Comparison of forces applied to oropharyngeal tissues with different blades during laryngoscopy in a standard pediatric endotracheal intubation model.

Abstract

Objectives: To measure the pressure exerted on the base of the tongue during endotracheal intubation using a standard pediatric model.

Methods: The study was conducted in October-November 2022 at Hacettepe University Faculty of Medicine, Department of Anesthesiology and Reanimation, Ankara, Turkey. Anesthesiology residents performed intubations with Glidescope^®-LoPro-T2, Storz^®-C-MAC-paediatric-D-blade, and standard-Macintosh-1-blade on the same pediatric intubation model. The force exerted on the base of the tongue was measured during intubation using a force sensor. The duration and success of intubation, Cormack-Lehane-grade, and the force exerted on the oropharyngeal tissues were recorded.

Results: A total of 156 intubations were performed by 52 residents. The force exerted with the Storz^®-C-MAC-pediatric-D-blade was significantly lower when the Cormack-Lehane view was acquired and during the insertion of the endotracheal tube as compared to that exerted with the Glidescope^®-LoPro-T2 and direct laryngoscopy with Macintosh-1-blade. Longer intubation time was associated with higher force application regardless of blade type.

Conclusion: Videolaryngoscopy improved glottic view even in the same manikin as compared to direct laryngoscopy. Significantly lower forces were measured with the C-MAC-D-blade as compared to the other blades. Further studies on real patients are required to determine what amount of force exerted on the oropharyngeal tissue is clinically meaningful and thus avoid complications.