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Midline versus paraglossal laryngoscopic approach using the Miller blade in small children: A randomised, controlled, cross-over study
Swarupa Roychoudhury1, Ratul Kundu2, Rituparna Murmu1, Tuhin Mistry3, Dipten Paul4, Amalendu Bikash Chatterjee5
1 Department of Anaesthesiology, ESI-PGIMSR, ESIC Medical College and Hospital, Joka, Kolkata, West Bengal, India
2 Department of Anaesthesiology, Ruby General Hospital, Kolkata, West Bengal, India
3 Department of Anaesthesiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
4 Department of Otorhinolaryngology, Diamond Harbour Government Medical College and South 24 pgs District Hospital, Diamond Harbour, India
5 Department of Anaesthesiology, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
Correspondence Address:
Dr. Tuhin Mistry
Flat No. 304, Tower 11, Surya Vihar, Junwani, Bhilai, Chhattisgarh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/arwy.arwy_30_20
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Background: Airway management in children is different from that of adults and needs special consideration. Laryngoscopy in children with the Miller straight blade can be performed via midline (MID) or paraglossal (PGL) approach. This study aimed to find out whether there was any advantage of one approach over the other in small children. Patients and Methods: After obtaining parental consent and approval from the Institutional Ethical Committee, this randomised, controlled, cross-over study was conducted in 110 children aged 2–24 months belonging to the American Society of Anesthesiologists Physical Status I or II. Children scheduled for elective surgeries under general anaesthesia were allocated randomly into one of the following two groups: A (PGL/MID) or B (MID/PGL) with 55 patients in each group. Following induction of anaesthesia and neuromuscular blockade, laryngoscopy was performed in a cross-over manner with either the PGL or MID approach first. The tip of the blade was placed at the vallecula. Intubation was performed following the second laryngoscopy. Glottic views with and without optimal external laryngeal manipulation (OELM) and ease of intubation were observed. Data were analysed, and P < 0.05 was considered statistically significant. Results: Both the approaches provided the same view in 81/110 children. In the remainder, a better view was obtained with the MID and PGL approaches in 14/110 and 15/110 children respectively. Laryngoscopy was easy in 93/110 children with both the approaches. OELM was required to improve the laryngoscopic view in 37/110 and 40/110 children with the MID and PGL approaches respectively. Conclusion: Using the Miller blade, both the MID and PGL approaches provided comparable laryngoscopic views and intubating conditions for young children in the age group between 2 and 24 months. When a restricted view is obtained, a change of approach may provide a better view.
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