The Management of Difficult Direct Laryngoscopy and Intubation in a Field Hospital: An Alternative to Fibreoptic Endoscopy

Abstract

Fibreoptic endoscopy and intubation continues to be recommended in guidelines for the management of difficult airways. Since fibrescopes are unavailable within United Kingdom field hospitals, an alternative is needed. The Airtraq optical laryngoscope is a versatile, inexpensive, single-use option, which could readily fill this void. It is easy to use and provides a full view of the glottis when direct laryngoscopy has failed. Its introduction will reinforce existing difficult airway equipment and simplify the management of 'can ventilate - can't intubate' patients.

Airway Management at Floor Level: A Comparison of Tracheal Intubation using the Macintosh and Airtraq Laryngoscopes

“…When used by trained practitioners the Airtraq could improve and simplify tracheal intubation in the pre-hospital environment. The Airtraq has many favourable characteristics and its introduction may usefully supplement existing airway management equipment [3,4,10].…”

“…Given its potential ease of use and advantages over direct laryngoscopy [4], patient-based randomised controlled trials evaluating the Airtraq laryngoscope should be conducted in both military and civilian pre-hospital environments. …”

“…Visualising the vocal cords using the Macintosh laryngoscope, whilst the patient is on the floor, can be a challenge even for experienced practitioners, especially when the cervical spine is immobilised or when access to the head or floor space is limited [3]. The Airtraq laryngoscope (Prodol Meditec SA., Vizcaya, Spain) does not require a direct line of sight [4] to obtain an adequate view of the glottis and surrounding structures (Fig 1). It has been used successfully following failed direct laryngoscopy in patients with suspected difficult airways [5,6] and as an alternative to fibreoptic endoscopy in both anaesthetised and awake patients [7,8].…”

Is Airtraq Video Laryngoscope a Better Alternative to Conventional Macintosh Direct Laryngoscope During Routine Intubation? A Comparative Study

“…1 The curved laryngoscope blade described by Macintosh remains the most widely used device to facilitate tracheal intubation. 2 Intubation situations can be managed by the use of newer type of video laryngoscopes, one such is Airtraq.…”

“…The Airtraq differs in many ways from the conventional Macintosh laryngoscope and is suiTable scope for managing anticipated/unanticipated difficult airway situations. 1 The Airtraq is designed to allow visualization of the glottis without alignment of the oral, pharyngeal, and laryngeal axes. Use of the Airtraq does not require displacement of the tongue and forceful elevation of the epiglottis resulting in less application of force compared with the conventional direct laryngoscopy.…”