Videolaringoskoplar ve Pediatrik Kullanımı
Synopsis
Videolaryngoscopes (VL) are modern airway devices that provide a higher resolution and indirect view of the airway compared to conventional direct laryngoscopy (DL). Anatomical differences in children compared to adults—such as a larger head-to-body ratio, shorter neck, prominent occiput, larger tongue relative to the oral cavity, smaller mandible, higher laryngeal position (C4 vertebra level), stiff/omega-shaped epiglottis, and the narrowest point being at the cricoid or subglottic level—can make airway management and laryngoscopy difficult. In direct laryngoscopy, straight Miller blades are used in infants to lift the epiglottis directly, whereas curved Macintosh blades are positioned in the vallecula in older children. In contrast, VL is performed by entering through the midline without sweeping the tongue aside, reducing the need to align the oral, pharyngeal, and laryngeal axes. VLs provide a better view angle and less traumatic intubation conditions in children, while also reducing the hemodynamic response and complication rates compared to DL. Devices such as C-MAC, McGrath MAC, GlideScope AVL, TruView PCD, and Rüsch Airtraq are widely used in pediatric practice. These devices feature high-resolution cameras or optical systems, anti-fogging mechanisms, and single- or multi-use blade options. Consequently, VLs serve as an effective alternative to DL in both routine and difficult pediatric airway management, depending on clinician experience and patient anatomy.
References
Santillanes, G., Gausche-Hill, M. Pediatric airway management. Emergency medicine clinics of North America, 2008; 26(4), 961-975.
Özcengiz, D., Barış, S. (2014) Pediyatrik Anestezi. (1. Baskı s. 273-185) Ankara: Akademisyen Tıp Kitapevi, 2014; 273-85.
Adewale, L. Anatomy and assessment of the pediatric airway. Pediatric Anesthesia, 2009; 19, 1-8. Doi:10.1111/j.1460-9592.2009.03012.x
Kayhan, Z. (2010). Pediatrik Anestezi. Filiz Tüzüner (Ed.), Anestezi Yoğun Bakım Ağrı içinde (s. 1009-1064). İstanbul: MN Medikal & Nobel Tıp Kitabevi
Weiss, M., Engelhardt, T. Proposal for the management of the unexpected difficult pediatric airway. Pediatric Anesthesia, 2010; 20(5), 454-464. Doi: 10.1111/j.1460-9592.2010.03284.x
Pediatric Anesthesia In John F. Butterworth, David C. Mackey, John D. Wasnick (Eds), Morgan & Mikhail’s Clinical Anesthesiology (6th ed. Chapter 42, e-book) New York: Mc Graw Hill
Holzki, J., Brown, K.A., Carroll, R.G. The anatomy of the pediatric airway: Has our knowledge changed in 120 years? A review of historic and recent investigations of the anatomy of the pediatric larynx. Pediatric Anesthesia, 2018; 28(1), 13-22. Doi: 10.1111/pan.13281
Yıldız Karamehmet. Neonatal ve Pediatrik Anestezi. İçinde: Klinik Anestezi Temelleri, Yıldız K, Biçer C, Bayram A (Çeviri Editörleri). Clinical Anesthesia Fundamentals, Barash PG, Gullen FB, Stoelting RK, Cahalan MK, Stock MC, Ortega R, Sharar SR. Ankara, 2017: 627-652.
Erbüyün K. Havayolu Yönetimi. İçinde: Miller Anestezi, Aydın D. (çeviri editörü). Miller’s Anesthesia, Miller RD. 6. Baskı, İzmir, Güven Kitabevi, 2010: 1617-1650.
Osborn IP, Kleinberger AJ, Gurudutt VV. (2013). Airway Management, Emergencies and the Difficult Airway. In A. I. Levine, S. Govindaraj (Eds). Anesthesiology and Otolaryngology, (pp. 115-132) Newyork: Springer
Holzki Z. (2014). Intubation of the Pediatric Patient. In Zahid Hussain Khan (Ed). Airway Management, (pp. 93-107) Springer. DOI 10.1007/978-3-319-08578-4
Thong SY, Teoh WHL. (2014). Videolaryngoscopy and Indirect Intubating Aids in Airway Management. In Zahid Hussain Khan (Ed). Airway Management, (pp. 33-70) Springer. DOI 10.1007/978-3-319-08578-4
Lim, Y., Lim, T. J., Liu, E. H. Ease of intubation with the GlideScope or Macintosh laryngoscope by inexperienced operators in simulated difficult airways. Canadian Journal of Anesthesia, 2004; 51(6), 641.
