Obaid Ahmed Siddiqui

Comparison of the Airtraq and McCoy laryngoscopes using a rigid neck collar in patients with simulated difficult laryngoscopy

STUDY OBJECTIVE To determine the efficacy of the Airtraq versus the McCoy laryngoscope as intubation devices with the neck stabilized by a rigid cervical collar. DESIGN Prospective, randomized, double-blinded study. SETTING Jawaharlal Nehru Medical College. PATIENTS 60 ASA physical status 1, 2, and 3 patients, aged 18-70 years, scheduled for various surgical procedures requiring tracheal intubation for surgical anesthesia. INTERVENTIONS Patients were randomly allocated to undergo intubation with the McCoy (n = 30) or Airtraq (n = 30) laryngoscope. MEASUREMENTS AND MAIN RESULTS Differences in intubation times between the Airtraq and the McCoy laryngoscope, modified Cormack-Lehane score, percentage of glottic opening (POGO) score, and airway trauma were compared. Overall intubation success rates were 100% with both devices and a similar number of intubation attempts were required. However, the mean (SD) time required for successful intubation was shorter with the Airtraq (28.73 ± 6.39 sec) than the McCoy laryngoscope (39.11 ± 14.01 sec; P < 0.0001). The frequencies of intubation complications were similar. Esophageal intubation occurred in 4 cases but only with the McCoy laryngoscope. CONCLUSION Intubation time was shorter with the Airtraq than the McCoy laryngoscope, even though the overall success rates between the two devices were similar.

Airtraq® optical laryngoscope for tracheal intubation in patients with severe ankylosing spondylitis: A report of two cases

Airway management in patients of ankylosing spondylitis remains a challenge for anaesthesiologists. Many new airway devices have been used for securing airway in these patients. The Airtraq® optical laryngoscope is one of the new rigid laryngoscopes with a proximal view finder that reflects an image transferred from the distal tip of the blade through a series of lenses, prisms and mirrors. We report two cases of ankylosing spondylitis who were scheduled for total hip replacement and subtotal thyroidectomy and were successfully intubated using the Airtraq® laryngoscope.

Airtraq® Optical Laryngoscope for Tracheal Intubation in a Patient with Giant Lipoma at the Nape: a Case Report

BACKGROUND AND OBJECTIVES Lipoma is a progressively increasing disease which may appear anywhere in the body. Its appearance at the back of the neck, especially when it is large enough to cause restriction of neck extension, poses challenges to anesthesiologists in airway management whenever needed. This paper evaluates the role of Airtraq® in restricted neck movement. CASE REPORT Case with a huge lipoma of 14×12cm at the nape, and its surgical removal during an elective operation theatre posed difficulty in securing the airway by conventional laryngoscopy. To overcome the problem we successfully used a newly developed device, the Airtraq®, which is an optical laryngoscope for securing the airway. CONCLUSION Airtraq® can be used for elective intubation in patients with restricted neck movements.

Videolaringoscópio King Vision para contratura grave do pescoço após queimadura: uma experiência encorajadora

BACKGROUND AND OBJECTIVES Managing the airway of post burn contracture of the neck has always been challenging to anesthesiologists as it limits the alignment of oro-pharyngo-laryngeal axes because of functional and anatomical deformities that occur as a result of long standing contractures. Here the role of the King Vision video laryngoscope which is the latest in the series of video laryngoscope has been evaluated for such patients. CASE REPORT A 35 year old male patient with post burn contracture of neck was scheduled for release of the contracture. As the patient had had fixed flexion deformity of the neck we did not attempt the conventional laryngoscopy. Instead we opted for King Vision video laryngoscope. CONCLUSION We therefore conclude that King Vision videolaryngoscope can be used for difficult airway situations like post burn contracture of neck.

King vision video laryngoscope: A suitable device for severe ankylosing spondylitis

Abstract Ankylosing spondylitis is a chronic, autoimmune disease affecting the spine. Involvement of the cervical spine, atlanto occipital, temporomandibular and cricoarytenoid joints leads to difficulty in airway management and securing airway by conventional laryngoscopy. We report a case of severe ankylosing spondylitis with severe restriction in neck movements and limited mouth opening. Conventional laryngoscopy and endotracheal intubation was impossible in this patient as there was no movement at the atlanto-occipital join. So, we decided to use King Vision™ video laryngoscope for intubation which proved to be of great use.

