Comparing the Ease of Mask Ventilation, Laryngoscopy, and Intubation in Supine and Lateral Position in Infants with Meningomyelocele

BACKGROUND: The biggest anesthetic challenge in infants with thoracolumbar /sacral meningomyelocele is securing the airway. For securing the airway, most of the anesthesiologist's practices supine position with doughnut or head ring placed around the swelling to prevent rupture, which has got disadvantages like risk of rupture, infection and damage to neural structure. Left lateral position has been recommended previously for tracheal intubation in post-tonsillectomy hemorrhage. Several studies have shown successful ventilation in lateral position using laryngeal mask airway and intubation using video laryngoscopes. AIMS AND OBJECTIVES: Primary objective is to compare the time taken for intubation, number of attempts required for intubation. Secondary objective is to compare ease of mask ventilation, Cormack Lehane grading and Backwards Upward Rightwards Pressure [BURP] manoeuvre. MATERIALS AND METHODS: A comparative, prospective randomized, controlled trial of 60 infants undergoing thoracolumbar/sacral meningomylocele repair. Infants were allocated to one of two groups of 30 patients each, by computer-generated randomization into Group S: mask ventilation, laryngoscopy and intubation in supine position and Group L: mask ventilation, laryngoscopy and intubation in lateral position. STATISTICAL METHODS: Chi-square/Fisher Exact test was used to find the significance of study parameters on categorical scale between two or more groups. RESULTS: Mean intubation time of sixteen seconds were clinically acceptable and comparable in each of the two positions P = 0.145. Ten patients in the left lateral position, eight patients in the supine position required second intubation attempts before the airway was secured. Only 8.3% of our patients required third intubation attempts. CONCLUSION: Anesthesiologist should pay more attention to the safety and quality of mask ventilation, laryngoscopy and intubation in meningomylocele infants. Both supine and lateral position were comparable.