Purpose: The McGrath videolaryngoscope (VL) offers better laryngeal view compared to Macintosh laryngoscopy in adult patients and increases success rate of orotracheal intubation in patients with difficult airways. This prospective randomised controlled study was performed to evaluate the usefulness of the McGrath VL compared to Macintosh laryngoscopy in paediatric patients during routine orotracheal intubation, by comparing the time to intubation and ease of intubation.

Materials and Methods: Eighty-four patients, aged 1-10 years (ASA physical status I-II) undergoing tracheal intubation for elective surgery were randomly assigned to the Macintosh group (n = 42) or McGrath group (n = 42). Anaesthesia was induced with propofol 2.5-3.0 mg/kg, sevoflurane 5-8 vol%. Orotracheal intubation was performed 2 min after rocuronium 0.6 mg/kg injection with McGrath VL or Macintosh laryngoscope. The primary outcome was time to intubation assessed by a blind observer. Cormack and Lehane glottic grade, and intubation difficulty score (IDS) were also assessed. Haemodynamic changes were recorded at baseline, 1 min after induction, before, and 1 min after intubation.

Results: Median time to intubation [interquartile range] was not different in the McGrath group than in the Macintosh group (25.0 [22.8-28.3] s vs. 26.0 [24.0-29.0] s, p = 0.301). The incidence of grade I glottic view was significantly higher in the McGrath group than in the Macintosh group (95% vs. 74%, p = 0.013). There was significant difference in median IDS between the McGrath group than in the Macintosh group (p = 0.018). There were no significant differences in haemodynamic changes over time between the two groups.

Conclusion: This study shows that the McGrath VL provides better laryngoscopic views and lower IDS, but similar intubation time compared to Macintosh laryngoscope during routine orotracheal intubation in paediatric patients.

A comparison of McGrath MAC videolaryngoscopy and Macintosh laryngoscopy for orotracheal intubation in children: a randomised controlled trial