Comparison of haemodynamic response to tracheal intubation with two different videolaryngoscopes: A randomized clinical trial

Abstract Background: Endotracheal intubation (ETI), which is the gold standard in coronary artery bypass grafting (CABG), may cause myocardial ischaemia by disturbing the balance between haemodynamic changes and oxygen supply and consumption of the myocardium as a result of sympathetic stimulation. In this study, we aimed to compare two different videolaryngoscopes (C-MAC and Airtraq) in the hemodynamic response to ETI. Methods: Fifty ASA II-III CABG surgery patients were randomly assigned to C-MAC or Airtraq. The hemodynamic data included arterial blood pressure [systolic (SAP), diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at six different points in time: before laryngoscopy-T1, during laryngoscopy-T2, immediately after intubation-T3, and 3 (T4), 5 (T5) and 10 (T6) minutes after intubation. Intraoperative complications were recorded. Patients were questioned about postoperative complications 2 and 24hours following extubation. Results: The hemodynamic response to ETI was significantly greater with C-MAC. The increase in HR started with the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started immediately after ETI (p = 0.024; p = 0.012; p = 0.030; p = 0.009, respectively). In group analyses, T1-T2, T2-T3 and T1-T3 comparisons did not show any significant differences in HR with Airtraq. However, with C-MAC, HR after intubation increased significantly compared to the pre-laryngoscopy values (T1-T3) (p = 0.004). The duration of laryngoscopy was significantly reduced with C-MAC (p < 0.001), but the duration of intubation and total intubation were similar (p = 0.36; p = 0.79). Conclusions: Compared to C-MAC, the hemodynamic response to ETI was less with Airtraq. Thus, Airtraq may be preferred in CABG patients for ETI.

Uso de dispositivos (hoja McCoy vs videolaringoscopio Airtraq®) en paciente con obesidad con predictores de vía aérea difícil en cirugía general / Use of devices (McCoy sheet vs. Airtraq® videolaryngoscope) in obese patient with predictors of difficult airway in general surgery

Resumen: Se realizó un ensayo clínico controlado, prospectivo, comparativo, aleatorizado, ciego simple. Objetivo: Determinar la correlación y valor predictivo de las escalas de evaluación de vía aérea e intubación difícil, obesidad, hoja McCoy y videolaringoscopio tipo Airtraq®. Material y métodos: 152 pacientes programados para cirugía, con antecedentes de obesidad y factores de riesgo de ventilación e intubación difícil sometidos a anestesia general. Se formaron dos grupos: grupo 1 intubación con hoja McCoy y grupo 2 videolaringoscopio Airtraq®. Resultados: En la estadística de contraste de ventilación difícil se obtuvo significancia estadística con p < de 0.05 para todos los factores, excepto el ronquido. En predictores de intubación difícil, la clasificación de Mallampati y Cormack-Lehane obtuvo p < 0.05, con sensibilidad de 63 y 68% respectivamente, con valor predictivo negativo alto para todos los factores. El promedio de intentos fue uno y duración de 55-59 segundos en ambos grupos. No hubo diferencias con el uso de hoja McCoy y Airtraq®. Conclusiones: La intubación orotraqueal fue exitosa en 97% de los casos gracias al uso de predictores de intubación difícil y de dispositivos para manejo de la misma.

Abstract: A controlled, prospective, comparative, randomized, simple blind clinical trial was conducted. Objective: Determine the correlation and predictive value of the airway assessment and difficult intubation scales, obesity, McCoy sheet and Airtraq® type videolaryngoscope. Material and methods: 152 patients scheduled for surgery, with a history of obesity and risk factors for difficult ventilation and intubation under general anesthesia. Two groups were formed: group, intubation with McCoy sheet and group 2, Airtraq® videolaryngoscope. Results: In the contrast statistics of difficult ventilation, statistical significance was obtained with p < 0.05 for all factors except snoring. In predictors of difficult intubation, the Mallampati and Cormack-Lehane classification obtained p < 0.05, with sensitivity of 63 and 68% respectively, with a high negative predictive value for all factors. The average of attempts was 1 and duration 55-59 seconds, in both groups. There were not differences with the use of McCoy sheet and Airtraq®. Conclusions: Orotracheal intubation was successful in 97% of cases, thanks to the use of difficult intubation predictors and devices for managing it.

Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial / Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado

Abstract Background: Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. Methods: Eighty patients with ASA physical status 1-3, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. Results: There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1s vs. 50.7 ± 21.2s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1s vs. 97.4 ± 42.7s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05). Conclusions: Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

Resumo Justificativa: A obesidade dificulta a ventilação manual e intubação traqueal devido ao acúmulo de tecido adiposo na via aérea superior e a complacência diminuída na caixa torácica. Os videolaringoscópios e as Máscaras Laríngeas para Intubação (MLI) são alternativas boas para o manuseio da via aérea difícil, de acordo com as diretrizes da Sociedade Americana de Anestesologia (ASA). O objetivo do estudo foi comparar o uso da MLI e do Airtraq, um videolaringoscópio com canal, em pacientes obesos. Método: Estudamos 80 pacientes com classificação ASA I-III, com idades entre 18 e 65 anos e índice de massa corporal acima de 35 kg.m-2, submetidos a cirurgia eletiva com indicação de intubação orotraqueal. Os pacientes foram intubados empregando-se um dos seguintes dispositivos: MLI ou Airtraq. Resultados: Não houve diferença entre o número de tentativas de intubação, tempo de inserção do dispositivo e necessidade de manobras de otimização para o Airtraq e MLI. A intubação com Airtraq foi realizada mais rapidamente do que no Grupo MLI (29,9 ± 22,1 s vs. 50,7 ± 21,2 s; p < 0,001). Houve diferença significante na comparação do tempo total para intubação (29,9 ± 22,1 s vs. 97,4 ± 42,7 s; p < 0,001). Houve aumento estatisticamente significante da pressão arterial média após a inserção do dispositivo no Grupo MLI (p < 0,05). Conclusões: Airtraq parece ser superior a MLI em pacientes obesos, apresentando tempo total de intubação abaixo de 60 segundos e com menor variação na pressão arterial média. Todavia, a MLI ainda é ferramenta útil que propicia tanto ventilação quanto intubação durante todo o processo de manejo da via aérea.

Comparative evaluation of hemodynamic responses and ease of intubation with airtraq video laryngoscope versus macintosh laryngoscope in patients with ischemic heart disease

Introduction: Hemodynamic responses during laryngoscopy can potentially precipitate ischemia in patients with coronary artery disease. There are conflicting reports regarding the hemodynamic stress responses between the conventional Macintosh and video laryngoscopes. There is a paucity of studies regarding the same in cardiac surgical patients. Materials and Methods: A prospective, randomized control study to compare the hemodynamic responses and ease of intubation using Airtraq video laryngoscope and Macintosh laryngoscope in patients with ischemic heart disease. Results: Seventy patients were randomized into two groups. Baseline variables including age, weight, Mallampati score, and comorbidities were comparable between the two groups. There was statistically significant elevation in mean heart rate in the Macintosh group at 2nd-min (P = 0.02) and 3rd-min (P = 0.05) postintubation. Similarly, there was a significant increase in mean arterial pressure at 2nd (P = 0.06), 3rd (P = 0.03), and 4th (P = 0.03) in the Macintosh group. The time for laryngoscopy and Intubation Difficulty Scale was significantly better in the Airtraq group (P = 0.001 and 0.001). However, the median time to intubation was longer in the Airtraq group (13 s vs. 11 s, P = 0.05). Laryngoscopy view was better with Airtraq even in patients with Mallampati score 3 (ten patients). The incidence of trauma was same in both the groups. Conclusion: Airtraq provides the better hemodynamic stability and ease of intubation and may be considered superior to conventional Macintosh laryngoscope for intubation in patients with ischemic heart disease.

