Video laryngoscopy guided glottic view grading and its correlation with tracheal intubation time in infants undergoing surgery. A prospective observational study

Airway management in infants is one of the most critical and technically challenging

aspects of pediatric anesthesia. Infants present unique anatomical and physiological

characteristics that can complicate tracheal intubation, including a larger tongue, a

more cephalad and anterior larynx, and a narrower airway lumen. These factors

contribute to a higher risk of failed or prolonged intubation, with potential for

significant morbidity such as hypoxemia, bradycardia, and airway trauma. Therefore,

optimizing the visualization of the glottis and understanding its relationship with

intubation outcomes is essential for improving the safety and efficacy of airway

management in this vulnerable population.

Video laryngoscopy (VL) has gained widespread acceptance in pediatric anesthesia

and critical care settings due to its ability to provide enhanced visualization of the

glottis compared to traditional direct laryngoscopy (DL). Unlike DL, which relies

on a direct line of sight, VL offers an indirect view of the airway structures via a

camera at the tip of the laryngoscope blade. This improved view can lead to better

glottic visualization, potentially increasing the success rate of tracheal intubation and

decreasing the time required to secure the airway.[7] Despite these advantages, the predictive value of videolaryngoscopic glottic view grading on intubation outcomes,

particularly in infants, remains underexplored.

Several grading systems, such as the Cormack-Lehane (CL) classification, are

commonly used to describe glottic views during laryngoscopy. However, these

systems were originally developed for adults and direct laryngoscopy, which may

limit their applicability in infants or with videolaryngoscopy. Recently, a specific six-

stage glottic view grading for videolaryngoscopy has been proposed to better capture

the nuances of VL-based airway assessments.  Despite this progress, there is a

paucity of prospective data examining the relationship between glottic view grading

and actual intubation performance, including time to successful tube placement, in

the infant population.

This prospective observational study aims to evaluate the correlation between video

laryngoscopy-guided glottic view grading and tracheal intubation time in infants

undergoing elective surgery. By systematically recording and analyzing

videolaryngoscopic views and timing data, we aim to determine whether glottic view

grading can serve as a reliable predictor of intubation difficulty and duration