Comparison of two external maneuvers with conventional laryngoscopic technique on glottic visualization using C-MAC video-laryngoscope in children: A single-center randomized comparative trial

Background: Airway management in pediatric patients remains challenging. Video laryngoscopes have improved intubation, but external airway maneuvers may still be required. This study compared jaw thrust and backward upward rightward pressure (BURP) maneuvers with the conventional technique for glottic visualization during video laryngoscopy. Subjects and Methods: Ninety pediatric patients (3–10 years) with normal airways were randomized into three groups. Under general anesthesia, C-MAC laryngoscopy images were obtained using conventional technique, BURP, and jaw thrust. Cormack–Lehane (CL) grade, percentage of glottic opening (POGO) score, and glottic area were recorded. Intubation was performed using the assigned technique: conventional (Group C), BURP (Group B), or jaw thrust (Group J). Intubation time, attempts, airway trauma, and postoperative sore throat were noted. Results: Jaw thrust produced the greatest improvement in CL grade and POGO score (97.8% vs. 76.7% in Group C and 88.9% in Group B) and glottic area (5332.8 pixel 2 vs. 4452.7 pixel 2 in Group B and 3469.8 pixel 2 in Group C). It also significantly reduced intubation time (7.93 s vs. 8.23 s in Group B and 9.57 s in Group C) and total insertion time. Conclusions: Jaw thrust provided superior glottic visualization compared to BURP and conventional techniques, with faster intubation and better overall intubation characteristics in pediatric patients using video laryngoscopy.