Comparison between Airtraq Optical Laryngoscope and Conventional Macintosh Laryngoscope for Intubation in Adult Surgical Patients: A Prospective Randomized Controlled Study

Introduction: Intubating trachea and securing the airway remain a challenge although it is a routine practice for theanesthesiologist. Failure to successfully intubate the trachea remains a leading cause of morbidity and mortality in anestheticand emergency setting.Aim: This study aims to compare the intubating conditions in adult surgical patients using Airtraq optical laryngoscope withMacintosh laryngoscope with respect to ease of intubation, the time taken for intubation, airway trauma, and hemodynamicresponse to laryngoscopy.Methods: In a single-center, prospective, randomized, parallel group, open-label, interventional study, 40 adult patients postedfor surgery under general anesthesia need of endotracheal intubation were recruited and allocated into two groups: Group A(n = 20) intubated with Airtraq laryngoscope and Group B (n = 20) intubated with conventional Macintosh laryngoscope instandard intravenous induction.Results: Mean duration of intubation with the Airtraq group was 15.93 s, whereas in the Macintosh group, it was found to be38.70 s (P < 0.0001). The increase in mean heart rate from the pre-induction to post-intubation in Airtraq group was 20.9/min,whereas in Macintosh group was 31.9/min. The increase in mean arterial pressure from pre-intubation to post-intubation inAirtraq group was 12.6 mmHg, whereas in Macintosh group was 30.3 mmHg. Three patients in the Macintosh group and twopatients in the Airtraq group experienced trauma to the airways (P = −0.958).Conclusion: A study concluded that endotracheal intubation is easier, less time is taken for intubation, less trauma, and lesshemodynamic response when using Airtraq laryngoscope than Macintosh laryngoscope.

Airtraq Video Laryngoscope for Nasotracheal Intubation in Patients With Obstructive Sleep Apnea and Hyperpnoea Syndrome:Prospective Randomized Controlled Trial / 中国微创外科杂志

Objective To compare the effect of nasotracheal intubation between Airtraq video laryngoscope and Macintosh laryngoscope in patients with obstructive sleep apnea and hyperpnoea syndrome(OSAHS). Methods A total of 60 patients with OSAHS receiving nasotracheal intubation were randomly divided into two groups: the group M was intubated with Macintosh laryngoscope and the group A was intubated with Airtraq video laryngoscope.The blood pressure and heart rate were recorded before induction(T0),before intubation(T1),immediately after intubation(T2),first minute(T3)and fifth minute(T4)after intubation. The intubation time,Cormach-Lehane scale,external laryngeal press,use of magil forceps and the incidence of blood on laryngoscope were recorded. Results The systolic pressure and heart rate at T 2,T3and T4were significantly higher than T1in the group M(P<0.05),but no significant changes were found among T 2,T3and T4in the group A(P>0.05).The systolic pressure was significantly different between the two groups at T 2and T3(P<0.05).The heart rate was significantly different between the two groups at T 2,T3 and T4(P<0.05).The diastolic pressure was not significantly different between the two groups(P >0.05).The laryngoscope exposure scale in the group A was significantly superior to the group M(Z=-4.935,P=0.000).The intubation time in the group A(30.4 ±9.0)s was significantly less than that in the group M[(42.3 ±16.5)s, t =-3.468, P =0.000]. Conclusion Nasotracheal intubation with Airtraq video laryngoscope has less influence on hemodynamics,shorter intubation time and easier performance as compared with Macintosh laryngoscope in patients with OSAHS.

A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery / Estudo comparativo randomizado do efeito do laringoscópio óptico Airtraq vs. laringoscópio Macintosh sobre a pressão intraocular em cirurgia não oftálmica

BACKGROUND: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. METHODS: Ninety adult patients were randomly assigned to study group or control group. Study group (n = 45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n = 45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. RESULTS: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. CONCLUSION: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

