A comparison of the STORZ video laryngoscope and standard direct laryngoscopy for intubation in the Pediatric airway – a randomized clinical trial

Introduction:  Direct laryngoscopy can be challenging in infants and neonates. Even with an optimal line of sight to the glottic opening, the viewing angle has been measured at 15°. The STORZ DCI video laryngoscope (Karl Storz, Tuttlingen, Germany) incorporates a fiberoptic camera in the light source of a standard laryngoscope of variable sizes. The image is displayed on a screen with a viewing angle of 80°. We studied the effectiveness of the STORZ DCI as an airway tool compared to standard direct laryngoscopy in children with normal airway.
Methods:  In this prospective, randomized study, 56 children (ages 4 years or younger) undergoing elective surgery with the need for endotracheal intubation were divided into two groups: children who underwent standard direct laryngoscopy using a Miller 1 or Macintosh 2 blade (DL) and children who underwent video laryngoscopy using the STORZ DCI video laryngoscope with a Miller 1 blade (VL). Time to best view (TTBV), time to intubate (TTI), Cormack–Lehane (CL), and percentage of glottis opening seen (POGO) score were recorded.
Results:  TTBV in DL was 5.5 (4–8) s and 7 (4.2–9) s in VL. TTI in DL was 21 (17–29) s and in VL 27 (22–37) s ( P  = 0.006). The view as assessed by POGO score was 97.5% (60–100%) in DL and 100% (100–100%) in the VL ( P  = 0.003). Data are presented as median and interquartile range and analyzed using t -test.
Discussion:  This study demonstrates that the STORZ DCI video laryngoscope provides an improved view to the glottis in children with normal airway anatomy, but requires a longer time for intubation.