Performance of the Airtraq™ laryngoscope after failed conventional tracheal intubation: a case series

Background: The Airtraq^™, a new disposable indirect laryngoscope, was evaluated in patients with difficult intubation.
Methods: The Airtraq^™ was used in 47 patients with predicted or unpredicted difficult intubation after failed orotracheal intubation performed by two senior anaesthesiologists with the Macintosh laryngoscope.
Results: Tracheal intubation with Airtraq^™ was successful in 36 patients (80%). The Cormack and Lehane score was IIb–III in 35 patients, and IV in 12 patients, with the Macintosh laryngoscope, while Cormack and Lehane score was I–IIa in 40 patients, IIb–III in three and IV in four with Airtraq^™. A gum elastic bougie was used to facilitate tracheal access in one-third (11/36) of the cases. Orotracheal intubation was not possible with Airtraq^™ in nine cases, five of whom had a pharyngeal, laryngeal or basal lingual tumour.
Conclusion: In patients with difficult airway, following failed conventional orotracheal intubation, Airtraq^™ allows securing the airway in 80% of cases mainly by improving glottis view. However, the Airtraq^™ does not guarantee successful intubation in all instances, especially in case of laryngeal and/or pharyngeal obstruction.     

Comparison of the Glidescope® and Airtraq® optical laryngoscopes in patients undergoing direct microlaryngoscopy

Optical laryngoscopes have been developed to facilitate difficult airway management. The Airtraq^® is a single-use device and the GlideScope^® is reusable. In this study, the Airtraq and the Glidescope were compared in 60 ASA I-III patients with tumours of the upper airway undergoing direct endoscopic microlaryngoscopy. Patients were randomly assigned to the Airtraq or the Glidescope group and the Cormack and Lehane grade was assessed by Macintosh laryngoscopy prior to tracheal intubation. There were no differences in tracheal intubation success rates or duration of intubation attempts between both devices. The Cormack and Lehane grade was improved in 77% and 82% of cases in the Airtraq and Glidescope group, respectively. Blood traces on the device and traumatic pharyngeal lesions were found more frequently in the Airtraq group. The Airtraq and Glidescope laryngoscopes are valuable tools for the management of patients with potentially difficult airways with the Glidescope appearing to be less traumatic.     

The new air-QTM intubating laryngeal airway for tracheal intubation in children with anticipated difficult airway: a case series

The air-Q intubating laryngeal airway (ILA) is a new supraglottic airway device which may overcome some limitations inherent to the classic laryngeal mask airway for tracheal intubation. We present a case series of patients with anticipated difficult airway in whom the air-Q ILA was successfully used as a conduit for fiberoptic intubation.     

The difficult paediatric airway: a new method of intubation using the laryngeal mask airway™, Cook® airway exchange catheter and tracheal intubation fibrescope

We describe a new technique of intubation for use in difficult paediatric airway cases utilizing the laryngeal mask airway, a Cook Airway Exchange Catheter and a paediatric intubation fibrescope. This method has a number of potential advantages over previously described methods.     

Optimising tracheal intubation success rate using the Airtraq laryngoscope

In this study we have used a video-recording, retrospective analysis technique to evaluate the influence of the Airtraq^™ 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.     

Failed tracheal intubation using a laryngoscope and intubating laryngeal mask

PURPOSE: To report unexpected failed tracheal intubation using a laryngoscope and an intubating laryngeal mask, and difficult ventilation via a facemask, laryngeal mask and intubating laryngeal mask, in a patient with an unrecognized lingual tonsillar hypertrophy. CLINICAL FEATURES: A 63-yr-old woman, who had undergone clipping of an aneurysm seven weeks previously, was scheduled for ventriculo-peritoneal shunt. At the previous surgery, there had been no difficulty in ventilation or in tracheal intubation. Her trachea remained intubated nasally for 11 days after surgery. Preoperatively, her consciousness was impaired. There were no restrictions in head and neck movements or mouth opening. The thyromental distance was 7 cm. After induction of anesthesia, manual ventilation via a facemask with a Guedel airway was suboptimal and the chest expanded insufficiently. At laryngoscopy using a Macintosh or McCoy device, only the tip of the epiglottis, but not the glottis, could be seen, and tracheal intubation failed. There was a partial obstruction during manual ventilation through either the intubating laryngeal mask or conventional laryngeal mask; intubation through each device failed. Digital examination of the pharynx, after removal of the laryngeal mask, indicated a mass occupying the vallecula. Lingual tonsillar hypertrophy (1 x 1 x 2 cm) was found to be the cause of the failure. Awake fibrescope-aided tracheal intubation was accomplished. CONCLUSIONS: Unexpected lingual tonsillar hypertrophy can cause both ventilation and tracheal intubation difficult, and neither the laryngeal mask nor intubating laryngeal mask may be helpful in the circumstances.     