JUSTIFICATIVA: Comparar as alterações de pressão intraocular após laringoscopia e intubação com lâmina Macintosh convencional e laringoscópio óptico Airtraq. MÉTODOS: Noventa pacientes adultos foram randomicamente designados para os grupos estudo ou controle. No grupo estudo (n = 45) o laringoscópio Airtraq foi usado para laringoscopia e no grupo controle (n = 45) o laringoscópio Macintosh convencional foi usado para laringoscopia. A pressão intraocular foi mensurada no pré-operatório com tonômetro Schiotz. A laringoscopia foi feita de acordo com o protocolo de cada grupo. Pressão intraocular e parâmetros hemodinâmicos foram registrados logo antes da inserção do dispositivo e três vezes após a inserção do dispositivo, com intervalo de um minuto. RESULTADOS: As características dos pacientes, os parâmetros hemodinâmicos basais e a PIO basal foram comparáveis nos dois grupos. Após a inserção do tubo endotraqueal com o laringoscópio Macintosh, houve um aumento estatisticamente significativo da frequência cardíaca e da pressão intraocular em comparação com o grupo Airtraq. Não houve alteração significativa da PAM. Oito pacientes do grupo Macintosh sofreram trauma de língua-lábio-dental durante a intubação, enquanto apenas dois pacientes sofreram trauma das vias aéreas superiores no grupo Airtraq. CONCLUSÃO: Concluímos que o laringoscópio Airtraq, em comparação com o laringoscópio Macintosh, resultou em elevações significativamente menores da PIO e em aumentos clinicamente menos acentuados da resposta hemodinâmica à laringoscopia e intubação.

A comparative study of tracheal intubation characteristics using Macintosh and Airtraq laryngoscope.

Background: Direct laryngoscopy for endotracheal intubation with the Macintosh blade is most commonly used for establishing a patent airway. AirtraqTm Optical Laryngoscope, does not require the alignment of the 3 airway axes for glottic visualization. Objective: We aim to compare these two laryngoscopes in view of laryngoscopic grading, ease of tracheal intubation and hemodynamic changes associated with laryngoscopy and intubation. Materials and Methods: 50 ASA I and II patients were randomly divided into Macintosh (M) group and Airtraq (A) group. Cormack Lehane grading, ease of intubation, laryngeal intubation time in secs and incidence of sore throat was noted. HR & BP was recorded at 0, 1, 3, 5 & 10 minutes following intubation. Unpaired ‘t’ test compared inter-group data, while paired ‘t’ test compared within group cardiovascular data. (p<0.05 statistically significant) Results: The demographic data of both groups were comparable. Cormack- Lehane grading was better in group A than in group M [grade I group A(84%) and group M(60%)]. The mean time for laryngeal intubation (Mean ± SD) for group A (8.3 ± 4.6 secs) and group M (20.46 ± 6.6 secs) (t = 7.6, p< 0.01). Ease of intubation was better in group A than group M. The rise in blood pressure and heart rate was significantly less in Group A as compared to Group M. Conclusion: Airtraq laryngoscope was superior to Macintosh laryngoscope as it provided better laryngoscopic views, shorter laryngoscopy and intubation time, easier intubation and the rise in heart rate and systolic blood pressure was significantly less.

Preanesthetic assessment data do not influence the time for tracheal intubation with Airtraq(tm) video laryngoscope in obese patients / Dados da avaliação pré-anestésica não influenciam o tempo de intubação com o videolaringoscópio Airtraq(r) em pacientes obesos / Datos de evaluación preanestésica no influyen en el tiempo de intubación traqueal con el videolaringoscopio Airtraq(r) en pacientes obesos

Purpose: this study investigated the influence of anatomical predictors on difficult laryngoscopy and orotracheal intubation in obese patients by comparing Macintosh and Airtraq(tm) laryngoscopes. Methods: from 132 bariatric surgery patients (body mass index = 35 kg m-1), cervical perimeter, sternomental distance, interincisor distance, and Mallampati score were recorded. The patients were randomized into two groups according to whether a Macintosh (n = 64) or an Airtraq(tm) (n = 68) laryngoscope was used for tracheal intubation. Time required for intubation was the first outcome. Cormack-Lehane score, number of intubation attempts, the Macintosh blade used, any need for external tracheal compression or the use of gum elastic bougie were recorded. Intubation failure and strategies adopted were also registered. Results: intubation failed in two patients in the Macintosh laryngoscope group, and these patients were included as worst cases scenario. The intubation times were 36.9 + 22.8 s and 13.7 + 3.1 s for the Macintosh and Airtraq(tm) laryngoscope groups (p < 0.01), respectively. Cormack-Lehane scores were also lower for the Airtraq(tm) group. One patient in the Macintosh group with intubation failure was quickly intubated with the Airtraq(tm). Cervical circumference (p < 0.01) and interincisor distance (p < 0.05) influenced the time required for intubation in the Macintosh group but not in the Airtraq(tm) group. Conclusion: in obese patients despite increased neck circumference and limited mouth opening, the Airtraq(tm) laryngoscope affords faster tracheal intubation than the Macintosh laryngoscope, and it may serve as an alternative when conventional laryngoscopy fails. .

