Optimising tracheal intubation success rate using the Airtraq laryngoscope

Abstract

SummaryIn this study we have used a video-recording, retrospective analysis technique to evaluate the influence of the Airtraq TM laryngoscope manipulations and the resulting changes in position of the glottic opening and inter-arytenoids cleft, on the success rate of tracheal intubation. The video recordings of the internal views of 109 tracheal intubation attempts, in 50 anaesthetised patients were analysed. We demonstrated that successful tracheal intubation using the Airtraq laryngoscope require the glottic opening to be centred in the view, and positioning the inter-arytenoid cleft medially below the horizontal line in the centre of the view. We also demonstrated that repositioning of the Airtraq laryngoscope following a failed tracheal intubation attempt required the performance of a standard series of manoeuvres. The Airtraq TM laryngoscope (Fannin (UK) Ltd, Calcot, Reading, UK) is a novel, single use, optical laryngoscope which has been shown to improve the ease of intubation in patients with normal and difficult airways [1][2][3]. Although, the Airtraq laryngoscope produces a reduction in the time required for tracheal intubation in most patients with difficult airways, tracheal intubation on the first attempt, may not always be successful [4,5]. In obese patients a clear view of the glottic opening can rapidly be obtained following insertion. However, tracheal intubation, may fail, requiring repositioning of the Airtraq laryngoscope in the pharynx prior to a further intubation attempt subsequently being successful. The manipulations frequently required are a lowering of the position of the glottis within the view.To investigate this, we analysed the influence of the position of the glottic opening and the inter-arytenoid cleft position in the laryngeal view, on the success rates of tracheal intubation, and described the repositioning of the Airtraq laryngoscope required to succeed, following a failed tracheal intubation attempt. MethodsThe Ethics Review Board approved this trial and written informed consent was obtained from each patient for filming and recording of the airway management technique used.The study was based on a retrospective analysis of videos recorded in the operating theatre during the airway management of elective patients using the Airtraq laryngoscope. The videos were of internal views of the larynx and external recordings. All airway management techniques were performed in anaesthetised patients, who had received neuromuscular blockade, by senior anaesthetists providing anaesthesia for patients in the morbid obesity and gynaecological units.External films of tracheal intubation were performed by an assistant using a standard video-camera and internal views were automatically recorded using the videocapture system (Vygon, É couen, France).All recorded films were converted to a similar 20 images per second format and transferred to a computer for image analysis. External and internal video recordings were synchronised. We then analysed the internal recordings of 50 patients' trachea...

Education in airway management

“…Practitioners teach themselves, without applying best practice [18]. This can lead to poor techniques and harm to patients [31,32]. Educators need to improve training in airway management while practitioners' skills need to be diversified to an adequate level of expertise without harming patients.…”

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

“…Dhonneur G et al in their study described manoeuvres involving the Airtraq tip (downward, backward and upward movement) to increase the success of intubation. 9 In our study, all intubation was performed by the single experienced consultant and a wireless monitor was used for intubation which could be considered as merits of the study.…”

“…[2][3][4][5][6][7][8] Failed intubation using Airtraq ® may be encountered owing to difficulty or inability to manipulate the endotracheal tube (ETT) tip across the glottis. 9 Gum elastic bougie (GEB) can be used as a rescue device in such cases. 10,11 The Airtraq ® can be preloaded with the ETT with the GEB placed inside it till the tip and the entire assembly is passed en bloc into the mouth.…”

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

“…L'insertion de la sonde dans la trachée était réalisée avec la glotte située au centre de la vision optique et l'échancrure interaryténoïdienne en dessous. 21 Après intubation, l'opérateur écartait le tube d'intubation latéralement, en le maintenant dans sa position trachéale et 23 basée sur sept items, et par une échelle visuelle analogique (0: facilité maximale, 10: difficulté maximale) exprimée par les opérateurs après l'intubation. L'IDS était ensuite classée en trois grades: facile (score = 0), difficulté légère (score de 1 à 5) et difficulté modérée ou importante (score [ 5).…”