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Article

Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis

by
Risa Takeuchi
1,
Hiroshi Hoshijima
2,*,
Takahiro Mihara
3,
Shinichi Kokubu
4,
Aiji Sato (Boku)
5,
Takumi Nagumo
6,
Tsutomu Mieda
6,
Toshiya Shiga
7 and
Kentaro Mizuta
1
1
Bunkoukai Special Needs Center, 2765-5 Ujiie, Sakura 329-1311, Tochigi, Japan
2
Division of Dento-Oral Anesthesiology, Graduate School of Dentistry, Tohoku University, 4-1 Seiryomachi, Aoba, Sendai 980-8575, Miyagi, Japan
3
Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama 236-0004, Kanagawa, Japan
4
Department of Anesthesiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsugagun 321-0293, Tochigi, Japan
5
Department of Anesthesiology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-ku, Nagoya 465-8651, Aichi, Japan
6
Department of Anesthesiology, Saitama Medical University Hospital, Irumagun 350-0495, Saitama, Japan
7
Department of Anesthesiology and Pain Medicine, International University of Health and Welfare Ichikawa Hospital, 6-1-4 Kounodai, Ichikawa 272-0827, Chiba, Japan
*
Author to whom correspondence should be addressed.
Children 2024, 11(1), 60; https://doi.org/10.3390/children11010060
Submission received: 7 December 2023 / Accepted: 26 December 2023 / Published: 31 December 2023
(This article belongs to the Section Pediatric Otolaryngology)
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Abstract

This meta-analysis was performed to determine whether an indirect laryngoscope is more advantageous than a direct laryngoscope for tracheal intubation in the setting of a difficult pediatric airway. Data on the intubation failure and intubation time during tracheal intubation were extracted from prospective and retrospective studies identified through a comprehensive literature search. Data from 10 individual articles (11 trials) were combined, and a DerSimonian and Laird random-effects model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) and the corresponding 95% confidence interval (CI). Meta-analysis of the 10 articles indicated that the intubation failure of tracheal intubation with an indirect laryngoscope was not significantly different from that of a direct laryngoscope in patients with a difficult airway (RR 0.86, 95% CI 0.51–1.46; p = 0.59; Cochrane’s Q = 50.5; I2 = 82%). Intubation time with an indirect laryngoscope was also similar to that with a direct laryngoscope (WMD 4.06 s; 95% CI −1.18–9.30; p = 0.13; Cochrane’s Q 39.8; I2 = 85%). In conclusion, indirect laryngoscopes had the same intubation failure and intubation time as direct laryngoscopes in pediatric patients with a difficult airway. Currently, the benefits of indirect laryngoscopes have not been observed in the setting of a difficult pediatric airway.
Keywords: indirect laryngoscopes; direct laryngoscopes; pediatric; difficult airway; meta-analysis indirect laryngoscopes; direct laryngoscopes; pediatric; difficult airway; meta-analysis

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MDPI and ACS Style

Takeuchi, R.; Hoshijima, H.; Mihara, T.; Kokubu, S.; Sato, A.; Nagumo, T.; Mieda, T.; Shiga, T.; Mizuta, K. Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis. Children 2024, 11, 60. https://doi.org/10.3390/children11010060

AMA Style

Takeuchi R, Hoshijima H, Mihara T, Kokubu S, Sato A, Nagumo T, Mieda T, Shiga T, Mizuta K. Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis. Children. 2024; 11(1):60. https://doi.org/10.3390/children11010060

Chicago/Turabian Style

Takeuchi, Risa, Hiroshi Hoshijima, Takahiro Mihara, Shinichi Kokubu, Aiji Sato (Boku), Takumi Nagumo, Tsutomu Mieda, Toshiya Shiga, and Kentaro Mizuta. 2024. "Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis" Children 11, no. 1: 60. https://doi.org/10.3390/children11010060

APA Style

Takeuchi, R., Hoshijima, H., Mihara, T., Kokubu, S., Sato, A., Nagumo, T., Mieda, T., Shiga, T., & Mizuta, K. (2024). Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis. Children, 11(1), 60. https://doi.org/10.3390/children11010060

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