• Eun-Hee Kim, Ji-Hyun Lee, In-Kyung Song, Jin-Tae Kim, Bo-Rim Kim, and Hee-Soo Kim.
• From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea.
• Eur J Anaesthesiol. 2016 Jul 1; 33 (7): 528-34.

BackgroundThe McGrath MAC video laryngoscope can improve visualisation of the glottis compared with the Macintosh direct laryngoscope. However, good visualisation of the glottis does not guarantee rapid or successful intubation because of difficulty in handling the McGrath device.ObjectiveWe evaluated the effect of head elevation, aligning the positions of the external auditory meatus and sternal notch in the horizontal plane, on visualisation of the glottis and handling of the McGrath laryngoscope in paediatric patients.DesignA randomised controlled trial.SettingThe operating rooms of our tertiary care hospital.PatientsForty-six children, American Society of Anaesthesiologists' physical status 1 or 2, aged 3 to 7 years.InterventionVideolaryngoscopy using the McGrath device was performed with the head either flat or elevated.Main Outcome MeasuresThe percentage of glottis opening score, the use of optimisation manoeuvre and time to successful tracheal intubation were recorded.ResultsThe median (IQR) percentage of glottis opening score was higher after head elevation than when the head was flat in all patients [100 (100 to 100)% vs. 100 (90 to 100)%, P = 0.0001). The need for use of optimisation procedures (50 vs. 9%, P = 0.004) and mean (SD) time to intubation (17 ± 4 s vs. 15 ± 3 s, P = 0.008) were lower in the head-elevated group.ConclusionVisualisation of the glottis and handling of the McGrath MAC video laryngoscope were significantly better when the external auditory meatus and sternal notch were aligned in the horizontal plane.Trial Registrationhttp://cris.nih.go.kridentifier:KCT0001443.

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