Table of Contents
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Abstract
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Case Presentations
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Introduction
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The Need For Improved Devices In The Pediatric Population
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Unique Pediatric Considerations
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Decreased Clinical Opportunities
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Critical Appraisal Of The Literature
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Video Laryngoscopy: Rationale For Development And Use
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History Of Video Laryngoscopy
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Video Laryngoscopes And Device Types In The Pediatric Setting
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Potential Benefits Of Video Laryngoscopy
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Line Of Sight
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Supervision And Training
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Procedural Review
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Video Laryngoscopy Use And Success Rates
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Use Of Video Laryngoscopy In Adults In The Emergency Department
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Use Of Video Laryngoscopy In Pediatric Patients In The Operative Setting
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Use Of Video Laryngoscopy In Pediatric Patients Outside The Operating Room
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The Difficult Airway
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Video Laryngoscopy In The Adult Difficult Airway
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Video Laryngoscopy In The Pediatric Difficult Airway
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Video Laryngoscopy In Special Populations
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Video Laryngoscopy In Patients With Cervical Spine Immobilization
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Video Laryngoscopy In Neonates
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Video Laryngoscopy In The Prehospital Setting
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Are There Benefits Of One Device Over Another?
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Use Of Video Laryngoscopy In Pediatric Patients In The Emergency Department
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Indications For Use
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Contraindications For Use
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Video Laryngoscopic Device Review
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Storz C-MAC® Video Laryngoscope
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Technique
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Challenges
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GlideScope® Video Laryngoscope
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Technique
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Challenges
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Airtraq Optical Laryngoscope
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Technique
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Challenges
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Video Laryngoscopes: Device Selection
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Other Nonpediatric Devices
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Universal Challenges
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Device Insertion
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Endotracheal Tube Insertion
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Adjusting The View
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Cautions And Complications With Video Laryngoscopes
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Controversies
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Slowed Adoption Of Video Laryngoscopy
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Potential Future Directions For Video Laryngoscopy
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Education And Quality Assurance Opportunities
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Summary
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Risk Management Pitfalls In Video Laryngoscopy In Pediatric Patients
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Time- And Cost-Effective Strategies
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Case Conclusions
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Tables and Figures
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Table 1. Comparison Of The Storz C-MAC, GildeScope, And Airtraq Laryngoscopes
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Figure 1. Video Laryngoscopy Publications In PubMed Over Time (As Of November 10, 2014)
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Figure 2. A Visual Comparison Of The GlideScope, Airtraq, and C-MAC Devices
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Figure 3. Video Laryngoscopy Changes The Visual Vantage Point
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Figure 4. Alignment Of Oral, Pharyngeal, And Laryngeal Axes
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Figure 5. Cormack-Lehane Grading System
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Figure 6. C-MAC Video Laryngoscope
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Figure 7. C-MAC Video Laryngoscope With Monitors
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Figure 8. Comparison Of C-MAC Handle Size To Direct Laryngoscope Size
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Figure 9. Hyperangulation Of The GildeScope
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Figure 10. Disposable GildeScope With Attached Light Source
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Figure 11. The GildeScope And Projection To Its Accompanying Monitor
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Figure 12. Reverse Loading The Endotracheal Tube When Using The GildeScope
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Figure 13. Viewing Options For The Airtraq Device
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Figure 14. The Guided Channel In The Airtraq For Endotracheal Tube Delivery
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References
Abstract
Endotracheal intubation of pediatric patients is an infrequent, though high-risk, procedure in emergency medicine. Emergency clinicians should be aware of available approaches to assist with successful intubation in pediatric patients. Video laryngoscopy involves the utilization of optical and video technology to facilitate indirect visualization of laryngeal structures during intubation. This technology can be advantageous when intubating patients with normal or difficult airways, and it is increasingly being used in the care of patients in the emergency department. A number of pediatric devices are now available, each with benefits as well as limitations and nuances in technique for use. This evidence-based review describes the emergence of video laryngoscopy into the pediatric and emergency medicine settings. A summary of the existing data on video laryngoscopy use in routine and difficult airways is included, and practical instruction on the use of 3 specific devices approved for use in pediatric patients is provided.
