BACKGROUND: Tracheal intubation in infants poses unique anatomical and physiological challenges and is particularly difficult for anesthesia trainees. Video laryngoscopy has been suggested to improve intubation success, yet evidence among novice providers remains limited. We aimed to evaluate whether anesthesia trainees had a higher first-attempt success rate for tracheal intubation in infants using traditional direct laryngoscopy (DL) with a Miller or Macintosh blade, or indirect video laryngoscopy with a McGrath video laryngoscope size 1 Macintosh blade (McGrath VL). METHODS: In this single-center, parallel-group, randomized controlled trial, infants (<1-year-old) scheduled for elective surgery requiring orotracheal intubation were randomly allocated to either McGrath VL or DL. All intubations were performed by anesthesia trainees under supervision. The primary outcome was the first-attempt intubation success rate. Secondary outcomes included intubation difficulty score, glottic visualization, time to intubation, and intubation-related complications. RESULTS: Between October 2021 and February 2024, 124 infants were enrolled and randomized (McGrath VL: n = 61; DL: n = 63). First-attempt success was achieved in 53/61 (86.9%) in the McGrath VL group and 47/63 (74.6%) in the DL group (risk difference 16.5%, 95% confidence interval CI,3.0%–29.9%; P = . 026). The Intubation Difficulty Score of 0 occurred in 30/61 (49.2%) in the McGrath VL group versus 20/63 (31.7%) in the DL group (risk difference 18.9%, 95% CI, 0.6%–37.2%), and a Percentage of Glottic Opening score of 100% was achieved in 37/61 (60.7%) in the McGrath VL group versus 23/63 (36.5%) in the DL group (risk difference 22.1%, 95% CI, 6.2%–37.9%). The overall incidence of intubation-related complications did not differ significantly between groups (McGrath VL: 5/61 8.2% vs DL: 7/63 11.1%, risk difference –4.1%, 95% CI, –14.7%–6.4%); however, esophageal intubation occurred in 0/61 (0%) in the McGrath VL group versus 3/63 (4.8%) in the DL group. CONCLUSION: The McGrath VL significantly improves first-attempt intubation success in infants when used by anesthesia trainees, especially among less experienced providers. Video laryngoscopy may enhance safety and effectiveness in infant airway management. These results support its routine use by novice providers in infant anesthesia.
Uchinami et al. (2026) studied this question.