C MAC VIDEO LARYNGOSCOPE VERSUS TUOREN VIDEO LARYNGOSCOPE FOR ENDOTRACHEAL INTUBATION IN THE PAEDIATRIC POPULATION UNDERGOING GENERAL ANAESTHESIA

The pediatric airway management poses a challenge to anaesthesiologists across the globe due to the major anatomical, physiological and developmental differences in them as compared to the adult population. One of the prime causes of anaesthetic morbidity and mortality is complications arising from difficult tracheal intubation despite recent evolution in airway management strategies. Direct laryngoscopy (DL) has been regarded as the gold standard for endotracheal intubation (ETI) in both paediatric and adult patients. Direct laryngoscopy guided tracheal intubation requires the three axes (oral, pharyngeal and laryngeal) to be arranged in one straight line, achieved by placing the head and neck in the sniffing position. Up to 4.7% of paediatric patients undergoing general anaesthesia (GA) may present with difficult intubation. Hence, one has to be equipped to manage a situation of difficult airway at all times.

In an attempt to reduce the morbidity and mortality associated with difficult airway, several video laryngoscopes (VLs) such as Glidescope, Truview, Airtraq and C-MAC have been introduced into clinical practice. These video laryngoscopes ensure a better glottic view, with greater intubation success and reduced complications as compared to the conventional direct laryngoscopy in the adult population, and are being increasingly used in the paediatric population. Flexible fiberoptic bronchoscopes are used in difficult pediatric airway, but are technically more challenging than the video laryngoscopes.

The C-MAC VL is a fourth generation VL, with a standard Miller/Macintosh blade with a distal camera at two-thirds of its length. It has been successfully used for visualization of the larynx in various difficult airway cases.It is available in the Macintosh blade sizes (sizes 2, 3, and 4) and pediatric Miller sizes (sizes 0 and 1). It also has a D- blade for difficult airways.

Tuoren is a newer video laryngoscope, which has advantages of disposable blades, large screen size, anti-fogging feature and a longer battery life, in addition to being portable and cost effective. It has a blade that has retained the shape and curvature of Macintosh blade. The reusable laryngoscope handle is fully compatible with 6 size of blades: Mac2/Mac3/Mac4/MIL00/MIL0/MIL1.

Hence, in this randomized comparative study, we aim to compare C Mac and Tuoren video laryngoscope guided endotracheal intubation using micro-cuffed endotracheal tube in paediatric patients undergoing elective surgery under general anaesthesia.