DOI: 10.4103/aam.aam_504_26 ISSN: 1596-3519

Comparative Evaluation of the Efficacy of C-MAC™, McGrath MAC™ Videolaryngoscopes, and the Direct Miller Laryngoscope for Neonatal Intubation under General Anesthesia

Toko Nem, Nidhi Agrawal, Anju Gupta, Ridhima Sharma, Ripon Choudhary
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Abstract

Background:

Neonatal endotracheal intubation remains technically challenging due to small airway dimensions and limited glottic visualization. Identifying the most effective device and technique to secure the airway is crucial. Video laryngoscopes (VLs) have been introduced to enhance visualization and improve intubation success. Considering the evolution of VL designs for pediatric use, this prospective, randomized trial compared two VLs with the conventional Miller Direct laryngoscopy (DL).

Materials and Methods:

Ninety neonates were randomly allocated into three equal groups ( n = 30 each): Group A (C-MAC VL), Group B (McGrath MAC VL), and Group C (Miller DL). The primary outcome was total time to successful intubation. Secondary outcomes included Time to achieve the best glottic view (TBGV), Cormack–Lehane (CL) grade, percentage of glottic opening (POGO) score, ease of intubation, and first-attempt success rate.

Results:

The median (interquartile range [IQR]) total intubation time was shortest with the C-MAC VL VL (27 s, IQR = 25–29.75 s), followed by the McGrath MAC VL (29 s, IQR = 28–30 s; P = 0.01) and Miller DL (29.5 s, IQR = 28–31 s; P = 0.02) and was statistically significant. TBGV was significantly shorter in Group A than in Group C but comparable to Group B (8 [6–8.75] s vs. 9 [8–11] s; P < 0.05). The C-MAC VL also provided better CL grades, higher POGO scores, and higher ease-of-intubation ratings. First-attempt success rates were 93.3%, 90.0%, and 86.7% in Groups A, B, and C, respectively.

Conclusions:

All devices were effective for neonatal intubation, but the C-MAC VL provided better glottic visualization and shorter intubation time, underscoring its potential usefulness in neonatal airway management.

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