Case Presentations
An 8-year-old boy is brought into the ED after a motor vehicle crash in which he was an unrestrained passenger. His mental status is depressed, with a GCS score of 7, and his cervical spine has been immobilized in a collar. His capnography shows bradypnea and hypercarbia, and he is intermittently desaturating. He has scattered ecchymoses over his chest wall. The pediatric emergency medicine fel low managing the airway has not previously intubated a trauma patient in the ED. You consider the best method to intubate this patient and provide guidance to the fellow…
A 5-year-old girl with a seizure disorder presented in status epilepticus, and is now somnolent after receiving 3 rounds of benzodiazepines and a loading dose of fosphe nytoin. She has intermittent apnea and hypotension. Her end-tidal CO2 remains elevated at 55 mm Hg, and she requires bag-valve mask ventilation during her apneic pe riods. Her last intubation procedure note reports a grade 2 Cormack-Lehane view. You are concerned about perform ing any diagnostic tests prior to securing the airway in this patient…
A 2-year-old girl with Pierre Robin sequence presents to the ED with respiratory distress and fever. She is ill-appearing, hypoxic to 88% despite a nonrebreather mask on 10 L/min of oxygen, and she is in moderate respiratory distress. A chest x-ray demonstrates multifocal pneu monia. She has a history of requiring airway support for pneumonia, and noninvasive support has been historically challenging secondary to her facial dysmorphisms. You wonder if intubating this patient will be difficult…
Introduction
Emergent endotracheal intubation is an infrequent, yet critical, procedure in pediatric patients in the emergency medicine setting. It can be lifesaving, though it also carries risks of significant morbidity (eg, hypoxia, aspiration, and esophageal intubation) and even mortality. Several studies have identified a clear relationship between an increased likelihood of adverse events and multiple attempts at intubation.1-3 Yet, data from both single and multicenter pediatric studies demonstrate that first-pass success rates for emergent intubation are variable, ranging from 37% to 78%.4-7 It comes as little surprise, then, that adverse event rates in pediatric intubation in acute settings have been shown to be as high as 21%.7 Therefore, efforts to improve rates of first-pass success and decrease intubation-related complica tions are essential.
The concept of integrating video technology into laryngoscopy has led to changes in advanced airway management. The quantity of available data has increased in the anesthesia, critical care, and emergency medicine literature in recent years. (See Figure 1.) Given the high success rates for orotracheal intubation, particularly in the operating room setting, video laryngoscopy (VL) devices were generally only considered as alternative strategies for use in patients with difficult airways. However, with improving technology, decreasing cost, and wider availability, the use of VL has become increasingly common for routine cases and across more practice settings, including emergency departments (EDs) that care for children.
This review covers the available literature regarding VL use in emergency medicine and the pediatric setting, including use in the context of potentially difficult airways, and provides practical instruction on the 3 VL devices approved for use across the entire spectrum of pediatric ages: the GlideScope®, the Airtraq, and the Storz C-MAC®. (See Figure 2.)
Risk Management Pitfalls In Video Laryngoscopy In Pediatric Patients
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“Passing the ETT using a GlideScope® is no different than when using a direct laryngoscope.”
The increased curvature of the blade of the GlideScope® is designed to provide optimal viewing around the curve of the airway toward anterior/superior airways. Passing an ETT around this same curved path can be challenging, particularly in children, as there is no commercially available rigid stylet to guide the tube. To overcome this challenge, use the stiffest stylet available, and bend the tube to match the shape of the blade. To facilitate tube passage once the tip has passed the vocal cords, withdraw the stylet slightly to prevent the tube from advancing into the anterior tracheal wall and allow it to travel down the length of the tracheal lumen.
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“VL devices are too large to be used in neonates. I would only use direct laryngoscopy in this age group.”
