Abstract
Purpose
The McCoy curved blade laryngoscope has been demonstrated to improve view at laryngoscopy in adults. A straightbladed version of this laryngoscope has recently been introduced into pediatric practice. The objective of this prospective, randomized study was to compare the intubating conditions afforded by the McCoy (#1) straight blade laryngoscope with the conventional Miller (# 1) blade in neonates and infants.
Methods
Forty patients under six months of age, were randomized into two groups: one group (n = 20) had an initial laryngoscopy with the McCoy blade and then had a laryngoscopy and subsequent intubation using the Miller blade; the second group (n = 20) had an initial laryngoscopy with the Miller blade, followed by laryngoscopy and intubation using the McCoy blade. All intubations were performed by one anesthesiologist familiar with using both blades.
Results
The majority of patients (39 out of 40) had a similar or superior view (Cormack and Lehane classification) with the Miller when compared with the McCoy laryngoscope. Mean time to laryngoscopy was 14.9 (12.7) sec with the McCoy and 6.8 (2.07) sec with the Miller blade (P = 0.001), whereas mean time to intubation was 25.13 (10.4) sec with the McCoy and 12 (8.5) sec with the Miller blade (P = 0.014). There was no difference between the groups regarding desaturation and changes in heart rate during laryngoscopy and intubation.
Conclusion
Our data indicate that the McCoy blade has no advantage over the conventional pediatric Miller blade in normal infants.
Résumé
Objectif
On sait que la lame courbe du laryngoscope McCoy peut améliorer la vue laryngoscopique chez les adultes. La version à lame droite du McCoy a été récemment introduite en pratique pédiatrique. Notre étude prospective et randomisée visait à comparer les conditions d’intubation fournies par la lame droite McCoy (# 1) et la lame Miller traditionnelle (# 1) chez des nouveau-nés et de jeunes enfants.
Méthode
Quarante patients de moins de six mois ont été répartis en deux groupes : dans le premier (n = 20), on a réalisé une première laryngoscopie avec la lame McCoy, puis une laryngoscopie et une intubation avec la lame Miller; dans le second (n = 20), on a d’abord utilisé la lame Miller, puis la lame McCoy pour une laryngoscopie et une intubation. Un anesthésiologiste habitué aux deux lames a fait toutes les intubations.
Résultats
Chez 39 patients sur 40, une exposition similaire ou supérieure (classification de Cormack et Lehane) a été obtenue avec la lame Miller comparée à la lame McCoy. La laryngoscopie a duré en moyenne 14,9 (12,7) sec avec la lame McCoy et de 6,8 (2,07) sec avec la lame Miller (P = 0,001), tandis que l’intubation a été de 25,13(10,4) sec avec la lame McCoy et de 12 (8,5) sec avec la lame Miller (P = 0,014). Aucune différence intergroupe n’a été notée quant à la désaturation et aux modifications de la fréquence cardiaque pendant la laryngoscopie et l’intubation.
Conclusion
La lame McCoy ne présente pas d’avantages sur la lame pédiatrique Miller traditionnelle utilisée chez de jeunes enfants normaux.
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Iohom, G., Franklin, R., Casey, W. et al. The McCoy straight blade does not improve laryngoscopy and intubation in normal infants. Can J Anesth 51, 155–159 (2004). https://doi.org/10.1007/BF03018775
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DOI: https://doi.org/10.1007/BF03018775