Author: Yuka Uchinami, et al.
Anesthesia & Analgesia. 2026;143(1):5–15.
Infant tracheal intubation can be particularly challenging for anesthesia trainees because of infants’ unique airway anatomy, limited oxygen reserve, and rapid risk of desaturation. This randomized controlled trial evaluated whether the McGRATH MAC video laryngoscope improved first-attempt intubation success compared with conventional direct laryngoscopy.
Study Design
This single-center randomized trial included 124 infants younger than 1 year who were undergoing elective surgery requiring oral tracheal intubation.
All intubations were performed by anesthesia trainees under supervision. Infants were assigned to:
- McGRATH MAC video laryngoscopy using a size 1 Macintosh blade: 61 patients
- Direct laryngoscopy using a Miller or Macintosh blade: 63 patients
The primary outcome was successful intubation on the first attempt. Secondary outcomes included glottic visualization, intubation difficulty, time to intubation, and complications.
Key Findings
First-attempt intubation was successful in:
- 86.9% of infants with McGRATH video laryngoscopy
- 74.6% of infants with direct laryngoscopy
The reported risk difference was 16.5%, and the difference was statistically significant.
The advantage of video laryngoscopy was particularly apparent among less-experienced anesthesia trainees.
A completely uncomplicated intubation, represented by an Intubation Difficulty Score of 0, occurred in:
- 49.2% of the McGRATH group
- 31.7% of the direct laryngoscopy group
A complete view of the glottic opening was obtained in:
- 60.7% of the McGRATH group
- 36.5% of the direct laryngoscopy group
These findings demonstrate that the McGRATH device provided trainees with substantially better visualization of the infant airway.
Complications
The overall incidence of intubation-related complications was similar:
- McGRATH video laryngoscopy: 8.2%
- Direct laryngoscopy: 11.1%
Esophageal intubation occurred in three infants in the direct laryngoscopy group but did not occur in the McGRATH group.
Although the study was not large enough to demonstrate significant differences in uncommon complications, improved first-attempt success and the absence of esophageal intubation support a potential safety benefit.
Clinical Implications
For anesthesia trainees, video laryngoscopy may reduce the technical difficulty of infant intubation by providing a clearer and shared view of the glottis.
The shared video image also allows supervising anesthesiologists to guide trainees in real time, potentially improving both patient safety and airway education.
These results support using the McGRATH MAC video laryngoscope as the preferred initial device for infant intubation by inexperienced providers, provided that clinicians continue to maintain competence in direct laryngoscopy.
Limitations
The study was conducted at a single institution and included infants undergoing elective surgery. The findings may not apply directly to emergency intubations, infants with difficult airways, or intubations performed in intensive care units and emergency departments.
The study also evaluated a specific video laryngoscope and blade, so the results should not automatically be generalized to every pediatric video laryngoscopy device.
Conclusion
The McGRATH MAC video laryngoscope significantly improved first-attempt tracheal intubation success among anesthesia trainees caring for infants. It also produced better glottic visualization and less difficult intubations than conventional direct laryngoscopy.
Video laryngoscopy appears especially beneficial for novice providers and may improve both the safety and educational effectiveness of infant airway management.
We thank Anesthesia & Analgesia for allowing us to summarize this important clinical research.