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Updated: Sep 18, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A
Risa Takeuchi1, Hiroshi Hoshijima2, Masanori Tsukamoto3
1Bunkoukai Special Needs Dental Clinic, 2765-5 Ujiie, Sakura 329-1311, Japan.
Insights
The Airtraq laryngoscope is most effective at preventing hemodynamic changes, such as increased heart rate (HR) and mean blood pressure (MBP), during tracheal intubation in pediatric patients. This network meta-analysis ranked Airtraq highest for minimizing these adverse hemodynamic responses.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Medical Device Technology
Background:
- Tracheal intubation can cause significant hemodynamic responses, including elevated heart rate (HR) and blood pressure (BP), posing risks in pediatric patients.
- Minimizing these adverse hemodynamic events during intubation is crucial for patient safety and outcomes.
Purpose of the Study:
- To conduct a network meta-analysis (NMA) to rank indirect and direct laryngoscopes based on their effectiveness in managing hemodynamic responses (HR and mean blood pressure, MBP) during tracheal intubation in pediatric patients.
- To identify laryngoscopy devices that best suppress increases in HR and MBP post-intubation.
Main Methods:
- Inclusion of 16 prospective randomized trials comparing hemodynamic responses to tracheal intubation using indirect and direct laryngoscopes in pediatric patients.
- Utilized a random-effects model for meta-analysis, calculating weighted mean differences (WMD) and 95% confidence intervals (CI) for HR and MBP.
- Employed P-scores derived from network estimates to rank intubation devices, also analyzing intubation time as a related factor.
Main Results:
- The Airtraq laryngoscope significantly suppressed increases in HR (WMD = -16.7) and MBP (WMD = -8.57) compared to the Macintosh laryngoscope.
- Airtraq achieved the highest P-score rankings for both HR and MBP, indicating superior hemodynamic stability.
- Top-ranking devices for HR and intubation time included Airtraq, Coopdech video laryngoscope, Miller, C-MAC, and Wis-Hipple.
Conclusions:
- Network meta-analysis provides a robust ranking of intubation devices for mitigating hemodynamic changes in pediatric tracheal intubation.
- The Airtraq laryngoscope is identified as the optimal device for preventing adverse hemodynamic responses during pediatric tracheal intubation.
- Airtraq also demonstrated the shortest intubation times among the evaluated devices.
Abstract:
Purpose: Hemodynamic response, particularly increased heart rate (HR) and blood pressure, can occur during tracheal intubation and is an adverse event to be avoided. The aim of this study was to use a network meta-analysis (NMA) to develop a ranking of hemodynamic responses (HR and mean blood pressure, MBP) after intubation of indirect and direct laryngoscopes in pediatric patients. Method: Studies were eligible for inclusion if they had a prospective randomized design, compared hemodynamic response (HR and MBP) to tracheal intubation between indirect and/or direct laryngoscopes, and were conducted in pediatric patients. The pooled difference between each intubation device's intubation time is expressed as a weighted mean difference (WMD) of a 95% confidence interval (CI). The intubation time of the device was evaluated using P-scores calculated from the network point estimates and standard errors. A random-effects model was used when pooling effect sizes. We also analyzed intubation time as a related factor to hemodynamic responses. Results: From the electronic databases, we selected 16 trials for review. In a Macintosh-referenced analysis, Airtraq suppressed an increase of HR and MBP during tracheal intubation in pediatric patients significantly more than a Macintosh laryngoscope. (HR; WMD = -16.7, 95%CI -22.5 to -10.9, MBP; WMD = -8.57, 95%CI -10.9 to -6.27). Airtraq also topped the HR and MBP P-score rankings. The results of this study showed similar laryngoscopes in the top five rankings of P-scores (Airtraq, Coopdech video laryngoscope, Miller, C-MAC, Wis-Hipple) for HR and intubation time. Conclusions: We applied a network meta-analysis to create a consistent ranking of intubation devices that prevent hemodynamic changes during tracheal intubation in pediatric patients. In this NMA, Airtraq proved to be the best laryngoscope for preventing hemodynamic responses during tracheal intubation in pediatric patients. In the analysis of intubation time, Airtraq showed the shortest intubation time.
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