correlation (r=-0.973, P = 0.005) with the anesthetist's age.

Conclusion: Neonatal and infantile intubation using VL is feasible and easy to handle by aged anesthetists and allows higher ISR and 1st attempt rate with minimal need for external assistant maneuvers and maneuver-related complications. VL might be more appropriate for the presbyopic pediatric anesthetists than the SL.

Limitations: The limitations of the study are the small sample size of anesthetists and the use of one type of VLs.