Anaesthesia, 2008, 63, pages 182–188 doi:10.1111/j.1365-2044.2007.05316.x ......
APPARATUS Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation*
C. H. Maharaj,1 J. F. Costello,1 B. H. Harte2 and J. G. Laffey3
1 Research Fellow in Anaesthesia, 2 Consultant Anaesthetist, 3 Professor of Anaesthesia and Consultant Anaesthetist, Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland
Summary The Airtraq , a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.
...... Correspondence to: Prof. J. G. Laffey E-mail: [email protected] *This paper has been presented in part at the Western Anaesthesia Symposium, Galway, Ireland, April 2007. Accepted: 20 August 2007
The Airtraq (Prodol Meditec S.A., Vizcaya, Spain) is a even novice [5] laryngoscopists. Recent reports have new single use laryngoscope designed to facilitate tracheal highlighted the utility of the Airtraq in a number of intubation in patients with both normal and difficult difficult airway settings, including post traumatic asphyxia upper airway anatomy. As a result of the exaggerated [6], in morbid obesity [7], and following failed conven- curvature of the blade and an internal arrangement of tional approaches to tracheal intubation [8]. optical components, a view of the glottis is provided The purpose of this study was to evaluate the usefulness without alignment of the oral, pharyngeal and tracheal of this new device for use by experienced anaesthetists in axes. Our group has recently demonstrated that the a randomised controlled trial of patients at increased risk performance of the Airtraq is superior to that of the for difficult intubation. We hypothesised that, in com- Macintosh laryngoscope in patients at low risk for difficult parison with the Macintosh laryngoscope, the use of the intubation [1], and in patients undergoing simulated Airtraq would be result in reduced laryngoscopy times, cervical immobilisation by means of manual in-line axial lower intubation difficulty scale (IDS) scores, and reduced stabilisation [2]. The Airtraq also produced less haemo- haemodynamic stimulation following intubation. Data dynamic stimulation in these patients, a potentially relating to four of the patients included in this study that important advantage in certain clinical situations [1, 2]. were not successfully intubated with the Macintosh In manikin studies, the Airtraq performs better than the laryngoscope have previously been published as part of Macintosh laryngoscope in the simulated difficult airway a series of cases of failed tracheal intubations rescued with when used by experienced [3], inexperienced [4] and the Airtraq laryngoscope [8].