Introduction

 

 

The battery-powered, portable Airtraq Optical Laryngoscope (AOL; manufactured by Prodol Meditec, Vizcaya, Spain) is a new disposable device (with an anatomically shaped blade) developed to facilitate orotracheal tracheal intubation in patients with normal and difficult airways. The AOL allows for the transmission of a color image to the view finder at the proximal end of the laryngoscope handle (by internal arrangements of optical components), usually providing the operator a panoramic view of the laryngeal aperture when properly inserted. However, the tube-guide channel at the right side of the AOL blade, for guidance of the tracheal tube (TT) into the correct position, may incorporate some problems with deflection and impingement of the TT on surounding laryngeal structures.

 

The performance of the AOL compared with the Macintosh laryngoscope (ML) for tracheal intubation was initially evaluated by Maharaj and co-workers on an airway model, simulating easy and difficult conventional laryngoscopy (CL) situations: the operators were anesthetists without prior experience of using the AOL (8), and medical students (5, 6) and medical residents (7) inexperienced in airway management (AM) techniques. In general, the AOL provided superior tracheal intubation conditions, resulting in greater success of tracheal intubation, particularly in simulated difficult CL situations. 

 

The first evaluation of the AOL in anesthetized patients with normal airways and low risk of difficult CL requiring tracheal intubation was performed by the same working group (10), published in November 2006; in comparison to the ML (including 30 patients in both groups), the AOL resulted in modest improvements in the ease of use and the intubation conditions, subjectively rated by the operators (anesthetists experienced with both laryngoscopes). All patients, except one patient in the ML group requring three attempts, were successfully intubated at the first attempt. Shortly afterwards, Dhonneur and co-workers (2) communicated their favorable experiences with the AOL for AM in two morbidly obese obstetric patients.

 

The introduction of a new device for AM into routine clinical practice requires validation of performance in controlled studies. In April 2007, there were only few published data on its use in patients. We therefore conducted this study exclusively on patients presenting for elective thyroid surgery to recruit a sufficient number of patients with variable degrees of airway difficulties and conventional laryngoscopic views. The handling of the AOL is similar to CL with the ML; therefore, we anticipated easy adoption by novice users. Because of expected problems with viewing the intubation process through the view finder and difficulties in manipulating the TT through the laryngeal aperture into a midtracheal position, the operators first received formal hands-on training on a suitable airway model and were then instructed during the early series of performance on patients.

 

 

Materials and Methods