Background: The Airtraq™, a new disposable indirect laryngoscope, was evaluated in patients with difficult intubation. Methods: The Airtraq™ was used in 47 patients with predicted or unpredicted difficult intubation after failed orotracheal intubation performed by two senior anaesthesiologists with the Macintosh laryngoscope. Results: Tracheal intubation with Airtraq™ was successful in 36 patients (80%). The Cormack and Lehane score was IIb–III in 35 patients, and IV in 12 patients, with the Macintosh laryngoscope, while Cormack and Lehane score was I–IIa in 40 patients, IIb–III in three and IV in four with Airtraq™. A gum elastic bougie was used to facilitate tracheal access in one‐third (11/36) of the cases. Orotracheal intubation was not possible with Airtraq™ in nine cases, five of whom had a pharyngeal, laryngeal or basal lingual tumour. Conclusion: In patients with difficult airway, following failed conventional orotracheal intubation, Airtraq™ allows securing the airway in 80% of cases mainly by improving glottis view. However, the Airtraq™ does not guarantee successful intubation in all instances, especially in case of laryngeal and/or pharyngeal obstruction.

Background There is no defined gold standard for pain management after video-assisted thoracic surgery (VATS) for pneumothorax. In addition to systemic analgesia, various loco-regional analgesic techniques have been proposed but remain poorly evaluated in this context. We aimed to assess the analgesic efficacy of several of these techniques for the management of postoperative pain. Methods We conducted a monocentric prospective observational cohort study from February 2017 to April 2018 in patients suffering from spontaneous pneumothorax and scheduled for VATS ( n = 59). Patients received systemic analgesia (i) alone ( n = 15); (ii) combined with a continuous paravertebral block ( n = 9); (iii) combined with a continuous serratus plane block ( n = 19); or (iv) single-shot serratus plane block ( n = 16) as decided by the attending physician. Pain scores and analgesic-related side effects were prospectively collected by an independent observer during the first postoperative 72 h. The primary endpoint criterion was the cumulative oral morphine consumption at the end of the third postoperative day. Statistical analysis used univariate and multivariate step-by-step forward logistic regression models to determine risk factors associated with the main criteria. Results Mean pain scores and morphine consumption were not significantly different between the 4 groups. In the multivariate analysis, the use of a continuous serratus plane block through a catheter was the only technique associated with a reduced incidence of high-dose oral morphine consumption (OR 0.09–95%CI [0.01–0.79], p = 0.03). Conclusion This study suggests that serratus plane block combined with continuous infusion through a catheter may have some benefits, although further studies are needed to confirm these results and determine the true place of the serratus plane block in pain management after VATS for pneumothorax.

Double-lumen intubation is commonly used for thoracic surgery as it allows rapid and effective one-lung ventilation. However, it is more difficult than single-lumen tube intubation, notably in the context of emergency surgery and/or in hypoxemic patients. We report the case of a 57-year-old patient requiring emergency revision surgery after an upper right lobectomy due to postoperative pneumothorax and pleuropneumonia. As rapid lung isolation was required due to a bronchopleural fistula, rapid sequence induction and double-lumen tube intubation were performed. In addition, as the patient was hypoxemic with incomplete pre-oxygenation and too uncomfortable to tolerate the recumbent position despite high-flow oxygen, intubation was performed in face-to-face position. The patient was successfully intubated in 22 seconds and the right lung immediately isolated, allowing the surgeon to clean the pleural cavity. This is the first report of a double-lumen tube intubation in face-to-face position. The expected difficulties related to this type of intubation were successfully prevented using an Airtraq laryngoscope. Although such a strategy cannot be recommended from this one case, this report is encouraging for future studies evaluating the potential advantages of Airtraq use for double-lumen face-to-face intubation for emergency thoracic surgery.