{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T10:10:26Z","timestamp":1779185426169,"version":"3.51.4"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T00:00:00Z","timestamp":1619049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Video laryngoscopy is an effective tool in the management of difficult pediatric airway. However, evidence to guide the choice of the most appropriate video laryngoscope (VL) for airway management in pediatric patients with Pierre Robin syndrome (PRS) is insufficient. Therefore, the aim of this study was to compare the efficacy of the Glidescope<jats:sup>\u00ae<\/jats:sup> Core<jats:sup>\u2122<\/jats:sup> with a hyperangulated blade, the C-MAC<jats:sup>\u00ae<\/jats:sup> with a nonangulated Miller blade (C-MAC<jats:sup>\u00ae<\/jats:sup> Miller) and a conventional Miller laryngoscope when used by anesthetists with limited and extensive experience in simulated Pierre Robin sequence.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Forty-three anesthetists with limited experience and forty-three anesthetists with extensive experience participated in our randomized crossover manikin trial. Each performed endotracheal intubation with the Glidescope<jats:sup>\u00ae<\/jats:sup> Core<jats:sup>\u2122<\/jats:sup> with a hyperangulated blade, the C-MAC<jats:sup>\u00ae<\/jats:sup> with a Miller blade and the conventional Miller laryngoscope. \u201cTime to intubate\u201d was the primary endpoint. Secondary endpoints were \u201ctime to vocal cords\u201d, \u201ctime to ventilate\u201d, overall success rate, number of intubation attempts and optimization maneuvers, Cormack-Lehane score, severity of dental trauma and subjective impressions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Both hyperangulated and nonangulated VLs provided superior intubation conditions. The Glidescope<jats:sup>\u00ae<\/jats:sup> Core<jats:sup>\u2122<\/jats:sup> enabled the best glottic view, caused the least dental trauma and significantly decreased the \u201ctime to vocal cords\u201d. However, the failure rate of intubation was 14% with the Glidescope<jats:sup>\u00ae<\/jats:sup> Core<jats:sup>\u2122<\/jats:sup>, 4.7% with the Miller laryngoscope and only 2.3% with the C-MAC<jats:sup>\u00ae<\/jats:sup> Miller when used by anesthetists with extensive previous experience. In addition, the \u201ctime to intubate\u201d, the \u201ctime to ventilate\u201d and the number of optimization maneuvers were significantly increased using the Glidescope<jats:sup>\u00ae<\/jats:sup> Core<jats:sup>\u2122<\/jats:sup>. In the hands of anesthetists with limited previous experience, the failure rate was 11.6% with the Glidescope<jats:sup>\u00ae<\/jats:sup> Core<jats:sup>\u2122<\/jats:sup> and 7% with the Miller laryngoscope. Using the C-MAC<jats:sup>\u00ae<\/jats:sup> Miller, the overall success rate increased to 100%. No differences in the \u201ctime to intubate\u201d or \u201ctime to ventilate\u201d were observed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The nonangulated C-MAC<jats:sup>\u00ae<\/jats:sup> Miller facilitated correct placement of the endotracheal tube and showed the highest overall success rate. Our results therefore suggest that the C-MAC<jats:sup>\u00ae<\/jats:sup> Miller could be beneficial and may contribute to increased safety in the airway management of infants with PRS when used by anesthetists with limited and extensive experience.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250369","type":"journal-article","created":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T19:37:39Z","timestamp":1619120259000},"page":"e0250369","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Comparison of Glidescope Core, C-MAC Miller and conventional Miller laryngoscope for difficult airway management by anesthetists with limited and extensive experience in a simulated Pierre Robin sequence: A randomized crossover manikin study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0321-4971","authenticated-orcid":true,"given":"Andreas","family":"Moritz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luise","family":"Holzhauser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Fuchte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sven","family":"Kremer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Irouschek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,22]]},"reference":[{"issue":"2","key":"pone.0250369.ref001","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1213\/ANE.0000000000000301","article-title":"ierre Robin Sequence: a perioperative review","volume":"119","author":"F Cladis","year":"2014","journal-title":"PAnesth Analg"},{"issue":"9","key":"pone.0250369.ref002","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1001\/jamapediatrics.2016.0796","article-title":"Best Practices for the Diagnosis and Evaluation of Infants With Robin Sequence: A Clinical Consensus Report","volume":"170","author":"CC Breugem","year":"2016","journal-title":"JAMA Pediatr"},{"issue":"1","key":"pone.0250369.ref003","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/s12871-019-0889-1","article-title":"A clinical prediction rule to identify difficult intubation in children with Robin sequence requiring