Objetivo: esse estudo investigou a influência de preditores anatômicos para laringoscopia e intubação orotraqueal difícil em pacientes obesos mediante a comparação dos laringoscópios Macintosh e Airtraq(r). Métodos: em 132 pacientes de cirurgia bariátrica foram registrados: perímetro cervical, distância esternomentoniana, distância inter-incisivos e escore de Mallampati. Os pacientes foram randomizados em dois grupos, de acordo com o laringoscópio usado para a intubação traqueal: Macintosh (n = 64) ou Airtraq(r) (n = 68). O tempo até a intubação foi o primeiro desfecho. Também foram registrados: escore de Cormack-Lehane, número de tentativas de intubação, lamina Macintosh usada, necessidade de compressão traqueal externa, ou uso de um bougie elástico de borracha. Também foram anotados o insucesso na intubação e as estratégias adotadas. Resultados: houve insucesso na intubação em dois pacientes no grupo com laringoscópio de Macintosh; esses pacientes foram incluídos como o pior cenário de caso. Os tempos para intubação foram 36,9 ± 22,8 seg e 13,7 ± 3,1 seg para os grupos Macintosh e Airtraq(r) (p < 0,01), respectivamente. Os escores de Cormack-Lehane também foram mais baixos para o grupo Airtraq(r). Um paciente no grupo Macintosh com insucesso na intubação foi rapidamente intubado com o laringoscópio Airtraq(r). A circunferência cervical (p < 0,01) e a distância inter-incisivos (p < 0,05) influenciaram o tempo até a intubação no grupo Macintosh, mas não no grupo Airtraq(r). Conclusão: em pacientes obesos, apesar da maior circunferência cervical e da limitada abertura da boca, o laringoscópio Airtraq(r) possibilita uma intubação traqueal mais rápida ...

Objetivo: el objetivo de este estudio fue evaluar la influencia de los predictores anatómicos en la laringoscopia e intubación orotraqueal difíciles en pacientes obesos comparando el laringoscopio Macintosh y el videolaringoscopio Airtraq(r). Métodos: en 132 pacientes sometidos a cirugía bariátrica (índice de masa corporal = 35 kg/m2), se registraron los valores de perímetro cervical, distancia mentoesternal, distancia interincisivos y puntuación de Mallampati. Los pacientes fueron aleatorizados en 2 grupos de acuerdo con el uso de los laringoscopios Macintosh (n = 64) o Airtraq(r) (n = 68) para intubación traqueal. El resultado primario fue el tiempo necesario para la intubación. Se registraron la puntuación de Cormack-Lehane, el número de intentos de intubación, el uso de lámina Macintosh y cualquier necesidad de compresión traqueal externa o la utilización de introductor del tubo traqueal. Las estrategias de intubación adoptadas y los fallos de las intubaciones también fueron recogidos en el informe. Resultados: en el grupo Macintosh, 2 pacientes presentaron fallo en la intubación y fueron incluidos como los peores casos de intubación. Los tiempos de intubación fueron 36,9 ± 22,8 s y 13,7 ± 3,1 s para los grupos Macintosh y Airtraq(r) (p < 0,01), respectivamente. Las puntuaciones de Cormack-Lehane también fueron menores para el grupo Airtraq(r). Un paciente del grupo Macintosh con fallo de intubación fue rápidamente intubado con el Airtraq(r). La circunferencia cervical (p < 0,01) y la distancia interincisivos (p < 0,05) influyeron en el tiempo necesario para la intubación en el grupo Macintosh, pero no en el grupo Airtraq(r). Conclusión: en los pacientes obesos, a pesar del aumento de la circunferencia del cuello y de la abertura limitada de la boca, el laringoscopio ...

Use of Airtraq Optical Laryngoscope for Naso-Tracheal Intubation in Anaesthetized Patients.

