Pediatric airway management: comparing the Berci–Kaplan Video Laryngoscope with direct laryngoscopy

Objectives:  To assess the utility of the Berci–Kaplan Video Laryngoscope (VL) in pediatric anesthesia.
Background:  The VL is designed to improve visualization of the glottis during tracheal intubation of normal and difficult airways in adults. This study was designed to assess the visual quality and the ease of tracheal intubation in children using the VL when compared with direct laryngoscopy (DL).
Methods:  Sixty children, aged 2–16 years requiring tracheal intubation, were enrolled in this prospective, randomized clinical trial. Following induction of anesthesia and muscle paralysis, the first laryngoscopy method, using either a DL or the VL, was performed by one anesthetist, and the laryngoscopic view was graded according to the Cormack–Lehane scale. Laryngoscopy and grading of the view in the second method were then performed by a second anesthetist. Tracheal intubation was completed following the second laryngoscopy, and time to intubation was recorded.
Results:  The average age and weight were 8.9 ± 3.6 years and 34.9 ± 16.0 kg respectively. Videolaryngoscopy improved 8/11 grade 2 views to grade 1 ( P  =   0.02), and one grade 3 to a grade 2. Three grade 2 views remained unchanged from DL to VL. 4/30 VL intubations required two attempts, and 1/30 failed after two attempts, but was easily intubated with DL. Median time (range) was 16.0 s (14.0–20.0 s) and 22.5 s (17.8–35.0 s) for DL and VL respectively ( P  <   0.001).
Conclusion:  Videolaryngoscopy provides better views than DL at the expense of time to intubate. Although the time taken to intubate is increased with the VL, it is clinically acceptable.