Evaluation of the Airtraq^® and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation*

Abstract

SummaryThe Airtraq Ò , a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope. The Airtraq Ò (Prodol Meditec S.A., Vizcaya, Spain) is a new single use laryngoscope designed to facilitate tracheal intubation in patients with both normal and difficult upper airway anatomy. As a result of the exaggerated curvature of the blade and an internal arrangement of optical components, a view of the glottis is provided without alignment of the oral, pharyngeal and tracheal axes. Our group has recently demonstrated that the performance of the Airtraq is superior to that of the Macintosh laryngoscope in patients at low risk for difficult intubation [1], and in patients undergoing simulated cervical immobilisation by means of manual in-line axial stabilisation [2]. The Airtraq also produced less haemodynamic stimulation in these patients, a potentially important advantage in certain clinical situations [1,2]. In manikin studies, the Airtraq performs better than the Macintosh laryngoscope in the simulated difficult airway when used by experienced [3], inexperienced [4] and even novice [5] laryngoscopists. Recent reports have highlighted the utility of the Airtraq in a number of difficult airway settings, including post traumatic asphyxia [6], in morbid obesity [7], and following failed conventional approaches to tracheal intubation [8].The purpose of this study was to evaluate the usefulness of this new device for use by experienced anaesthetists in a randomised controlled trial of patients at increased risk for difficult intubation. We hypothesised that, in comparison with the Macintosh laryngoscope, the use of the Airtraq would be result in reduced laryngoscopy times, lower intubation difficulty scale (IDS) scores, and reduced haemodynamic stimulation following intubation. Data relating to four of the patients included in this study that were not successfully intubated with the Macintosh laryngoscope ...

Innovations in anesthesia education: the development and implementation of a resident rotation for advanced airway management

“…17 Forty patients who possessed C3 characteristics indicating an increased risk for difficult intubation were randomly assigned to undergo intubation using a DL (n = 20) or AT (n = 20) laryngoscope. Intubation was performed by anesthetists experienced in the use of both laryngoscopes.…”

Comparison of two methods of gum elastic bougie aided endotracheal intubation using Airtraq® video laryngoscope

“…Airtraq ® provides superior intubating conditions than conventional direct laryngoscopes by providing better glottic view with minimal head and neck movement. 12 In spite of better glottic view, intubation using Airtraq ® may not always be successful although it reduces intubation time. 13,14 GEB when used along with Airtraq ® aids in intubation and prevents repeated attempts.…”

Comparison between the Airtraq, X-Lite, and direct laryngoscopes for thyroid surgery: a randomized clinical trial

“…27 Dans une autre étude incluant des patients avec des critères prédictifs d'intubation difficile, l'Airtraq a permis de réduire le temps d'intubation, le recours aux manoeuvres alternatives et la difficulté d'intubation. 28 Dans cette étude, il y a eu quatre échecs d'intubation avec le laryngoscope standard, qui ont été convertis en succès grâce à l'Airtraq. D'autres études ont montré l'efficacité de l'Airtraq en tant que dispositif de secours après échec du laryngoscope standard.…”

“…Cet avantage de l'Airtraq a été reconnu dans plusieurs études, avec moins de recours aux manoeuvres alternatives. 14,27,28 Dans notre série, l'Airtraq a permis une meilleure stabilité hémodynamique que le X-Lite et le laryngoscope standard. Les faibles niveaux de pression appliqués sur la langue et la mandibule 37 et surtout l'absence de nécessité d'alignement des trois axes 38 expliquent le retentissement hémodynamique moindre de ce dispositif.…”