Although there are no large comparative trials on the use of VL in neonates, case reports and series have shown success in this age group. Becoming comfortable with the size of the blades and the technique for use in this population requires experience. However, many devices (including the C-MAC®, GlideScope®, and Airtraq) have blade sizes designed for use in children of all ages, including neonates. For emergency clinicians with training, these devices can offer the same advantages as in older pediatric patients and adult patients. Emergency clinicians who are comfortable with airway management in this age group and with VL may safely use VL in neonates.
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“The VL screen went blank as I was preparing to intubate.”
Although VL offers technical advantages, like any equipment, there is a risk of malfunction. All electronic connections from the blade to the screen, as well as the power source, should be checked to ensure proper function. It is also important to have a back-up intubation plan in place.
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“I am most familiar with adult-sized blades, so I will plan to use them when I intubate children. “
Each of the VL devices reviewed here has a range of different-sized blades to be used based on the age and size of the child. Just as with direct laryngoscopy, choosing appropriately sized equipment is key to success with this procedure. Use of incorrectly sized equipment may compromise procedural success and can be potentially harmful to the patient.
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“Our ED is looking to purchase every available VL device for use in pediatrics so that we have a device for every circumstance.”
Although each VL device may have some advantage in different clinical circumstances, gaining and maintaining proficiency in many devices can be challenging, particularly if they are not used frequently. For emergency clinicians committed to being prepared to use each, it is important to have sufficient training and frequent practice opportunities. If these opportunities do not arise in the ED, then maintenance of skills using either simulation or dedicated time in an operating room or other controlled setting can be valuable.
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“The patient was in a motor vehicle crash and arrived in cervical spine immobilization with a hard collar. Is it safe to use a VL in this patient?”
VL can be used safely in trauma patients and may offer the additional advantage of providing an improved glottic view without the need to move the head and neck. It should be noted, however, that, in some cases blood, secretions, or vomit may obscure the camera lens.
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“I had trouble sweeping the tongue to the left when using the GlideScope®.”
The GlideScope® is designed for indirect laryngoscopy only, and, therefore, there is no need to sweep the tongue. Unlike direct laryngoscope blades, the GlideScope® blade does not have a flange to control the tongue. Instead, it is recommended that the device should be inserted in the midline until the glottic structures are visualized.
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“I have an Airtraq available in my difficult airway cart. I have never tried it before, but I will use it as my rescue device with my next crash intubation.”
Although some use video and optical devices as back-up or rescue devices, emergency clinicians should only use equipment on which they have been trained and feel comfortable. There are nuances to the technique for each device, and the opportunity to learn these is not during a difficult or crash airway. Becoming familiar with the devices that are available in a given clinical environment and the circumstances in which it might be used is paramount for anyone who might be emergently managing a child’s airway.
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“The patient has bronchiolitis and copious oral secretions. Is that a contraindication to using VL?”
Secretions, vomitus, or blood can cover the camera lens and compromise visualization. Although this is not an absolute contraindication to the use of VL, preparations such as suction, gauze to wipe the camera, and back-up blades may be helpful. In addition, availability of a device that allows for direct visualization (either a C-MAC® or a traditional laryngoscope) may help obviate the risk of reliance on an indirect (camera) view.
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“I did not use VL because of the risk of lip or dental trauma.”
There is a tendency to look at the image in the viewfinder or on the projected screen when using VL, which can result in advertent lip or dental injury when the VL is being introduced or adjusted in the oral cavity. To mitigate this risk, emergency clinicians should proceed in the following order: (1) Look in the mouth as the VL blade is inserted past the dentition; (2) then look at the screen to guide movement of the blade tip; (3) then, again directly visualize the ETT as it enters the mouth; and (4) return to the VL screen view to guide final indirect positioning of the tube.
Tables and Figures
References
Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.
To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study will be included in bold type following the references cited in this paper, as determined by the author, will be noted by an asterisk (*) next to the number of the reference.
