The Effect of C-MAC Miller 1 Blade Placement in the Vallecula Versus Direct Epiglottic Elevation on Glottic Visualization and Intubation Performance in Children Under 2 Years of Age: A Prospective Randomized Controlled Trial.

Background/Objectives: This study aimed to compare glottic visualization and intubation performance during laryngoscopy with the C-MAC video laryngoscope size 1 Miller blade using direct epiglottic elevation versus vallecular placement of the blade tip in children younger than 2 years of age. Methods: This prospective, randomized controlled trial enrolled 127 ASA physical status I-II children younger than 2 years undergoing elective surgery. Participants were randomly allocated to Group V (vallecular placement; n = 62) or Group E (direct epiglottic elevation; n = 65). Anesthesia was induced with fentanyl, thiopental, sevoflurane, and rocuronium. The Percentage of Glottic Opening (POGO) score, Cormack-Lehane grade, Intubation Difficulty Score (IDS), Visual Analogue Scale (VAS) score, laryngoscopy and intubation times, intubation attempts, optimization maneuvers, and complications were recorded. Results: The POGO score was significantly higher in Group E (median [IQR], 96 [92-100]) than in Group V (95 [88-100]; p = 0.032). Cormack-Lehane grades were significantly better in Group E than in Group V (p = 0.042). Laryngoscopy time was significantly shorter in Group V (5.61 ± 1.15 s) than in Group E (6.95 ± 1.80 s; p = 0.001). Intubation time was also significantly shorter in Group V (23.16 ± 4.44 s) than in Group E (26.60 ± 4.73 s; p = 0.001). VAS scores were significantly higher in Group V (9.48 ± 1.09) than in Group E (9.02 ± 1.09; p = 0.018). Conclusions: Direct epiglottic elevation with the C-MAC video laryngoscope size 1 Miller blade improved glottic visualization, whereas vallecular placement was associated with shorter laryngoscopy and intubation times in children younger than 2 years. The choice between the two techniques may depend on clinical priorities; vallecular placement may be considered when minimizing intubation time is a priority, although this hypothesis requires prospective evaluation in higher-risk populations.