Laringoscópio óptico Airtraq® para intubação traqueal em paciente com grande lipoma na nuca: relato de caso

JUSTIFICATIVA E OBJETIVOS: Lipoma e uma doenca de crescimento progressivo que pode surgir em qualquer parte do corpo. O seu aparecimento na parte de tras do pescoco, especialmente quando e grande o bastante para causar restricao do pescoco, principalmente da extensao, e um desafio para os anestesiologistas sempre que precisam manejar as vias aereas. Aqui, o papel do Airtraq® foi avaliado no movimento restrito do pescoco. RELATO DE CASO: Relatamos o caso de uma paciente selecionada para remocao cirurgica eletiva de um lipoma enorme na nuca, medindo 14 x 12 cm, que apresentou dificuldade para assegurar a permeabilidade das vias aereas por meio de laringoscopia convencional. Para resolver o problema, usamos com sucesso um dispositivo recentemente desenvolvido, o Airtraq®, que e um laringoscopio optico para assegurar a via aerea. CONCLUSAO: O Airtraq® pode ser usado para intubacao eletiva em pacientes com movimentos restritos do pescoco.

Successful tracheal intubation with Airtaq optical laryngoscope for severe ankylosing spondylitis

Ankylosing spondylitis is a chronic, autoimmune, and progressive spondyloarthropathy affecting the spine and sacroiliac joints.1 The cervical spine is involved late in the disease, leading to restriction of the neck movement and head rotation, making the alignment of the oral, pharyngeal, and laryngeal axes impossibleandresulting inpotentially difficult airway for tracheal intubation.2 The Airtraq (Prodol Ltd, Vizcaya, Spain) is a recently introduced airway device to facilitate tracheal intubation inpatientswith both normal and difficult airways. We describe two patients with severe ankylosing spondylitis who were successfully intubated using Airtraq laryngoscope (Prodol Ltd.). The first case was a 40-year-old male patient suffering from ankylosing spondylitis and who was scheduled for total hip replacement. Airwayassessment revealedarestrictedmouthopening,withMallampati grade IV viewand an interincisor gapof<2 cm.Neckmobilitywas restricted, and the thyromental distancewas<6.5 cm.X-rayof cervical spine showed fusion of the posterior elements at all levels. The second case, a 65-year-old female known to have ankylosing spondylitis, was planned for subtotal thyroidectomy. Airway examination revealed a restricted mouth opening, with Mallampatti grade III view, and an interincisor gap of <3 cm. Thyromental distance was <6 cm with severe limitation of neck movements. X-ray of cervical spine showed grossosteopeniawith complete fusionofposteriorelements, endplate sclerosis and decreased joint space at C4–C5 and C5–C6 levels. After obtaining written informed consent from the patients, assessment of difficult intubation was made and both patients were planned for general anesthesia. On the day of the surgery, the patients were premedicated with intravenous (i.v.) midazolam 2mg and intramuscular (i.m.) glycopyrrolate 0.2 mg. The patients were instructed to lie down in a supine positionwith the head supported by pillows, and all standard monitoring procedures were applied. A difficult airway cart was kept ready. Anesthesia was induced with i.v. fentanyl 1 mg/kg and i.v. propofol 2 mg/kg. After confirming adequate bag mask ventilation, neuromuscular relaxationwasmadepossiblewith1.5mg/kg succinylcholine given intravenously. The tablewas adjusted to the head down position with flexion of both knees. The blade of the optical laryngoscope was introduced into the oral cavity in the midline over the base of the tongue and the tip positioned in the vallecula. Tracheal intubation was performed successfully with standard-sized endotracheal tube (PVC) in the first attempt after an adequate visualization of the vocal cordswhich requiredminor adjustments of Airtraq laryngoscope and wrist movement. The intraoperative course in both