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Hasegawa K, Shigemitsu K, Hagiwara Y, et al. Association between repeated intubation attempts and adverse events in emergency departments: an analysis of a multicenter prospective observational study. Ann Emerg Med. 2012;60(6):749- 754. (Prospective study; 2616 patients)
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* Sakles JC, Chiu S, Mosier J, et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med. 2013;20(1):71-78. (Retrospective study; 1828 intubations)
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Mort TC. Video laryngoscopy improves intubation success and reduces esophageal intubations compared with direct laryngoscopy in the medical intensive care unit. Crit Care. 2013;17(6):1019. (Commentary)
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Kerrey BT, Rinderknecht AS, Geis GL, et al. Rapid sequence intubation for pediatric emergency patients: higher frequency of failed attempts and adverse effects found by video review. Ann Emerg Med. 2012;60(3):259-251. (Retrospective study; 114 patients)
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Sagarin MJ, Barton ED, Chng Y-M, et al. Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts. Ann Emerg Med. 2005;46(4):328-336. (Prosepctive study; > 6000 intubations)
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Nishisaki A, Turner DA, Brown CA, et al. A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs. Crit Care Med. 2013;41(3):874-885. (Prospective study; 1715 patients).
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Sanders RC, Giuliano JS, Sullivan JE, et al. Level of trainee and tracheal intubation outcomes. Pediatrics. 2013;131(3):e821-e828. (Prospective study; 1265 intubations)
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Luten RC, Mick N. Differentiating aspects of the pediatric airway. In: Walls RM, Murphy M, eds. Manual of Emergency Airway Management. 4th ed. Philadelphia, PA: Lippincott, Wiliams, and Wilkins; 2012. (Textbook chapter)
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Losek JD, Olson LR, Dobson JV, et al. Tracheal intubation practice and maintaining skill competency. Pediatr Emerg Care. 2008;24(5):294-299. (Observational survey report)
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Sakles JC, Laurin EG, Rantapaa AA, et al. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31(3):325-332. (Observational consecutive series; 610 patients)
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Ganu SS, Gautam A, Wilkins B, et al. Increase in use of non-invasive ventilation for infants with severe bronchiolitis is associated with decline in intubation rates over a decade. Intensive Care Med. 2012;38(7):1177-1183. (Retrospective database review; 520 patients)
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Wiswell TE, Gannon CM, Jacob J, et al. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Pediatrics. 2000;105(1):1-7. (Prosepective study; 2094 patients)
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ACGME. Program Requirements for Graduate Medical Education in Pediatrics. 2013. Available at: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/320_pediatrics_07012013.pdf. (Institutional publication)
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Mittiga MR, Geis GL, Kerrey BT, et al. The spectrum and frequency of critical procedures performed in a pediatric emergency department: implications of a provider-level view. Ann Emerg Med. 2013;61(3):263-270. (Retrospective study; 194 patients)
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Di Marco P, Scattoni L, Spinoglio A, et al. Learning curves of the Airtraq and the Macintosh laryngoscopes for tracheal intubation by novice laryngoscopists: a clinical study. Anesth Analg. 2011;112(1):122-125. (Prospective study; 108 patients)
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Sakles JC, Mosier J, Patanwala AE, et al. Learning curves for direct laryngoscopy and GlideScope® video laryngoscopy in an emergency medicine residency. West J Emerg Med. 2014;15(7):930-937. (Prospective collected study; 1613 patients)
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Miller R. A new laryngoscope. Anesthesiology. 1941;2(3):310- 316. (Commentary)
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Macintosh D. A new laryngoscope. Lancet. 1943;241(6233):205. (Commentary)
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Lee RA, van Zundert AA, Maassen RL, et al. Forces applied to the maxillary incisors during video-assisted intubation. Anesth Analg. 2009;108(1):187-191. (Prospective study; 44 patients)
