The effect of placement of a support under the shoulders on laryngeal visualization with a C‐MAC Miller Video Laryngoscope in children younger than 2 years of age

Background We aimed to evaluate glottis visualization and time to intubation in children younger than 2 years of age during laryngoscopy performed with a C‐MAC Miller Video Laryngoscope in a position determined by placing a folded towel under the shoulders to align the oral‐pharyngeal and laryngeal axes in the horizontal plane. Methods Ninety‐six children younger than 2 years of age, who were classified by the American Society of Anesthesiologists as having a physical status I or II and who were scheduled for elective surgery necessitating endotracheal intubation under general anesthesia, were included in the study. All patients were intubated with a C‐MAC Miller Video Laryngoscope. The children intubated by placing a folded towel under the shoulders were categorized as Group 1 (n = 48), and the children intubated without placement of a folded towel were categorized as Group 2 (n = 48). The percentage of glottis opening and Cormack‐Lehane Scores, values of visual analogue scale to determine the ease of using a C‐MAC Miller Video Laryngoscope, time to intubation, number of intubation attempts, optimization procedures and complications were recorded for all children. Results There was a statistically significant difference between Group 1 (mean ± SD; 97.71 ± 4.24) and Group 2 (mean ± SD; 94.17 ± 7.09) in terms of the percentage of glottis opening scores ( P  = 0.004). The mean difference in the percentage of glottis opening scores (95% confidence interval) between the groups was 3.54 (1.17‐5.90). Conclusion We showed that a folded towel placed under the shoulders in children younger than 2 years of age improves glottis visualization provides ease of use of the C‐MAC Miller Video Laryngoscope. Therefore, we think that the placement of a folded towel under the shoulders during the use of a C‐MAC Miller Video Laryngoscope may be useful for airway management in children younger than 2 years of age.