A comparison of the ease of tracheal intubation using a McGrath MAC® laryngoscope and a standard Macintosh laryngoscope

We compared the McGrath MAC^® videolaryngoscope when used as both a direct and an indirect laryngoscope with a standard Macintosh laryngoscope in patients without predictors of a difficult tracheal intubation. We found higher median Intubation Difficulty Scores with the McGrath MAC as a direct laryngoscope, 1 (0–3 [0–5]) than when using it as an indirect videolaryngoscope, 0 (0–1 [0–5]) or when using the Macintosh laryngoscope, 0 (0–1 [0–5]), p = 0.04. This was mirrored in the subjective user reporting, scored out of 10, of difficulty for each method 3.0 (2.0–3.4 [0.5–80]); 2.0 (1.0–3.9 [0–70]) and 2.0 (1.0–3.3 [0–70]), respectively (p = 0.01). This difficulty is in part explained by the poorer laryngeal views recorded using the Cormack and Lehane classification system (p < 0.001) and reflected in the higher than normal operator force required (25%, 4%, 8% for each method, respectively, p < 0.001) and the increased use of rigid intubation aids (21%, 6%, 2%, respectively, p < 0.001). There was no difference between the groups in time taken to intubate or incidence of complications. There was no statistical difference in the performances as measured between the McGrath MAC used as an indirect videolaryngoscope and the Macintosh laryngoscope. We cannot recommend that the McGrath videolaryngoscope be used as a direct laryngscopic device in place of the Macintosh.     

Evaluation of the GlideScope® for tracheal intubation in patients with cervical spine immobilisation by a semi-rigid collar

Application of cervical collars may reduce cervical spine movements but render tracheal intubation with a standard laryngoscope difficult if not impossible. We hypothesised that despite the presence of a Philadelphia Patriot^® cervical collar and with the patient's head taped to the trolley, tracheal intubation would be possible in 50 adult patients using the GlideScope^® and its dedicated stylet. Laryngoscopy was attempted using a Macintosh laryngoscope with a size 4 blade, and the modified Cormack–Lehane grade was scored. Subsequently, laryngoscopy with the GlideScope was graded and followed by tracheal intubation. All patients' tracheas were successfully intubated with the GlideScope. The median (IQR) intubation time was 50 s (43–61 s). The modified Cormack–Lehane grade was 3 or 4 at direct laryngoscopy. It was significantly reduced with the GlideScope (p < 0.0001), reaching grade 2a in most patients. Tracheal intubation in patients wearing a semi-rigid collar and having their head taped to the trolley is possible with the help of the GlideScope.     

Awake tracheal intubation through the intubating laryngeal mask

PURPOSE: To report successful awake insertion of the intubating laryngeal mask (Fastrach) and subsequent tracheal intubation through it, in a patient with predicted difficult tracheal intubation, due to limited mouth opening, and difficult ventilation through a facemask, due to a large mass at the corner of the mouth. CLINICAL FEATURES: A 53-yr-old woman with a large post-gangrenous mass on the right cheek to the angle of the mouth was scheduled for its resection. The right side of her face was damaged by a bomb attack followed by cancrum oris 50 yr ago. The distance between the incisors during maximum mouth opening was 2 cm and that between the gums on the right side < 1 cm. After preoxygenation and 50 micrograms fentanyl and 30 mg propofol i.v., propofol was infused at 2 mg.kg-1.hr-1. Lidocaine, 8%, was sprayed on the oropharynx. A #4 intubating laryngeal mask was inserted with a little difficulty. A fibrescope was passed through a 7.5-mm ID RAE tracheal tube, and the combination was easily passed through the laryngeal mask into the trachea. General ansthesia was then induced. Finally, the intubating laryngeal mask was removed, while the RAE tube was being stabilized using an uncuffed 6.0-mm ID tracheal tube. CONCLUSION: Awake tracheal intubation through the intubating laryngeal mask is a useful technique in patients with limited mouth opening in whom ventilation via a facemask is expected to be difficult.