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Rodriguez-Nunez A, Oulego-Erroz I, Perez-Gay L, et al. Comparison of the GlideScope videolaryngoscope to the standard Macintosh for intubation by pediatric residents in simulated child airway scenarios. Pediatr Emerg Care. 2010;26(10):726-729. (Prospective study; 18 patients)
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Russell T, Khan S, Elman J, et al. Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope® videolaryngoscopy. Anaesthesia. 2012;67(6):626- 631. (Prospective study; 24 patients)
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Green-Hopkins I, Nagler J. Utilization of video laryngoscopy recordings to evaluate pediatric endotracheal intubation success rates and complications. In: Pediatric Academic Societies. Vancouver, BC; 2014. (Retrospective study; 93 subjects)
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Rai M, Dering A, Verghese C. The Glidescope system: a clinical assessment of performance. Anaesthesia. 2005;60(1):60-64. (Prospective study; 50 patients)
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Kaplan MB, Ward DS, Berci G. A new video laryngoscope — an aid to intubation and teaching. J Clin Anesth. 2003;14(8):620-626. (Prospective study; 235 patients)
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* Sun Y, Lu Y, Huang Y, et al. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2014;(1). (Meta-analysis; 14 prospective studies)
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* De Jong A, Molinari N, Conseil M, et al. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014;40(5):629-639. (Meta-analysis; 9 studies)
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* Sakles JC, Mosier J, Chiu S, et al. A comparison of the C-MAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department. Ann Emerg Med. 2012;60(6):739-748. (Retrospective study; 750 patients)
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* Sakles JC, Mosier JM, Chiu S, et al. Tracheal intubation in the emergency department: a comparison of GlideScope® video laryngoscopy to direct laryngoscopy in 822 intubations. J Emerg Med. 2012;42(4):400-405. (Retrospective study; 823 patients)
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Mosier J, Chiu S, Patanwala AE, et al. A comparison of the glidescope video laryngoscope to the C-MAC video laryngoscope for intubation in the emergency department. Ann Emerg Med. 2013:1-8. (Retrospective study; 463 patients)
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* Brown CA, Bair AE, Pallin DJ, et al. Improved glottic exposure with the video Macintosh laryngoscope in adult emergency department tracheal intubations. Ann Emerg Med. 2010;56(2):83-88. (Prospective study; 198 patients)
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Bair AE, Olmsted K, Brown CA, et al. Assessment of the Storz video Macintosh laryngoscope for use in difficult airways: a human simulator study. Acad Emerg Med. 2010;17(10):1134-1137. (Prospective study; 198 patients)
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Vlatten A, Aucoin S, Litz S, et al. A comparison of the Storz video laryngoscope and standard direct laryngoscopy for intubation in the pediatric airway--a randomized clinical trial. Paediatr Anaesth. 2009;19(11):1102-1107. (Prospective study; 56 patients)
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Macnair D, Baraclough D, Wilson G, et al. Pediatric airway management: comparing the Berci-Kaplan Video Laryngoscope with direct laryngoscopy. Paediatr Anaesth. 2009;19(6):577-580. (Prospective study; 60 patients)
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Fiadjoe JE, Gurnaney H, Dalesio N, et al. A prospective randomized equivalence trial of the GlideScope Cobalt® video laryngoscope to traditional direct laryngoscopy in neonates and infants. Anesthesiology. 2012;116(3):622-628. (Prospective study; 60 patients)
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Kim JT, Na HS, Bae JY, et al. GlideScope video laryngoscope: a randomized clinical trial in 203 paediatric patients. Br J Anaesth. 2008;101(4):531-534. (Prospective study; 203 patients)
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Redel A, Karademir F, Schlitterlau A, et al. Validation of the GlideScope video laryngoscope in pediatric patients. Paediatr Anaesth. 2009;19(7):667-671. (Prospective study; 60 patients)
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Lu Y, Jiang H, Zhu YS. Airtraq laryngoscope versus conventional Macintosh laryngoscope: a systematic review and meta-analysis. Anaesthesia 2011;66:1160-1167. (Meta-analysis; 1061 patients)
