The Effect of C-MAC Miller 1 Blade Placement in the Vallecula Versus Direct Epiglottic Elevation on Glottic Visualization and Intubation Performance in Children Under 2 Years of Age: A Prospective Randomized Controlled Trial.
- 1Department of Anesthesiology and Reanimation, Battalgazi State Hospital, Malatya 44210, Turkey.
- 2Department of Anesthesiology and Reanimation, Faculty of Medicine, İnönü University, Malatya 44210, Turkey.
- 3Department of Biostatistics, and Medical Informatics, Faculty of Medicine, İnönü University, Malatya 44210, Turkey.
Abstract
Background/Objectives: This study aimed to compare glottic visualization and intubation performance during laryngoscopy with the C-MAC video laryngoscope size 1 Miller blade using direct epiglottic elevation versus vallecular placement of the blade tip in children younger than 2 years of age. Methods: This prospective, randomized controlled trial enrolled 127 ASA physical status I-II children younger than 2 years undergoing elective surgery. Participants were randomly allocated to Group V (vallecular placement; n = 62) or Group E (direct epiglottic elevation; n = 65). Anesthesia was induced with fentanyl, thiopental, sevoflurane, and rocuronium. The Percentage of Glottic Opening (POGO) score, Cormack-Lehane grade, Intubation Difficulty Score (IDS), Visual Analogue Scale (VAS) score, laryngoscopy and intubation times, intubation attempts, optimization maneuvers, and complications were recorded. Results: The POGO score was significantly higher in Group E (median [IQR], 96 [92-100]) than in Group V (95 [88-100]; p = 0.032). Cormack-Lehane grades were significantly better in Group E than in Group V (p = 0.042). Laryngoscopy time was significantly shorter in Group V (5.61 ± 1.15 s) than in Group E (6.95 ± 1.80 s; p = 0.001). Intubation time was also significantly shorter in Group V (23.16 ± 4.44 s) than in Group E (26.60 ± 4.73 s; p = 0.001). VAS scores were significantly higher in Group V (9.48 ± 1.09) than in Group E (9.02 ± 1.09; p = 0.018). Conclusions: Direct epiglottic elevation with the C-MAC video laryngoscope size 1 Miller blade improved glottic visualization, whereas vallecular placement was associated with shorter laryngoscopy and intubation times in children younger than 2 years. The choice between the two techniques may depend on clinical priorities; vallecular placement may be considered when minimizing intubation time is a priority, although this hypothesis requires prospective evaluation in higher-risk populations.
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BibTeX
@article{kenc2026effect,
title = {{The Effect of C-MAC Miller 1 Blade Placement in the Vallecula Versus Direct Epiglottic Elevation on Glottic Visualization and Intubation Performance in Children Under 2 Years of Age: A Prospective Randomized Controlled Trial.}},
author = {Ahmet Kenç and Zekine Begeç and Ülkü Özgül and Cemil Çolak and Oya Olcay Özdeş},
journal = {Journal of clinical medicine},
year = {2026},
month = sep,
doi = {10.3390/jcm15197483},
url = {https://europepmc.org/article/MED/42881945},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Effect of C-MAC Miller 1 Blade Placement in the Vallecula Versus Direct Epiglottic Elevation on Glottic Visualization and Intubation Performance in Children Under 2 Years of Age: A Prospective Randomized Controlled Trial.
AU - Ahmet Kenç
AU - Zekine Begeç
AU - Ülkü Özgül
AU - Cemil Çolak
AU - Oya Olcay Özdeş
PY - 2026
DA - 2026/09/26
JO - Journal of clinical medicine
DO - 10.3390/jcm15197483
UR - https://europepmc.org/article/MED/42881945
AB - Background/Objectives: This study aimed to compare glottic visualization and intubation performance during laryngoscopy with the C-MAC video laryngoscope size 1 Miller blade using direct epiglottic elevation versus vallecular placement of the blade tip in children younger than 2 years of age. Methods: This prospective, randomized controlled trial enrolled 127 ASA physical status I-II children younger than 2 years undergoing elective surgery. Participants were randomly allocated to Group V (vallecular placement; n = 62) or Group E (direct epiglottic elevation; n = 65). Anesthesia was induced with fentanyl, thiopental, sevoflurane, and rocuronium. The Percentage of Glottic Opening (POGO) score, Cormack-Lehane grade, Intubation Difficulty Score (IDS), Visual Analogue Scale (VAS) score, laryngoscopy and intubation times, intubation attempts, optimization maneuvers, and complications were recorded. Results: The POGO score was significantly higher in Group E (median [IQR], 96 [92-100]) than in Group V (95 [88-100]; p = 0.032). Cormack-Lehane grades were significantly better in Group E than in Group V (p = 0.042). Laryngoscopy time was significantly shorter in Group V (5.61 ± 1.15 s) than in Group E (6.95 ± 1.80 s; p = 0.001). Intubation time was also significantly shorter in Group V (23.16 ± 4.44 s) than in Group E (26.60 ± 4.73 s; p = 0.001). VAS scores were significantly higher in Group V (9.48 ± 1.09) than in Group E (9.02 ± 1.09; p = 0.018). Conclusions: Direct epiglottic elevation with the C-MAC video laryngoscope size 1 Miller blade improved glottic visualization, whereas vallecular placement was associated with shorter laryngoscopy and intubation times in children younger than 2 years. The choice between the two techniques may depend on clinical priorities; vallecular placement may be considered when minimizing intubation time is a priority, although this hypothesis requires prospective evaluation in higher-risk populations.
SN - 2077-0383
ER -