mandibular distraction osteogenesis based on craniofacial CT measures","volume":"19","author":"Z Mao","year":"2019","journal-title":"BMC Anesthesiol"},{"issue":"4","key":"pone.0250369.ref004","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1111\/pan.12049","article-title":"Anesthetic implications of infants with mandibular hypoplasia treated with mandibular distraction osteogenesis","volume":"23","author":"G Frawley","year":"2013","journal-title":"Paediatr Anaesth"},{"issue":"4","key":"pone.0250369.ref005","doi-asserted-by":"crossref","first-page":"381","DOI":"10.6061\/clinics\/2012(04)12","article-title":"Anesthesia-related mortality in pediatric patients: a systematic review.","volume":"67","author":"LP Gonzalez","year":"2012","journal-title":"Clinics (Sao Paulo)"},{"issue":"2","key":"pone.0250369.ref006","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/j.1460-9592.2004.01167.x","article-title":"Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30-month period","volume":"14","author":"I Murat","year":"2004","journal-title":"Paediatr Anaesth"},{"issue":"1","key":"pone.0250369.ref007","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S2213-2600(15)00508-1","article-title":"Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis.","volume":"4","author":"JE Fiadjoe","year":"2016","journal-title":"Lancet Respir Med"},{"issue":"2","key":"pone.0250369.ref008","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1460-9592.2010.03487.x","article-title":"The difficult pediatric airway\u2014a review of new devices for indirect laryngoscopy in children younger than two years of age","volume":"21","author":"R. Holm-Knudsen","year":"2011","journal-title":"Paediatr Anaesth"},{"issue":"5","key":"pone.0250369.ref009","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1097\/PCC.0000000000001128","article-title":"Videolaryngoscopy in Neonates, Infants, and Children","volume":"18","author":"O Balaban","year":"2017","journal-title":"Pediatr Crit Care Med"},{"issue":"7","key":"pone.0250369.ref010","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/j.1460-9592.2009.02987.x","article-title":"Difficult airway management with the STORZ video laryngoscope in a child with Robin Sequence","volume":"19","author":"A Vlatten","year":"2009","journal-title":"Paediatr Anaesth"},{"issue":"7","key":"pone.0250369.ref011","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/j.1460-9592.2009.03038.x","article-title":"Airtraq optical laryngoscope intubation in a 5-month-old infant with a difficult airway because of Robin Sequence","volume":"19","author":"A Vlatten","year":"2009","journal-title":"Paediatr Anaesth"},{"issue":"4","key":"pone.0250369.ref012","doi-asserted-by":"crossref","first-page":"310","DOI":"10.4097\/kjae.2014.66.4.310","article-title":"Combined use of a McGrath\u00ae MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome: a case report","volume":"66","author":"Y Kim","year":"2014","journal-title":"Korean J Anesthesiol"},{"issue":"4","key":"pone.0250369.ref013","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/pan.12538","article-title":"A new twist in the pediatric difficult airway","volume":"25","author":"EM Lillie","year":"2015","journal-title":"Paediatr Anaesth"},{"issue":"8","key":"pone.0250369.ref014","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1111\/pan.12668","article-title":"A randomized multi-institutional crossover comparison of the GlideScope\u00ae Cobalt Video laryngoscope to the flexible fiberoptic bronchoscope in a Pierre Robin manikin","volume":"25","author":"JE Fiadjoe","year":"2015","journal-title":"Paediatr Anaesth"},{"issue":"11","key":"pone.0250369.ref015","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1111\/j.1365-2044.1984.tb08932.x","article-title":"Difficult tracheal intubation in obstetrics","volume":"39","author":"RS Cormack","year":"1984","journal-title":"Anaesthesia"},{"issue":"3","key":"pone.0250369.ref016","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1111\/pan.13814","article-title":"Emerging trends, techniques, and equipment for airway management in pediatric patients","volume":"30","author":"ML Stein","year":"2020","journal-title":"Paediatr Anaesth"},{"issue":"5","key":"pone.0250369.ref017","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/j.1460-9592.2006.02149.x","article-title":"Airway management using the pediatric GlideScope in a child with Goldenhar syndrome and atypical plasma cholinesterase","volume":"17","author":"AD Milne","year":"2007","journal-title":"Paediatr Anaesth"},{"issue":"7","key":"pone.0250369.ref018","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1460-9592.2009.03021.x","article-title":"Use of GlideScope Ranger in the management of a child with Treacher Collins syndrome in a developing world setting","volume":"19","author":"S Bishop","year":"2009","journal-title":"Paediatr Anaesth"},{"issue":"3","key":"pone.0250369.ref019","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/bja\/aei041","article-title":"The GlideScope Video Laryngoscope: randomized clinical trial in 200 patients","volume":"94","author":"DA Sun","year":"2005","journal-title":"Br J Anaesth"},{"issue":"8","key":"pone.0250369.ref020","doi-asserted-by":"crossref","first-page":"e0237593","DOI":"10.1371\/journal.pone.0237593","article-title":"Comparison