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Ali QE, Amir SH, Firdaus U, et al. A comparative study of the efficacy of pediatric Airtraq® with conventional laryngoscope in children. Minerva Anestesiol. 2013;79(12):1366-1370. (Prospective study; 24 patients)
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Sylvia MJ, Maranda L, Harris KL, et al. Comparison of success rates using video laryngoscopy versus direct laryngoscopy by residents during a simulated pediatric emergency. Simul Healthc. 2013;8(3):155-161. (Prospective study; 69 subjects)
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Rabiner JE, Auerbach M, Avner JR, et al. Comparison of GlideScope videolaryngoscopy to direct laryngoscopy for intubation of a pediatric simulator by novice physicians. Emerg Med Int. 2013;2013:407547. (Prospective study; 25 subjects)
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* Donoghue AJ, Ades AM, Nishisaki A, et al. Videolaryngoscopy versus direct laryngoscopy in simulated pediatric intubation. Ann Emerg Med. 2012;61(3):271-277. (Cross-sectional study; 148 intubations)
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Ramachandran SK, Klock PA. Definition and incidence of the difficult airway. In: Hagberg CA, ed. Benumof’s Airway Management: Principles and Practice. 2nd ed. Philadelphia, PA: Mosby, Inc; 2007:201-208. (Textbook chapter)
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* Walls RM, Brown CA, Bair AE, et al. Emergency airway management: a multi-center report of 8937 emergency department intubations. J Emerg Med. 2011;41(4):347-354. (Prospective multicenter study; 8937 patients)
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Walls RM. Manual of Emergency Airway Management. 4th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott, Williams, & Wilkins; 2012:464. (Textbook)
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Orebaugh S. Difficult airway management in the emergency department. J Emerg Med. 2002;22(1):31-48. (Review)
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* Aziz MF, Dillman D, Fu R, et al. Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology. 2012;116(3):629-636. (Prospective study; 300 patients)
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McElwain J, Malik MA, Harte BH, et al. Comparison of the C-MAC videolaryngoscope with the Macintosh, Glidescope, and Airtraq laryngoscopes in easy and difficult laryngoscopy scenarios in mannequins. Anaesthesia. 2010;65(5):483-489. (Prospective study; 31 subjects)
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Lim TJ, Lim Y, Liu EHC. Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngoscopy. Anaesthesia. 2005;60(2):180-183. (Prospective study; 20 subjects)
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Mosier JM, Stolz U, Chiu S, et al. Difficult airway management in the emergency department: GlideScope videolaryngoscopy compared to direct laryngoscopy. J Emerg Med. 2012;42(6):629-634. (Retrospective study; 772 patients)
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Bair AE, Caravelli R, Tyler K, et al. Feasibility of the preoperative Mallampati airway assessment in emergency department patients. J Emerg Med. 2010;38(5):677-680. (Prospective study; 296 patients)
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Levitan RM, Everett WW, Ochroch EA. Limitations of difficult airway prediction in patients intubated in the emergency department. Ann Emerg Med. 2004;44(4):307-313. (Retrospective study; 850 patients)
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Tong DC, Beus J, Litman RS. The Children’s Hospital of Philadelphia difficult intubation registry. Anesthesiology. 2007;A1637. (Retrospective study)
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Wald SH, Keyes M, Brown A. Pediatric video laryngoscope rescue for a difficult neonatal intubation. Paediatr Anaesth. 2008;18(8):790-792. (Case report)
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Xue FS, Liu HP, Liu JH, et al. Facilitating endotracheal intubation using the GlideScope video laryngoscope in children with difficult airways. Paediatr Anaesth. 2009;19(9):918-919. (Correspondence letter)
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White M, Weale N, Nolan J, et al. Comparison of the Cobalt Glidescope video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways. Paediatr Anaesth. 2009;19(11):1108-1112. (Prospective study; 28 subjects)
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Fiadjoe JE, Stricker PA, Hackell RS, et al. The efficacy of the Storz Miller 1 video laryngoscope in a simulated infant difficult intubation. Anesth Analg. 2009;108(6):1783-1786. (Prospective study; 32 subjects)
