Awake intubation with the Pentax Airway Scope

Evidence for benefit vs novelty in new intubation equipment

“…Several of these devices have a high intubation success rate in this clinical scenario [22][23][24]. ................................................................................................................................................................................................................... Ó 2011 The Authors (d) New intubation equipment has been used successfully in awake intubation in patients with known difficult airways [29][30][31][32][33][34][35][36]. However, flexible optical scopes remain the gold standard in this patient population [42].…”

“…Many of the new intubation devices have been used successfully to perform awake intubation [29][30][31][32][33][34][35][36]. Combined use of a flexible optical scope and another new device has also been described [33].…”

‘From darkness into light’: time to make awake intubation with videolaryngoscopy the primary technique for an anticipated difficult airway?

“…The insertion and subsequent manipulation of the videolaryngoscope blade relies on the pre-existence of a space within the airway; they may not, for instance, be appropriate in patients with limited mouth opening (Kramer et al excluded patients with a mouth opening < 14 mm). This limit is extended to 18 mm [31] or 25 mm [9] when using videolaryngoscopes with a tube channel. In addition, in patients with a space-occupying lesion within the oral cavity or pharynx, insertion of the videolaryngoscope blade into the airway is likely to be difficult or impossible.…”

“…For example, videolaryngoscopes with a Macintosh-like curved blade without a tube channel (such as the C-MAC D-blade used in Kramer et al's study) are quite likely to require some form of airway adjunct, such as a stylet [2,11], tracheal tube introducer [35,36] or fibrescope [6] to aid tracheal tube placement. On the other hand, videolaryngoscopes with a tube channel, such as the Pentax Airway Scope â and Airtraq â optical laryngoscope, are more commonly used without the need of an airway adjunct [9,10,13,37]. Although there is a suggestion that a videolaryngoscope with a tube guide may offer a few advantages over videolaryngoscopes with an anatomically shaped blade but no tube guide [38], the evidence is lacking on the most appropriate type of videolaryngoscope for awake intubation.…”

“…This trend is further illustrated by the application of videolaryngoscopes. There have been a number of case reports [5][6][7][8][9][10] but very few studies [2,11] looking at this technique. The use of a videolaryngoscope to facilitate an awake oral or nasal intubation has been shown to be of benefit in patients with a predicted difficult airway [5][6][7][8][9][10], in the obese [2,12], and in patients with peri-glottic tumours [10,13], but Kramer et al's study is the first to compare awake fibreoptic with videolaryngoscope-assisted nasal intubation.…”