Visibility of the glottis in children using video and direct laryngoscopy during induction of general anesthesia: a retrospective comparative study

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Background and purpose: Hypertrophic tonsils can limit the visibility of glottis as a prerequisite for successful intubation. Although expected, studies have not unequivocally proven that videolaryngoscopy improves the visibility of the glottis in children. The aim of this study was to compare the visibility of the glottis using direct (DL) and video laryngoscopy (VL) during induction of general anesthesia in children undergoing adenotonsillectomy or adenoidectomy. Materials and methods: This retrospective study was performed by reviewing the medical charts of 88 children, up to 8 years of age, who underwent adenotonsillectomy/adenoidectomy in the period from January to December 2024 at the Sveti Duh University Hospital in Zagreb. General data were taken for each patient: age, gender, height and weight; preoperative anesthesiology data; ASA classification, Mallampati; intraoperative anesthesia data: difficulty of manual ventilation (according to Han), glottic visualization according to the Cormack Lehane classification, intubation (orderly, difficult, impossible), type of laryngoscope used, type of mechanical ventilation (volume, pressure) and postoperative data on postoperative respiratory complications. Thirty-eight children had complete data. Results: The Cormack-Lehane classification distribution was similar between the VL and DL (p=0.250). The distribution of glottic visibility according to the Cormack-Lehane classification from 1 to 4 in the VL group (n=13), was as follows: 10 (76.9%), 3 (23.1%), 0 (%), and 0 (0%), while in the DL group (n=25) was as follows: 18 (72%), 3 (12%), 4 (16%), and 0(0%). Conclusion: In our patient sample, VL compared to DL did not increase glottic visibility according to the Cormack-Lehane classificatio

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