Complications after using the Airtraq laryngoscope for a predicted difficult intubation

Abstract

Although standard management of an expected difficult intubation is based on fibre-optic techniques, the application of optical laryngoscopes such as Airtraq is gaining widespread acceptance. We here describe a case where an intubation attempt with the Airtraq laryngoscope was not only unsuccessful, but negatively influenced subsequent use of a flexible fibroscopic approach. caSe RepoRtA 52 year-old female patient (ASA 3) was scheduled for cervical laminectomy in a prone position. She had a long history of rheumatoid arthritis that had led to compression of the spinal cord and progressive neurological deterioration. She had symptoms of imminent tetraparesis: decreased muscle strength, especially in the lower limbs, and paresthesiae in the upper extremities. She had been treated with steroids and methotrexate without improvement. A distinct retrosternal thyroid goitre precluded an anterior approach to the cervical spine, and a posterior approach was chosen.The patient's medical history included a failed tracheal intubation six years before. A minor gynaecological procedure was then completed with bag and mask ventilation. Physical examination revealed multiple predictors of difficult tracheal intubation. The cervical spine was almost completely immobilised in flexion (Fig. 1). The chin was withdrawn and the mouth opening was limited to 2.2 cm. Upper incisors were protruding and the left one was missing. The thyromental distance was 7 cm and visibility of the posterior pharyngeal wall was recognised as the fourth Mallampati class. The hyoid bone and the larynx were not immobilised, however slight clicks within the soft tissues of the neck were felt during palpation. The trachea was not deviated. Chest X-ray did not reveal deviation or tracheal stenosis.The patient had agreed to an intubation attempt with an Airtraq (Prodol Meditec S.A., Vizcaya, Spain) laryngoscope under topical airway anaesthesia and sedation. As a 'Plan B' , according to Difficult Airway Society guidelines [1] we chose oral fibre-optic intubation under sedation.After premedication with 15 mg of midazolam orally, the patient was brought to the operating suite and standard monitoring was begun. The tongue and throat were topi-

The King Vision™ video laryngoscope for awake intubation: series of cases and literature review

“…However, unexpected complications, such as extensive bleeding, may occur when using the video laryngoscope for awake intubation. 20 …”