Use of the Airtraq by inexperienced physicians supervised during a series of tracheal intubation in adult patient with anticipated difficult airway

Introduction

The Airtraq^® optical laryngoscope (Vygon, Écouen, France) is a new intubation device designed to provide a view of the glottis without alignment of the oral, pharyngeal and laryngeal axes. In recent literature, the efficiency of the Airtraq^® even in difficult intubation and its short learning curve were characterized. The goal of our study is to evaluate Airtraq™ efficiency when use by inexperienced physicians in anticipated difficult intubation adult patients.

Methods

The patients showing at least one of the four difficult intubation predictors (history of difficult intubation, thyromental distance less than 60 mm, mouth opening less than 35 mm and Mallampati class 3 or 4 were included. Before induction of anaesthesia, the inexperienced physicians participating the study received a short oral formation on the use of the Airtraq^®. For each intubation manoeuvres, the participant were supervised by an expert in Airtraq^® handling. The Cormack and Lehane grade of direct laryngoscopy view, the duration times to best glottis view and to intubate the trachea, the success or failure of tracheal intubation, the drop in arterial oxygen saturation of below 95%, the need for external manipulation, and the difficulties met by the operators were noted.

Results

Twenty patients were included over a month period. Thirteen had a history of difficult intubation, eight a thyromental distance less than 60 mm, nine a mouth opening less than 35 mm and 12 patients were classified as Mallampati IV. The success rate of tracheal intubation with the Airtraq^® laryngoscope was 80%. Times to best glottis view and to complete tracheal intubation were 28 and 47 s, respectively. Four tracheal intubation failures were encountered. The LMA Fastrach^® and the flexible fiberoscope were used respectively in one and three patients.

Discussion

In the majority of the cases, the insertion of the Airtraq^®, the visualization of the glottis and the subsequent intubation were easy and rapid, without arterial oxygen desaturation. However, the four tracheal intubation failures associated with prolonged tracheal intubation times in some patients highlight the fact that the Airtraq^® laryngoscope requires a clinical training process particularly in case of anticipated difficult airway management situations.