The Airtraq Optical Laryngoscope Specifically
Designed for
Nasotracheal Intubation
Ernst Zadrobilek, MD1
1Associate Professor
of Anesthesia and Intensive Care, Chairman of the Austrian Working
Group for Airway Management and Director of the Department of Anesthesia and Intensive Care, Empress Elisabeth Hospital of the City of
Vienna,
Vienna, Austria.
Address correspondence and comments to Ernst
Zadrobilek.
Received from the
Department of Anesthesia
and Intensive Care, Empress Elisabeth Hospital
of the City of Vienna, Vienna, Austria.
Key
Words
Nasotracheal
intubation: Airtraq Optical Laryngoscope.
Published: December 1, 2007.
The correct citation of this
communiction of new equipment and techniques is:
Zadrobilek E. The Airtraq Optical Laryngoscope specifically designed for
nasotracheal intubation. Internet Journal of Airway Management
4, 2006-2007.
Available from URL:
http://www.adair.at/ijam/volume04/newequipment05/default.htm
Date accessed: month day, year.
Last updated: July 1, 2008.
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 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 (1-3). We recently
evaluated the AOL in formally instructed but novice users and
determined that the success of tracheal intubation with this
device was not affected by conventional laryngoscopic view
grading (3).
The manufacturer recently released a modified AOL specifically
designed for nasotracheal intubation. This AOL is currently available in one size (orange-coded, maximum thickness of the blade:
18 mm). The tube-guide
channel at the right side of the original AOL [to guide standard
tracheal tubes (TTs) into the correct position] was removed; the
remaining flange of the blade serves now as guidance for the
nasally introduced TT.
Nasotracheal
intubation is simple [evaluated on a suitable airway management model (AirSim
Multi, TruCorp, Belfast, United Kingdom)] as with orotracheal intubation
using the original AOL. The modified AOL is first inserted in the midline just into the
oral cavity; when the TT is in view at the right side of the blade
flange, the blade is then further slided around the tongue into the
posterior pharynx. The tip of the blade is placed posterior and slightly
distal to the posterior surface of the epiglottis (Miller-laryngoscopy
technique), followed by a slightly vertical-directed lifting force to
directly elevate the epiglottis and expose the laryngeal aperture (Pedro A.
Gandarias, personal communication). When
the laryngeal aperture is in the center of the view finder, the TT may be
easily passsed along the flange of the blade through the laryngeal aperture
into a midtracheal position. Unfortunately, there are currently no studies
available to support these experiences in clinical practice.
The costs of
the modified AOL for nasotracheal intubation are about 48 Euro (exclusive
value-added taxes, according to the offer of the Austrian distributor, queried in July 2008).
References
-
Maharaj CH, Buckley E, Harte BH, Laffey JG. Endotracheal intubation in patients with cervical
spine immobilization. A comparison of Macintosh and Airtraq
laryngoscopes.
Anesthesiology 107:53-59, 2007.
-
Maharaj CH,
O'Croinin D, Curley G, Harte BH, Laffey JG. A comparison of tracheal
intubation using the AirtraqR or the Macintosh laryngoscope
in routine airway management: a randomised, controlled clinical trial.
Anaesthesia 61:1093-1099, 2006.
-
Missaghi MS, Krasser K, Lackner-Ausserhofer H, Moser A,
Zadrobilek E. The Airtraq Optical Laryngoscope: experiences
with a new disposable device for orotracheal intubation.
Internet Journal of Airway Management
4, 2006-2007. Date accessed:
July 1, 2008.