Reported is a case of successful Nasotracheal intubation using Airtraq optical laryngoscope in a patient of fracture zygomatic arch with cervical spine injury. Th e patient had predicted diffi cult direct laryngoscopy with restricted mouth opening.

Comparison of students' learning curves between Macintosh laryngoscope and Airtraq laryngoscope in endotracheal intubation / 中华医学教育探索杂志

Objective To compare medical students' learning curve between Macintosh laryngoscope and optical laryngoscope in endotracheal intubation and to decide which one is more suitable for novice personnel.Methods Totally 26 interns after being trained by experienced anesthesiologists were enrolled in this study.They performed intubation on 6 patients by using both Macintosh laryngoscope and optical laryngoscope ( each laryngoscope for 3 patients) under the supervision of experienced anesthesiologists.The sequence of laryngoscope was determined by computer-generated random number list.Results Totally 149 patients who were ready to receive surgery under general anesthesia were enrolled in this randomized crossover controlled study.Duration of intubation was significantly shorter in Airtraq group (78 -± 33 ) s than in Macintosh group (114 ± 32) s,P ＜ 0.001.Intubation success rate was significantly higher in Airtraq group than in Macintosh group ( 87.8％ vs.66.7％,P ＜ 0.05 ).Conclusions With the advantages of rapid learning curve,higher intubation success rate and shorter intubation duration,Airtraq laryngoscope is easier to master for novice personnel.

Study on the effectiveness of Airtraq laryngoscope combined with a Bougie for tracheal intubation / 中国医师进修杂志

ObjectiveTo compare and evaluate the effectiveness of Airtraq laryngoscope combined with a Bougie and Airtraq laryngoscope alone for tracheal intubation in simulated difficult airway.Methods Four anesthetists and 4 clinical physicians of standardized training were enrolled in the study.The participants intubated the trachea of the ALS simulator manikin in 5 tongue edema scenarios simulating modified Cormack-Lehane grade 1,2a,2b,3,and 4 views and 1 cervical immobilization scenario.Results No significant difference in the rate of successful intubation was detected between two techniques(P＞ 0.05 ).In Cormack-Lehane grade 1,2a views,the duration of successful intubation in Airtraq laryngoscope alone [ ( 14.3 ± 1.3),( 17.1 ± 2.9) s] was shorter than that in Airtraq laryngoscope combined with a Bougie [ (26.6 ± 3.8),(36.4 ± 3.6) s ] with significant difference (P ＜ 0.01 ).Cormack-Lehane grade 2b,3,4 views,the duration of successful intubation in Airtraq laryngoscope alone[ (74.5 ± 6.5 ),(116.3 ± 9.8),(53.0 ± 6.1 )s] was longer than that in Airtraq laryngoscope combined with a Bougie [ (35.4 ± 4.3 ),(52.3 ± 5.0),(40.4 ± 3.8 ) s ] with significant difference (P ＜ 0.05).ConclusionAirtraq laryngoscope combined with a Bougie can be quickly intubated in simulated difficult airway compared with Airtraq laryngoscope alone.

Uso del laringoscopio airtraq. Una alternativa a la vía aérea difícil / Use of the Airtraq laryngoscope: an option for the difficult airway

Antecedentes: Una de las responsabilidades fundamentales del anestesiólogo es establecer y mantener la vía aérea permeable en cualquier situación clínica que conlleve un compromiso de la misma. Objetivo: Evaluar y comparar la eficacia y seguridad del tubo endotraqueal y el uso del Airtraq en el abordaje de la vía aérea difícil. Material y método: Se realizó un estudio prospectivo, comparativo y aleatorizado entre los meses de julio del 2008 y agosto del 2010 en pacientes mayores de 18 años con probabilidad de vía aérea difícil, intervenidos quirúrgica con anestesia general orotraqueal, en el CIMEQ. Se dividieron en dos grupos de 25 cada uno. El Grupo A se utilizó el Airtraq y en el M se utilizó el laringoscopio Macintosh. Resultados: El tiempo de la intubación en el grupo A fue menor que en el grupo M (18.8 ± 6.5 seg) contra (35.9 ± 20.6 seg). El éxito de la intubación fue 100 % en el Grupo A versus 68 % en el Grupo M. Aparecieron menos complicaciones en el Grupo A (4 %) versus 32 % en el otro Grupo M. Los valores de tensión arterial media y frecuencia cardiaca durante la intubación y a los 3 minutos de realizada la misma, también fueron menores en el grupo A, con diferencias significativos estadísticamente. Conclusiones: El Airtraq es seguro y eficaz en el abordaje de la vía aérea difícil predicha.

