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Airway Scope: early clinical experience in 405 patients

The Airway Scope (Pentax, Tokyo, Japan) is a new device used for tracheal intubation. It allows visualization of the glottis through a non-line-of sight view. The aim of the present study was to evaluate the suitability of this device for the tracheal intubation of surgical patients. In this prospective study, the Airway Scope was used for the endotracheal intubation of 405 patients by 74 airway operators. The Airway Scope allowed visualization of the glottis in all 405 patients, including those with a Cormack-Lehane view of grade III (n = 15) or grade IV (n = 1) on Macintosh laryngoscopy. All tracheal intubations using the Airway Scope were successful. The mean time to complete tracheal intubation was 42.4 ± 19.7 s (±SD; range, 13–192 s). No dental damage was encountered, though minor mucosal injury caused by the blade was experienced in 2 patients. The Airway Scope consistently permitted a better intubation environment. With its potential advantages, the Airway Scope could be an effective aid to airway management in surgical patients.

Airtraq optical laryngoscope: tracheal intubation by novice laryngoscopists

Objective: To evaluate the performance of the Airtraq optical laryngoscope for tracheal intubation by novice laryngoscopists, compared with that of the Macintosh laryngoscope. Methods: Under supervision by staff anaesthetists, non-anaesthesia physicians performed tracheal intubation using either the Airtraq optical laryngoscope (n  =  100) or the Macintosh laryngoscope (n  =  100). The time required for airway instrumentation, the number of attempts until successful intubation and erroneous oesophageal intubation were investigated. Results: The time to secure the airway was shorter with the Airtraq optical laryngoscope than with the Macintosh laryngoscope (p<0.001). The number of attempts until successful intubation was smaller with the Airtraq optical laryngoscope than with the Macintosh laryngoscope (p<0.001). Erroneous oesophageal intubation was less with the Airtraq optical laryngoscope than with the Macintosh laryngoscope (p<0.01). Conclusion: The Airtraq optical laryngoscope reduces the time to secure the airway and the incidence of failed tracheal intubation by novice laryngoscopists.

The Airtraq® laryngoscope for placement of double-lumen endobronchial tube

Placement of a double-lumen endobronchial tube (DLT) is sometimes difficult due to the size and configuration of the tube compared with standard endotracheal tubes. For patients with difficult airways, DLT placement can be extremely challenging. The Airtraq® (Prodol, Meditec S.A., Vizcaya, Spain) laryngoscope is a new intubation device that provides a non-line-of sight view of the glottis. This anatomically shaped rigid laryngoscope has been reported to have several advantages, compared with the conventional Macintosh laryngoscope, in the management of normal and difficult airways. However, one limitation is that the regular-size Airtraq® laryngoscope accepts a standard endotracheal tube with an internal diameter between 7.0–8.5 mm only. We report here the successful placement of DLTs with the aid of the Airtraq® laryngoscope in surgical patients. This Article

Airtraq laryngoscope has an advantage over Macintosh laryngoscope for nasotracheal intubation by novice laryngoscopists

