A randomized comparative evaluation of C-MAC video-laryngoscope with Miller laryngoscope for neonatal endotracheal intubation

Background and Aims: An efficient neonatal airway management is peculiarly challenging even in the most experienced hands. Considering the recent interest in assessing the performance of various video-laryngoscopes (VL) in pediatric cohort, the prospective randomized study was contemplated to stage a comparative evaluation of C-MAC with Miller laryngoscope for neonatal endotracheal intubation. Material and Methods: 150 neonates were randomized to undergo intubation with either the C-MAC VL (n = 75) or the Miller laryngoscope (n = 75) performed by an experienced anesthesiologist in a tertiary care perioperative setting. The percentage of glottic opening (POGO), time to best glottic view (TTBGV), time to intubation (TTI), number of attempts, optimal external laryngeal manipulation (OELM) employed, and the complications were assessed and compared between the two groups. Results: C-MAC group demonstrated a significantly higher POGO, compared to the Miller group (88 & PLUSMN; 26.7%;76.8 & PLUSMN; 32.1%, respectively, P = 0.022). TTBGV was significantly lower in the C-MAC (7.7 & PLUSMN; 0.1s) group as opposed to the Miller group (11.3 & PLUSMN; 1.1s). The C-MAC group displayed higher TTI values compared to the Miller group (25.4 & PLUSMN; 1.6s; 19.7 & PLUSMN; 1.2s, respectively, P < 0.01).The first-attempt intubation success rate and the number of attempts were comparable in both the groups. OELM was required in 24% of the patients in the Miller group as opposed to 10.7% in the C-MAC group (P = 0.031).Higher patient percentage in the C-MAC group required the need of stylet for assisting a successful intubation, although the difference between the two groups was not statistically significant. Conclusion: Despite an improved view of the glottis, the TTI was higher for C-MAC compared to direct laryngoscopy with a comparable first-attempt success rate in the two techniques.