Backgrounds: One of the main responsibilities of the anesthesiologist is to establish and to maintain a permeable airway in any clinical situation entailing its involvement. Objective: To assess and to compare the efficacy and safety of endotracheal tube and the use of Airtraq in the approach of a difficult airway. Material and Methods: A randomized, comparative and prospective study was conducted between July, 2008 and August, 2010 in patients aged over 18 with a probable difficult airway, operated on using orotracheal general anesthesia in CIMEQ, who were divided into two groups of 25 patients each. In A group we used Airtraq and in M group we used the Macintosh laryngoscope. Results: Intubation time in the A group was less than in the M group (18.8 ± 6.5 sec) versus (35.9 ± 20.6 sec). The success rate was of 100% in the A group versus 68 % in the M one. There were less complications in the A group (4%) versus 32% in the M group. Values of mean arterial pressure and the heart rate during intubation and at three minutes after it were less in the A group, with statistically significant differences. Conclusions: Airtraq is safe and effective in the approach of above mentioned difficult airway.

Comparison of Airtraq optical laryngoscope and Storz video laryngoscope in a cadaver model / 世界急诊医学杂志（英文）

BACKGROUND: Airway management in the emergency department is a critical intervention that requires both standard techniques and rescue techniques to ensure a high rate of success. Recently, video laryngoscope (VL) systems have become increasingly common in many large urban Eds, but these systems may exceed the budgets of smaller rural Eds and EMS services and the Airtraq optical laryngoscope (OL) may provide an effective, low-cost alternative. We hypothesized that laryngeal view and time to endothracheal tube placement for OL and VL intubations would not be significantly different. METHODS: This was a prospective, crossover trial. Setting: University-based emergency medicine residency program procedure laboratory utilizing lightly embalmed cadavers. Subjects:PGY1-3 emergency medicine residents. The study subjects performed timed endotracheal intubations alternately using the OL and VL. The subjects then rated the Cormack-Lehane laryngeal view for each device. Statistical analysis: Mean time to intubation and the mean laryngeal view score were calculated with 95％ confidence intervals and statistical significance was determined by Student's t test. RESULTS: Fourteen subjects completed the study. The average laryngeal view achieved with the OL vs. the VL was not significantly different, with Cormack-Lehane grade of 1.14 vs. 1.07, respectively. Time to endotracheal intubation, however, was significantly different (P<0.001) with the average time to intubation for the OL 25.49 seconds (95％ CI: 17.95-33.03) and the VL 13.41 seconds (10.27-16.55). CONCLUSION: The Airtraq OL and the Storz VL yielded similar laryngeal views in the lightly embalmed cadaver model. Time to endotracheal tube placement, however, was less for the VL.

Comparison of the laryngeal view during intubation using Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization and mouth opening limitation / 대한마취과학회지

BACKGROUND: For patients suspicious of cervical spine injury, a Philadelphia cervical collar is usually applied. Application of Philadelphia cervical collar may cause difficult airway. The aim of this study was to evaluate the laryngeal view and the success rate at first intubation attempt of the Airtraq and conventional laryngoscopy in patients with simulated cervical spine injury after application of a Philadelphia cervical collar. METHODS: Anesthesia was induced with propofol, remifentanil, and rocuronium. After a Philadelphia cervical collar applied, patients were randomly assigned to tracheal intubation with an Airtraq (Group A, n = 25) or with conventional laryngoscopy (Group L, n = 25). Measurements included intubation time, success rate of first intubation attempt, number of intubation attempts, and percentage of glottic opening (POGO) score. Mean blood pressure and heart rate were also recorded at baseline, just before and after intubation. RESULTS: The success rate of the first attempt in Group A (96%) was significantly greater than with the Group L (40%). POGO score was significantly greater in Group A (84 +/- 20%) than in Group L (6 +/- 11%). The duration of successful intubation at first tracheal intubation attempt and hemodynamic changes were not significantly different between the two groups. CONCLUSIONS: The Airtraq offers a better laryngeal view and higher success rate at first intubation attempt in patients who are applied with a Philadelphia cervical collar due to suspicion of cervical spine injury.

