A randomised comparative study of Miller laryngoscope blade versus Oxiport® Miller laryngoscope blade for neonatal and infant intubations

Abstract

Background and Aims: Neonates and infants are prone to oxygen desaturation during the induction of general anaesthesia. Pharyngeal oxygen insufflation has been shown to delay the onset of desaturation and hypoxaemia during apnoea. We tested the hypothesis that deep laryngeal oxygenation with Oxiport® Miller blade would delay the onset of desaturation compared to laryngoscopy without supplemental oxygen (Miller blade). Methods: One hundred neonates and infants undergoing general anaesthesia with endotracheal intubation for surgery were recruited and randomly assigned to one of the two groups: Miller or Oxiport group (laryngoscopy performed with Miller or Oxiport® blade, respectively). Primary outcome measure was the lowest oxygen saturation (SpO2) attained during intubation. Secondary outcomes were the incidence of severe desaturation (SpO2< 85%), correlation between SpO2and time to intubation in each group. Pearson's correlation coefficient was used to measure the correlation between time to intubation and desaturation in each group. P< 0.05 was considered statistically significant. Results: Data from 95 patients were available for the final analysis: Miller group (n = 48) and Oxiport group (n = 47). Mean lowest SpO2was 95.9% ± 5.75% in Miller group and 97.55% ± 2.93% in Oxiport group (P = 0.049). Correlation between time to intubation and SpO2was −0.110; P = 0.459 in Miller group and −0.468; P = 0.001 in Oxiport group. Severe desaturation occurred in 12.5% patients in Miller group and none in Oxiport group. Conclusion: Apnoeic laryngeal oxygen insufflation with Oxiport® laryngoscope blade decreases the incidence of severe desaturation during neonatal and infant intubations.

Keywords

• Apnoeic oxygenation
• endotracheal intubation
• infants
• Miller blade
• neonates
• Oxiport blade