The Airtraq Optical Laryngoscope Suitable for Bronchial Intubation with Double-Lumen Tubes

 

 

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

Bronchial intubation with double-lumen tubes: Airtraq Optical Laryngoscope.
 

Published: December 31, 2007.

 

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The correct citation of this communiction of new equipment and techniques is:

Zadrobilek E. The Airtraq Optical Laryngoscope suitable for bronchial intubation with double-lumen tubes. Internet Journal of Airway Management 4, 2006-2007.
Available from URL: http://www.adair.at/ijam/volume04/newequipment06/default.htm
Date accessed: month day, year.

 

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Last updated: August 18, 2009.

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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 published our favorable experiences with the AOL and determined that the success of tracheal intubation with this device was not affected by conventional laryngoscopic view grading (3).

 

The manufacturer now launched a special AOL suitable for bronchial intubation with double-lumen tubes (DLTs). This AOL is available in one size (yellow-coded, maximum thickness of the blade: 18 mm). The tube-guide channel at the right side of the blade may be loaded with DLTs up to an outer diameter of 39 French. In June 2008, the manufacturer revised the design of this AOL (now with a maximum thickness of 19 mm) to be loaded also with DLTs with an outer diameter of 41 French.     

 

Bronchial intubation with DLTs is simple [evaluated on a suitable airway management model (AirSim Multi, TruCorp, Belfast, United Kingdom)] as with orotracheal intubation using the original AOL and single-lumen tracheal tubes (TTs). This special AOL is first inserted in the midline into the oral cavity and then slided around the tongue into the posterior pharynx; optimum depth of insertion is determined by the vallecula (Macintosh-laryngoscopy technique). When the laryngeal aperture is in the center of the view finder (usually requiring a slightly vertical lifting force), the selected DLT may be easily passed through the laryngeal aperture into the desired bronchial position. Unfortunately, there are currently no studies available to support these experiences in clinical practice.

 

Bronchial intubation with DLTs may be easier to perfom by using the AOL specifically designed for nasotracheal intubation (Wolfgang Puchner, Linz, Austria; personal communication, unpublished experiences in clinical practice); 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 originally AOL (to guide standard TTs into the correct position) was removed (4); the remaining flange of the blade provides much space for unrestricted and freehanded guidance even of large-sized styletted DLTs through the oral cavity and further into the trachea and the selected bronchial position.        

 

The costs of the modified AOLs for bronchial intubation with DLTs and the 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

1. 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.

2. Maharaj CH, O'Croinin D, Curley G, Harte BH, Laffey JG. A comparison of tracheal intubation using the Airtraq^R or the Macintosh laryngoscope in routine airway management: a randomised, controlled clinical trial. Anaesthesia 61:1093-1099, 2006.

3. 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.

4. Zadrobilek E. The Airtraq Optical Laryngoscope specifically designed for nasotracheal intubation. Internet Journal of Airway Management 4, 2006-2007. Date accessed: July 1, 2008.