duration of the subsequent attempt was added to the time of the fi rst attempt to secure the airway. Patients in the two groups were comparable in age, weight, and height. Nasotracheal intubation was achieved in 65 ± 24 s (mean ± SD; range, 43–115 s) using Airtraq laryngoscopy, while it required a signifi cantly longer time, of 123 ± 70 s (range, 58–270 s) using Macintosh laryngoscopy with Magill forceps (P < 0.05; Student’s t-test). No patient in the Airtraq group experienced esophageal intubation, while one resident performed an esophageal intubation in the Macintosh group. The incorrect tube placement was identifi ed immediately and a staff anesthesiologist successfully established nasotracheal intubation. No patient experienced oxygen desaturation during laryngoscopy. Our study demonstrates that, in comparison with the Macintosh laryngoscope, the Airtraq laryngoscope provides superior intubation conditions for personnel who are training in airway management, resulting in less time to secure the airway. There are several potential advantages of the Airtraq laryngoscope for novice laryngoscopists. First, an unobstructed view of the glottis is easily secured without the alignment of the oral, pharyngeal, and laryngeal axes, allowing the operator to more quickly visualize the target to which the nasotracheal tube is being directed. Second, the anatomically shaped blade of the Airtraq laryngoscope distorts the anterior airway structures less than does the Macintosh laryngoscope. Reduced airway distortion can potentially create a more direct route from the nasopharynx to the tracheal inlet, necessitating less nasotracheal tube manipulation. In the present study, Magill forceps were not needed for any patient for nasotracheal intubation with Airtraq laryngoscopy. The use of the Airtraq lessens the chance of damage to the cuff of the tracheal tube caused by the grasping arms of the forceps. Finally, the Airtraq provides a display of the intubation procedure for both the laryngoscopist and the supervisor. The magnifi ed monitor view of the glottis is signifi cantly better compared with a direct laryngoscopic view and helps novice laryngoscopists to recognize the anatomical structure. It seems to be a safe and benefi cial approach for teaching and supervising tracheal intubation. The unobstructed view of the glottis helped the operator to complete the nasotracheal intubation while a supervisor provided instructions and suggestions to improve the coordinated effort. These factors may affect the time needed to successful intubation. Increasing evidence indicates that a non-line-of sight view provides a good condition for nasotracheal intubation [4,5]. Nasotracheal intubation in the present study was performed by nonanesthesia physicians, and it should be noted that the time to secure the airway would not apply to experienced opAirtraq laryngoscope has an advantage over Macintosh laryngoscope for nasotracheal intubation by novice laryngoscopists

Use of a new videolaryngoscope (Airway Scope) in the management of difficult airway.

A 63-year-old female (weight 39 kg; 150-cm tall) presented for elective hysterectomy because of carcinoma in situ. She had suffered from rheumatoid arthritis for 10 years. On examination, she had a class III Mallampati view and a thyromental distance of 5 cm. Anesthesia was induced with fentanyl, propofol, and vecuronium following oxygenation. Macintosh laryngoscopy, performed by a supervisor, revealed the glottic opening was C-L grade III. A non-anesthesia resident, after having received 2 months of training, inserted the AWS, and C-L grade I glottic exposure was easily obtained. The tracheal intubation procedure was completed in 23 s. The AWS has a built-in charge-coupled device (CCD) camera and light-emitting diode (LED) attached to its tip. The image is transmitted to a 2.4-inch liquid crystal display (LCD) color monitor built at the top of the hand grip (Fig. 1A). This built-in monitor screen has a wide viewing angle and is readily visible both from behind and from the side of the scope. The curved-shaped blade has a side channel which acts as a housing for the placement and insertion of the tracheal tube. Once the target signal shown on the monitor has been aligned with the glottic opening (Fig. 1B), the tracheal tube is passed through the vocal cords and held in place, and the device is removed. A view of the glottis and tracheal tube is maintained throughout the intubation process and the tracheal tube does not obstruct the view of the vocal cords (Fig. 1C). There are several potential advantages of the AWS, in comparison with conventional rigid fi beroptic laryngoscopes and/ or fl exible fi beroptic bronchoscopes. First, the AWS seems easier to use than the conventional fi beroptic endoscopes, which generally require a signifi cant amount of experience to achieve profi ciency. The operators reported here were both residents who had no prior experience of performing tracheal intubation with the AWS. A short demonstration of the AWS device was the only requirement for successful intubations. Second, the high-resolution CCD camera provides an excellent view of the airway with a wide-angle view of the glottis Use of a new videolaryngoscope (Airway Scope) in the management of diffi cult airway

Awake intubation using the Airway Scope.

tracheal tubes were inserted smoothly at the fi rst attempt, without complications. Based on our experience, the Airway Scope seems suitable for awake intubation. The non-line-of sight view of the glottis is expected to minimize the extension of the neck and need for excessive force, causing less stress to the patient, compared with direct laryngoscopy with the Macintosh blade. The Airway Scope is signifi cantly robust compared with the fi beroptic bronchoscope; hence, the easy maneuverability and less susceptibility to damage. Further clinical studies are warranted to confi rm these positive fi ndings.