Is the Airtraq optical laryngoscope effective in tracheal intubation by novice personnel? / 대한마취과학회지

BACKGROUND: Macintosh laryngoscopic intubation is a lifesaving procedure, but a difficult skill to learn. The Airtraq optical laryngoscope (AOL) is a novel intubation device with advantages over the direct laryngoscope for untrained personnel in a manikin study. We compared the effectiveness of AOL with Macintosh laryngoscope for tracheal intubation by novice personnel. METHODS: We selected 37 medical students with no prior tracheal intubation experience and educated them on using both laryngoscopes. Seventy-four patients were randomly divided into two groups (group A: AOL, group M: Macintosh laryngoscope). We recorded the tracheal intubation success rate, intubation time, number of attempts, intubation difficulty scale, and adverse effects. RESULTS: The total success rate was similar in the two groups, but the success rate at first attempt was higher in group A (P < 0.01). Group A also showed reduced duration and attempts at intubation, as well as adverse effects such as oral cavity injury. Additionally, participant reports indicated that using the AOL was easier than the Macintosh laryngoscope (P < 0.01). CONCLUSIONS: The AOL is a more effective instrument for tracheal intubation than Macintosh laryngoscope when used by novice personnel.

Un nuevo dispositivo para el abordaje de la vía respiratoria anatómicamente difícil.: El Airtraq ® / A new device for a respiratory airway of difficult anatomically access.: The Airtrak®

Introducción: La vía respiratoria anatómicamente difícil, resulta un reto al anestesiólogo. Múltiples son las opciones que existen para resolverlas. Recientemente, el laringoscopio óptico Airtraq ®, constituye una opción válida para abordar la tráquea en estas condiciones. Objetivos: Proporcionar la enseñanza de un nuevo dispositivo para el abordaje de la vía respiratoria anatómicamente difícil. Desarrollo: Se propuso realizar el proceso de enseñanza aprendizaje con el laringoscopio óptico Airtraq ® para adquirir las habilidades suficientes y necesarias para poder realizar el abordaje de la vía respiratoria en general y de la vía respiratoria anatómicamente difícil en particular. Se describió la forma de colocar el dispositivo y las ventajas de su uso. Conclusiones: El Airtraq ®, es un dispositivos para el abordaje de la vía respiratoria anatómicamente difícil que puede ser utilizado de forma rápida y fácil.

Introduction: The airway anatomically difficult is a challenge for anesthesiologist. There many options for its solution. Recently, the optical laryngoscope Airtraq®, is a valid option to approach the trachea in these conditions. Objectives: To teach on a new device to approach the airway anatomically difficult. Development: We propose to carry out the teaching process with optical laryngoscope Airtraq® to acquire abilities sufficient and necessary to carry out the approach of the airway in general and of the airway anatomically difficult in particular. We described the way to insert the device and the advantages of its use. Conclusions: Airtraq® is a device to approach this type of airway that may to be used in a fast and easy way.

Use of the Airtraq(R) optical laryngoscope as a rescue airway device following failed awake flexible fiberoptic nasotracheal intubation of a patient with severe microsomia: A case report / 대한마취과학회지

We report here the successful use of the Airtraq(R) optical laryngoscope (AOL) as a rescue device following failed awake flexible fiberoptic nasotracheal intubation of a patient with severe mandibular microsomia. We attempted awake fiberoptic nasotracheal intubation following topical anesthesia with 4% lidocaine spray three times to induce general anesthesia for distraction osteogenesis of mandibular bone. However, due to a shallow pharyngeal cavity and cranially displaced larynx, we failed to locate the larynx each time and were therefore not able to intubate the patient. Awake orotracheal intubation using the AOL allowed us to easily intubate the patient. Therefore, we recommend that the AOL be used as a rescue airway device for intubation of difficult airways.