Pentax-AWS airway Scope as an alternative for awake flexible fiberoptic intubation of a morbidly obese patient in the semi-sitting position

Abstract

For anesthesia induction in a morbidly obese patient with a full stomach, awake flexible fiberoptic bronchoscope (FOB) intubation in the semi-sitting position may be a suitable choice. A new rigid indirect videolaryngoscope, the Pentax-AWS system, has a unique feature of an adjustable built-in monitor and is designed to be used in patients in various positions. However, the efficacy of its use in such situations has not been investigated or reported. We used the Pentax-AWS system for the intubation of a morbidly obese patient (body mass index >50) who was at risk of regurgitation, anticipated difficult intubation, and supine hypotensive syndrome due to inferior vena cava compression by a huge ovarian cyst. The patient was placed in the sitting position during the intubation procedure. The patient's trachea was intubated with the Pentax-AWS by an anesthesiologist positioned at the patient's right and facing her. The Pentax-AWS offered easy intubation under good visualization of the glottic aperture as a consequence of its adjustable integrated monitor, in contrast to difficult intubation with other videolaryngoscopes which require an external monitor. This report illustrates that the Pentax-AWS is useful as an alternative for flexible fiberoptic intubation under these circumstances, as a consequence of its adjustable built-in monitor and integrated tube channel.

Evaluation of tracheal intubation in several positions by the Pentax-AWS Airway Scope: a manikin study

“…Because the video image can be seen from various angles by adjusting the position of the display screen, it is theoretically unnecessary for the rescuer to stand close to the patient's head [5,14]. Application of the AWS in a face-to-face approach with the patient in a sitting position has been reported in morbidly obese patients and in patients with bilateral giant thyroid tumors [15,16]. In our study, time to intubation with the AWS was significantly different with the manikin in the different patient positions, but all intubations performed by the non-anesthesia residents participating in the study were successful.…”

The videolaryngoscope is less traumatic than the classic laryngoscope for a difficult airway in an obese patient

“…The manufacturers of other videolaryngoscopes (GlideScope, Verathon, WA, USA and Mc.Grath Series 5, Aircraft Medical, Edinburgh, UK) advocate midline insertion and the use of a styletted endotracheal tube. Both the Airway Scope (Pentax-AWS system; AWS; Pentax, Tokyo, Japan) and the Airtraq (ATQ; Prodol Meditec, Vizcaya, Spain) are anatomically shaped rigid indirect videolaryngoscope intubation devices with an adjustable built-in monitor; both devices provide an indirect view of the glottis without requiring the laryngoscope's line of sight [17][18][19]. These devices use a tube channel in the right side of the blade which holds the endotracheal tube and directs it towards the vocal cords.…”

Awake videolaryngoscopy‐assisted tracheal intubation of the morbidly obese

“…Videolaryngoscopy has been shown to be useful for awake tracheal intubations [3], and for tracheal intubation in morbidly obese patients after induction of anaesthesia [4]. Case reports exist of videolaryngoscopy being used to facilitate awake tracheal intubation in morbidly obese patients [5,6], but this technique has not been evaluated systematically and its overall success rate is unknown. The present study was undertaken to assess prospectively the efficacy of awake tracheal intubation assisted by videolaryngoscopy in morbidly obese patients scheduled for laparoscopic bariatric surgery.…”