Airtraq® is the preferred device for difficult intubation by residents?

Abstract

Background: The Airtraq® optical laryngoscope is an intubation device designed to provide a view of the glottis without alignment of the oro-pharyngeal and laryngeal axes. Recent literature shows that, given its two significant features: time effectiveness and short learning curve, Airtraq® is the most favorable option when it comes to difficult intubation. Objectives: The goal was to analyze Airtraq® effectiveness when used by inexperienced physicians in anticipated difficult intubation in adult patients. Materials and methods: We conducted a prospective evaluation in ten medical residents using the Airtraq® device for the first time. All of them were experienced in using Macintosh. Each resident conducted laryngoscopy and intubation with the Airtraq® device after short didactic guidance. Eighteen patients were included, over a period of seven months. The patients showed 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. All of them were clinically examined for difficult airway by an ENT specialist. Results: Before induction of anaesthesia all residents received a short demonstration on the use of the Airtraq®. Every participant was supervised by an Airtraq® handling specialist for each intubation maneuver. In sixteen patients, Airtraq® insertion, glottis visualization and subsequent intubation were easy and rapid, without arterial oxygen desaturation. In two patients the trachea was intubated from the second and third attempt. There were two tracheal intubation failures, associated with extended tracheal intubation and an Airtraq® specialist had to continue with intubation. The Airtraq® reduced the duration of intubation attempts in all cases, reduced the number of optimization maneuvers required, and reduced the potential for dental trauma. However, the two intubation failures emphasize the fact that Airtraq® laryngoscopy requires a clinical training process, especially in the event of anticipated difficult airway management situations. Conclusion: The residents participating the study, found the Airtraq® easier to use in all scenarios compared to the Macintosh laryngoscope. The Airtraq® may be the preferred device, required by inexperienced physicians in cases of difficult airway