A Comparison Between Two Video Laryngoscopes,in Successfully Intubating Pediatric Mannequins w/wo Difficult Airways
A Comparison Between Two Video Laryngoscopes,in Successfully Intubating Pediatric Mannequins w/wo Difficult Airways
The study is a randomized crossover study where anesthesia practitioners will intubate three
 different pediatric infant mannequins (normal airway, anterior larynx, Pierre Robin syndrome
 anatomy) using three different intubation devices (the Miller blade, the Truview VL, the
 Glidescope Cobalt video-laryngoscope) in two different scenarios (normal neck and with an
 immobile neck). The order of presentation will be randomized. As this is a cross over study,
 all subjects will complete all scenarios. There is no placebo group, and each subject wil be
 his or her own control.
Participants will be given individual, standardized instructions and demonstrations for each
 device as per the manufacturers' instructions. The participants will practice with
 instructor's feedback on an infant mannequin with a normal airway until he/she feel
 comfortable with each of the three devices. The investigator will record the prior experience
 of the participant in using each of the 3 devices in clinical situations. Each subject will
 be asked to intubate each of the mannequins with each of the devices. The choice of the order
 of device and mannequin will be based on a Latin square design and the sequence will be
 assigned to participants based on a computer generated random number. A closed envelope
 technique will blind participants and investigators to the order of airway device and
 mannequin till the start of the individual trial. Participants will first finish the test on
 unchanged conditions and then repeat the process using the same order of mannequins and
 devices but with the neck held immobile to simulate a scenario of a child with an unstable
 cervical spine. Data from different scenarios will be recorded from a total number of 18
 attempts of tracheal intubation per participant. Participants will be asked to proceed as
 though they were in the operating room with an assistant available to follow their commands.
 The order of presentation of each mannequin, airway device and scenario will be randomized as
 described above. The time from placing the device in the mannequin's mouth to the time the
 Ambu bag is connected to the end of the tracheal tube and a positive pressure breath is given
 will constitute the intubation time. During each intubation the participant will be asked to
 state when he or she has obtained the best view for intubation and this time this will be
 recorded as the time for visualization. The subject will assess the quality of the best
 glottic view on the Cormack - Lehane grade of 1 -4. The investigators will record all
 maneuvers to optimize visualization of the larynx such as tracheal pressure, lip retraction,
 pulling the tongue forward etc. The time from entry of the device in the mouth to the time
 the tracheal tube is started to be advanced is the visualization time. The time a positive
 pressure breath is given at the end of the tracheal tube will constitute the end of the
 attempt of intubation. A failed attempt is defined as removal of the laryngoscope from the
 mouth without a successful intubation. The number of times the endotracheal tube is advanced
 will also be recorded. Failure of intubation will be defined as unrecognized esophageal
 intubation, abandoned procedure, intubation taking longer than 120 seconds and intubation
 requiring more than 3 attempts. The observer will estimate the maximum force applied to the
 maxilla on a 0 -10 scale where 0= no force and 10 = maximum force with distortion of the
 maxilla. The observer will also estimate potential damage of laryngeal structures on a 0 -10
 scale.
Inclusion Criteria:

 -  Anesthesia practitioners including anesthesia attendings, fellows, residents CAIII and
 CRNA's at Texas Children's Hospital Department of Anesthesiology with clinical
 experience of >500 intubations with Miller blades.

 Exclusion Criteria:

 -  Anesthesia practitioners with <500 intubations with Miller blades.