Awake tracheal intubation using the Airtraq laryngoscope: a case series.

The Airtraq laryngoscope (AL) is a new single use indirect laryngoscope designed to facilitate tracheal intubation in anaesthetised patients either with normal or difficult airway anatomy. It is designed to provide a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. We report four cases of successful awake tracheal intubation using the AL. The first case is a patient with severe ankylosing spondylitis and the other three cases with anticipated difficult airway. An awake intubation under sedation and topical airway anaesthesia was chosen. We consider that the AL can be used effectively to accomplish an awake intubation in patients with a suspected or known difficult airway and may be a useful alternative where other methods for awake intubation have failed or are not available.

Comparative evaluation of the prolonged use of the cuffed oropharyngeal airway and the laryngeal mask airway in spontaneously breathing anaesthetized patients.

The cuffed oropharyngeal airway (COPA) was compared with the laryngeal mask airway (LMA) with respect to airway quality and respiratory adverse events in 140 spontaneously breathing patients undergoing procedures of duration more than 1 h. Patients were allocated randomly to receive either a COPA (n = 72) or a LMA (n = 68) for airway management during anaesthesia induced with propofol and maintained with sevoflurane, nitrous oxide and oxygen. Groups were similar when comparing the first-time successful insertion rates (COPA: 94.5%, LMA: 95.6%), but airway manipulations (head tilt, chin lift, jaw thrust) were reported more frequently in the COPA group, 27.8% vs. LMA, 4.4%; P = 0.0005. During the post-induction apnoeic period, all patients were ventilated manually and although, mean (SD) leak pressure was lower in the COPA group (18 (4) cm H2O vs. LMA, 22 (3) cm H2O; P < 0.0001), the tidal volumes achieved did not differ in both groups: COPA, 9.5 (4) mL kg-1 vs. LMA, 10.5 (4.5) mL kg-1. The incidences of intra-operative coughing, gagging, laryngospasm, oxygen desaturation and hypercarbia were similar in both groups. Although both devices are equivalent with respect to the overall respiratory problems during spontaneous breathing anaesthesia of intermediate or prolonged duration, the LMA was associated with fewer airway quality problems, suggesting that it is more efficacious in securing the airway.