Comparison of Airtraq with Macintosh Laryngoscope for Endotracheal Intubation in Paediatric Patients: A Randomised Controlled Trial

Introduction: The Airtraq is a new intubation device that has been developed to facilitate tracheal intubation in patients with normal or difficult airway. The available paediatric sizes are 0, 1 and 2 and are of grey, purple, green colour. These can insert endotracheal tube of size 2.0-3.5/4-5.5/6-7.5, respectively. Aim: To evaluate the clinical efficacy of Airtraq laryngoscope in comparison with Macintosh by experienced anaesthesiologist for intubation in paediatric patients. Materials and Methods: The randomised controlled trial was conducted at Sarojini Naidu Medical College, Agra, Uttar Pradesh. India, from December 2015 to August 2017. Fifty healthy children, aged 2-10 years of American Society of Anesthesiologists (ASA) grades I/II, presenting for elective surgery were randomly allocated in two equal groups. Endotracheal intubation was done either using Airtraq or Macintosh laryngoscope. Duration of intubation (primary variable), number of attempts, ease of intubation, oesophageal intubation, optimisation maneuvers, Percentage Of Glottic Opening (POGO) scoring and haemodynamic parameters were compared between two groups. Patients' demographic data, intubation time, haemodynamic variables were analysed by Unpaired t-test. While number of attempts for intubation, ease of intubation, optimisation maneuvers and POGO scoring were analysed by Fisher's-exact test. Data was presented as mean (SD) with categorical data presented as number (%) and as frequencies. The p-value of <0.05 was considered as significant. Results: There was no difference in demographic variables and duration of surgery between two groups. Intubation time, which was taken as primary variable, was found to be significantly longer in Macintosh (56.28 +/- 6.02 sec) as compared to Airtraq (25.60 +/- 3.73 sec) (p-value <0.0001). In terms of ease of intubation and POGO scoring Airtraq was better as compared to Macintosh. Haemodynamically, Airtraq was found to be better as compared to Macintosh reflected by postintubation heart rate which was 110 +/- 7.84 beats/min with Airtraq while 119.32 +/- 10.61 beats/min with Macintosh (p-value=0.0028). The two groups were statistically comparable in terms of number of attempts, optimisation maneuvers and mean blood pressure changes. Conclusion: It can be concluded that Airtraq is a reliable and promising alternative to Macintosh for endotracheal intubation in paediatric patients as seen by duration of intubation, better Laryngeal view, ease of intubation and haemodynamic changes.

Automated summary

This study aimed to evaluate the clinical efficacy of Airtraq laryngoscope compared to Macintosh laryngoscope for intubation in pediatric patients. The results showed that the intubation time was significantly shorter with Airtraq compared to Macintosh, and Airtraq also provided better ease of intubation and glottic opening scoring. Hemodynamically, Airtraq was found to be superior with lower post-intubation heart rate. Therefore, Airtraq can be considered a reliable and promising alternative to Macintosh for endotracheal intubation in pediatric patients.