{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:25:21Z","timestamp":1780507521591,"version":"3.54.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deutsche Forschungsgemeinschaft and Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg"}],"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>Airway management can be challenging in neonates and infants. The Pierre Robin sequence (PRS) is a condition characterized by micrognathia, glossoptosis and airway obstruction. The airway management of these patients poses great challenges for anesthesiologists and pediatricians alike. To date, there has been no direct comparison of the hyperangulated GlideScope<jats:sup>\u00ae<\/jats:sup> Spectrum LoPro (GLP), the straight GlideScope<jats:sup>\u00ae<\/jats:sup> Spectrum Miller (GSM), a conventional Macintosh (MC) and a conventional Miller blade (ML) in patients with PRS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>For this purpose, 90 anesthesiologists (43 with limited experience, 47 with extensive experience) performed orotracheal intubation on an Air-Sim<jats:sup>\u00ae<\/jats:sup> Pierre Robin X manikin using GLP, GSM, MC and ML in randomized order. \u2018Time-to-vocal-cords\u2019, \u2018time-to-intubate\u2019, \u2018time-to-ventilate\u2019, the severity of oral-soft-tissue-trauma and the subjective evaluation of each device were recorded.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A significantly faster and better view of the vocal cords and lower oral-soft-tissue-trauma was achieved using the GLP (p&lt;0.001). Though, there were no significant differences in the \u2018time-to-intubate\u2019 or \u2018time-to-ventilate\u2019. The highest intubation success rate was found with GSM and the lowest with GLP (GSM 100%, ML 97.8%, MC 96.7%, GLP 93.3%). When using the videolaryngoscopes, there were no undetected esophageal intubations but in six cases prolonged attempts of intubation (&gt;120s) with the GLP. In the sub-group with extensive experience, we found significantly shorter intubation times for the GSM and ML. The GLP was the tool of choice for most participants, while the conventional MC received the lowest rating.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Videolaryngoscopy leads to increased safety for the prevention of undetected esophageal intubation in the airway management in a PRS manikin. Hyperangulated blades may ensure a good and fast view of the vocal cords and low oral-soft-tissue-trauma but pose a challenge during the placement of the tube. Specific skills and handling seem to be necessary to ensure a safe tube placement with this sort of blades.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0288816","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T17:33:17Z","timestamp":1691083997000},"page":"e0288816","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["An approach to difficult airway in infants: Comparison of GlideScope\u00ae Spectrum LoPro, GlideScope\u00ae Spectrum Miller and conventional Macintosh and Miller blades in a simulated Pierre Robin sequence performed by 90 anesthesiologists"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2420-9602","authenticated-orcid":true,"given":"Andrea","family":"Irouschek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Moritz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Kremer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Fuchte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Danzl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Golditz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"issue":"8","key":"pone.0288816.ref001","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/j.1460-9592.2012.03813.x","article-title":"Incidence and predictors of difficult laryngoscopy in 11,219 pediatric anesthesia procedures","volume":"22","author":"S Heinrich","year":"2012","journal-title":"Paediatr Anaesth"},{"issue":"6","key":"pone.0288816.ref002","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/j.bja.2021.02.021","article-title":"Difficult tracheal intubation in neonates and infants. 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