of the MultiViewScope Stylet Scope and the direct laryngoscope with the Miller blade for the intubation in normal and difficult pediatric airways: A randomized, crossover, manikin study","volume":"15","author":"K Godai","year":"2020","journal-title":"PLoS One"},{"issue":"3","key":"pone.0250369.ref021","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1213\/ANE.0b013e3181ad8a05","article-title":"Management of the difficult infant airway with the Storz Video Laryngoscope: a case series","volume":"109","author":"RS Hackell","year":"2009","journal-title":"Anesth Analg"},{"issue":"11","key":"pone.0250369.ref022","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1111\/j.1460-9592.2009.03127.x","article-title":"A comparison of the STORZ video laryngoscope and standard direct laryngoscopy for intubation in the Pediatric airway\u2014a randomized clinical trial","volume":"19","author":"A Vlatten","year":"2009","journal-title":"Paediatr Anaesth"},{"issue":"5","key":"pone.0250369.ref023","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1093\/bja\/aex344","article-title":"The efficacy of GlideScope\u00ae videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry","volume":"119","author":"R Park","year":"2017","journal-title":"Br J Anaesth"},{"issue":"1","key":"pone.0250369.ref024","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.bja.2020.08.010","article-title":"A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry","volume":"126","author":"J Peyton","year":"2021","journal-title":"Br J Anaesth"},{"issue":"2","key":"pone.0250369.ref025","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1213\/ANE.0000000000003412","article-title":"A Prospective Observational Study of Technical Difficulty With GlideScope-Guided Tracheal Intubation in Children","volume":"127","author":"B Zhang","year":"2018","journal-title":"Anesth Analg"},{"issue":"7","key":"pone.0250369.ref026","doi-asserted-by":"crossref","first-page":"e0236474","DOI":"10.1371\/journal.pone.0236474","article-title":"Comparison of Glidescope\u00ae Go\u2122, King Vision\u2122, Dahlhausen VL, I\u2011View\u2122 and Macintosh laryngoscope use during difficult airway management simulation by experienced and inexperienced emergency medical staff: A randomized crossover manikin study","volume":"15","author":"A Moritz","year":"2020","journal-title":"PLoS One"},{"issue":"3","key":"pone.0250369.ref027","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1111\/pan.12298","article-title":"Straight video blades are advantageous than curved blades in simulated pediatric difficult intubation","volume":"24","author":"KT Saracoglu","year":"2014","journal-title":"Paediatr Anaesth"},{"issue":"2","key":"pone.0250369.ref028","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1093\/bja\/65.2.268","article-title":"Rapidity and accuracy of tracheal intubation in a mannequin: comparison of the fibreoptic with the Bullard laryngoscope","volume":"65","author":"A Dyson","year":"1990","journal-title":"Br J Anaesth"},{"issue":"6","key":"pone.0250369.ref029","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1111\/pan.12906","article-title":"A comparison of the Truview PCD and the GlideScope Cobalt AVL video-laryngoscopes to the Miller blade for successfully intubating manikins simulating normal and difficult pediatric airways","volume":"26","author":"HK Hippard","year":"2016","journal-title":"Paediatr Anaesth"},{"issue":"1","key":"pone.0250369.ref030","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1046\/j.1365-2753.2001.00280.x","article-title":"Hawthorne effects and research into professional practice","volume":"7","author":"JD Holden","year":"2001","journal-title":"J Eval Clin Pract"},{"issue":"11","key":"pone.0250369.ref031","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/BF03026792","article-title":"The GlideScope-specific rigid stylet and standard malleable stylet are equally effective for GlideScope use","volume":"54","author":"TP Turkstra","year":"2007","journal-title":"Can J Anaesth"},{"issue":"3","key":"pone.0250369.ref032","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s12630-010-9440-z","article-title":"A randomized comparison of the GlideRite(\u00ae) Rigid Stylet to a malleable stylet for orotracheal intubation by novices using the GlideScope(\u00ae).","volume":"58","author":"PM Jones","year":"2011","journal-title":"Can J Anaesth"},{"issue":"5","key":"pone.0250369.ref033","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1177\/0310057X0903700502","article-title":"The influence of gender and experience on intubation ability and technique: a manikin study","volume":"37","author":"MS Waddington","year":"2009","journal-title":"Anaesth Intensive Care"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250369","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T19:38:14Z","timestamp":1619120294000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250369"}},"subtitle":[],"editor":[{"given":"Tai-Heng","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,22]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250369","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,22]]}}}