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Armstrong J, John J, Karsli C. A comparison between the GlideScope Video Laryngoscope and direct laryngoscope in paediatric patients with difficult airways - a pilot study. Anaesthesia. 2010;65(4):353-357. (Prospective study; 18 patients)
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Hackell RS, Held LD, Stricker PA, et al. Management of the difficult infant airway with the Storz Video Laryngoscope: a case series. Anesth Analg. 2009;109(3):763-766. (Case series)
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Bishop S, Clements P, Kale K, et al. Use of GlideScope Ranger in the management of a child with Treacher Collins syndrome in a developing world setting. Paediatr Anaesth. 2009;19(7):695-696. (Case report)
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Eaton J, Atiles R, Tuchman JB. GlideScope for management of the difficult airway in a child with Beckwith-Wiedemann syndrome. Paediatr Anaesth. 2009;19(7):696-698. (Case report)
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Péan D, Desdoits A, Asehnoune K, et al. Airtraq laryngoscope for intubation in Treacher Collins syndrome. Paediatr Anaesth. 2009;19(7):698-699. (Case report)
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Vlatten A, Aucoin S, Gray A, et al. Difficult airway management with the STORZ video laryngoscope in a child with Robin Sequence. Paediatr Anaesth. 2009;19(7):700-701. (Case report)
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Vlatten A, Soder C. Airtraq optical laryngoscope intubation in a 5-month-old infant with a difficult airway because of Robin Sequence. Paediatr Anaesth. 2009;19(7):699-700. (Case report)
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Holm-Knudsen R. The difficult pediatric airway--a review of new devices for indirect laryngoscopy in children younger than two years of age. Paediatr Anaesth. 2011;21(2):98-103. (Review)
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Enomoto Y, Asai T, Arai T, et al. Pentax-AWS, a new videolaryngoscope, is more effective than the Macintosh laryngoscope for tracheal intubation in patients with restricted neck movements: a randomized comparative study. Br J Anaesth. 2008;100(4):544-548. (Prospective study; 203 patients)
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Malik MA, Maharaj CH, Harte BH, et al. Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth. 2008;101(5):723-730. (Prospective study; 120 patients)
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Turkstra TP, Pelz DM, Jones PM. Cervical spine motion: a fluoroscopic comparison of the AirTraq Laryngoscope versus the Macintosh laryngoscope. Anesthesiology. 2009;111(1):97- 101. (Prospective study; 24 patients
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Kill C, Risse J, Wallot P, et al. Videolaryngoscopy with glidescope reduces cervical spine movement in patients with unsecured cervical spine. J Emerg Med. 2013;44(4):750-756. (Prospective study; 60 patients)
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Vanderhal AL, Berci G, Simmons CF, et al. A videolaryngoscopy technique for the intubation of the newborn: preliminary report. Pediatrics. 2009;124(2):e339-46. (Prospective study; 42 patients)
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Aziz M, Dillman D, Kirsch JR, et al. Video laryngoscopy with the Macintosh video laryngoscope in simulated prehospital scenarios by paramedic students. Prehosp Emerg Care. 2008;13(2):251-255. (Prospective study; 25 subjects)
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Carlson JN, Quintero J, Guyette FX, et al. Variables associated with successful intubation attempts using video laryngoscopy: a preliminary report in a helicopter emergency medical service. Prehosp Emerg Care. 2012;16(2):293-298. (Retrospective study; 87 patients)
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Cavus E, Callies A, Doerges V, et al. The C-MAC videolaryngoscope for prehospital emergency intubation: a prospective, multicentre, observational study. Emerg Med J. 2011;28(8):650- 653. (Prospective study; 80 patients)
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Burnett AM, Frascone RJ, Wewerka SS, et al. Comparison of success rates between two video laryngoscope systems used in a prehospital clinical trial. Prehosp Emerg Care. 2014;18(2):231-238. (Prospective study; 107 patients)
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Butchart AG, Tjen C, Garg A, et al. Paramedic laryngoscopy in the simulated difficult airway: comparison of the Venner A.P. Advance and GlideScope Ranger video laryngoscopes. Acad Emerg Med. 2011;18(7):692-698. (Prospective study; 30 subjects)
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