Xue, F. S., Tian, M., Liao, X. Safe and successful intubation using the GlideScope videolaryngoscope in children with craniofacial anomalies. Plastic and reconstructive surgery, 2009; 123(3), 1127-1129. doi: 10.1097/PRS.0b013e31819a33b7
Xue, F. S., Tian, M., Liao, X. Safe and successful intubation using a Storz video laryngoscope in management of pediatric difficult airways. Paediatric anaesthesia, 2008; 18(12), 1251-1252. Doi: 10.1111/j.1460-9592.2008.02753.x
Eaton, J., Atiles, R., Tuchman, J. B. GlideScope for management of the difficult airway in a child with Beckwith–Wiedemann syndrome. Pediatric Anesthesia, 2009; 19(7), 696-698. Doi: 10.1111/j.1460-9592.2009.03031.x
Bishop, S., Clements, P., Kale, K., Tremlett, M. R. Use of GlideScope Ranger in the management of a child with Treacher Collins syndrome in a developing world setting. Paediatric anaesthesia, 2009; 19(7), 695-696. Doi: 10.1111/j.1460-9592.2009.03021.x
Smereka, J., Madziala, M., Dunder, D. Comparison of Miller laryngoscope and UEScope videolaryngoscope for endotracheal intubation in four pediatric airway scenarios: a randomized, crossover simulation trial. European journal of pediatrics, 2019; 178(6), 937-945. Doi: 10.1007/s00431-019-03375-y
Cavus, E., Kieckhaefer, J., Doerges, V. The C-MAC videolaryngoscope: first experiences with a new device for videolaryngoscopy-guided intubation. Anesthesia & Analgesia, 2010; 110(2), 473-477. doi: 10.1213/ANE.0b013e3181c5bce5
Sakles, J. C., Mosier, J., Chiu, S. A comparison of the C-MAC video laryngoscope to the Macintosh direct laryngoscope for intubation in the emergency department. Annals of emergency medicine, 2012; 60(6), 739-748. Doi: 10.1016/j.annemergmed.2012.03.031
Karl Storz (2021). What do you need for your airway management? We offer the solution: The C-MAC® system (07.02.2021 tarihinde https://www.karlstorz.com/cps/rde/xbcr/karlstorz_assets/ASSETS/3540822.pdf adresinden ulaşılmıştır).
Cavus, E., Neumann, T., Doerges, V. First clinical evaluation of the C-MAC D-Blade videolaryngoscope during routine and difficult intubation. Anesthesia & Analgesia, 2011; 112(2), 382-385. doi: 10.1213/ANE.0b013e31820553fb
Medtronic (2021). McGRATH™ MAC Video Laryngoscope (07.02.2021 tarihinde https://www.medtronic.com/covidien/en-us/products/intubation/mcgrath-mac-video-laryngoscope.html adresinden ulaşılmıştır).
Ross, M., Baxter, A. Use of the new McGrath® MAC size‐1 paediatric videolaryngoscope. Anaesthesia, 2015; 70(10), 1217-1218.
Verathon (2021). (07.02.2021 tarihinde https://www.verathon.com/glidescope-avl/ adresinden ulaşılmıştır).
Wallace, C., Engelhardt, T. Videolaryngoscopes in paediatric anaesthesia. Current Treatment Options in Pediatrics, 2015; 1(1), 25-37. Doi: 10.1007/s40746-014-0007-z
Medicalexpo (2021). (07.02.2021 tarihinde https://pdf.medicalexpo.com/pdf/truphatek-international/truview-pediatriic-pcd/70379-68484.html adresinden ulaşılmıştır).
Teleflex (2021). (07.02.2021 tarihinde https://www.teleflex.com/usa/en/product-areas/military-federal/airway-management/video-laryngoscopy/index.html adresinden ulaşılmıştır).
