In this study, the Airtraq laryngoscope shortened the duration of tracheal intubation and prevented reductions in arterial oxygen saturation in morbidly obese patients.

Because LMA CTrach promoted short apnea time and the Airtraq laryngoscope allowed early definitive airway, both video-assisted tracheal intubation devices prevented most serious arterial oxygenation desaturation evidenced during tracheal intubation of morbidly obese patients with the conventional Macintosh laryngoscope.

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We demonstrated that the CT was an efficient airway device for ventilation and tracheal intubation in case of a difficult airway in morbidly obese patients.

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We demonstrated that LaT, EMGp, and ALA of the swallowing reflex were influenced by tracheostomy tube CP. The swallowing reflex was progressively more difficult to elicit with increasing CP and when activated, the resulting motor swallowing activity and efficiency at elevating the larynx were depressed.

SummaryIn this study we have used a video-recording, retrospective analysis technique to evaluate the influence of the Airtraq TM laryngoscope manipulations and the resulting changes in position of the glottic opening and inter-arytenoids cleft, on the success rate of tracheal intubation. The video recordings of the internal views of 109 tracheal intubation attempts, in 50 anaesthetised patients were analysed. We demonstrated that successful tracheal intubation using the Airtraq laryngoscope require the glottic opening to be centred in the view, and positioning the inter-arytenoid cleft medially below the horizontal line in the centre of the view. We also demonstrated that repositioning of the Airtraq laryngoscope following a failed tracheal intubation attempt required the performance of a standard series of manoeuvres. The Airtraq TM laryngoscope (Fannin (UK) Ltd, Calcot, Reading, UK) is a novel, single use, optical laryngoscope which has been shown to improve the ease of intubation in patients with normal and difficult airways [1][2][3]. Although, the Airtraq laryngoscope produces a reduction in the time required for tracheal intubation in most patients with difficult airways, tracheal intubation on the first attempt, may not always be successful [4,5]. In obese patients a clear view of the glottic opening can rapidly be obtained following insertion. However, tracheal intubation, may fail, requiring repositioning of the Airtraq laryngoscope in the pharynx prior to a further intubation attempt subsequently being successful. The manipulations frequently required are a lowering of the position of the glottis within the view.To investigate this, we analysed the influence of the position of the glottic opening and the inter-arytenoid cleft position in the laryngeal view, on the success rates of tracheal intubation, and described the repositioning of the Airtraq laryngoscope required to succeed, following a failed tracheal intubation attempt. MethodsThe Ethics Review Board approved this trial and written informed consent was obtained from each patient for filming and recording of the airway management technique used.The study was based on a retrospective analysis of videos recorded in the operating theatre during the airway management of elective patients using the Airtraq laryngoscope. The videos were of internal views of the larynx and external recordings. All airway management techniques were performed in anaesthetised patients, who had received neuromuscular blockade, by senior anaesthetists providing anaesthesia for patients in the morbid obesity and gynaecological units.External films of tracheal intubation were performed by an assistant using a standard video-camera and internal views were automatically recorded using the videocapture system (Vygon, É couen, France).All recorded films were converted to a similar 20 images per second format and transferred to a computer for image analysis. External and internal video recordings were synchronised. We then analysed the internal recordings of 50 patients' trachea...

SummaryWe postulated that video-controlled tracheal intubation with the Airtraq TM laryngoscope using the reverse manoeuvre instead of the standard technique of insertion could facilitate the airway management of morbidly obese patients. For the reverse manoeuvre the laryngoscope is inserted 180°opposite to that recommended, and once in place rotated into the conventional pharyngeal position. Eighty (40 lean and 40 morbidly obese) ASA I-III adult patients were randomly allocated to four equal groups to compare the standard technique to the reverse manoeuvre for inserting the Airtraq laryngoscope. Video-controlled and clinical tracheal intubation characteristics were recorded. The reverse manoeuvre did not influence tracheal intubation characteristics in the group of lean patients. In the group of morbidly obese patients, the standard technique of insertion was not satisfactory in 20% of cases and the reverse manoeuvre facilitated, speeded and secured tracheal intubation. The Airtraq TM (Prodol Meditec S.A., Vizcaya, Spain) disposable laryngoscope was designed to provide a view of the glottis without altering the normal alignment of the oral and pharyngeal axes. The Airtraq laryngoscope has been used in normal airways [1] and under simulated difficult airway scenarios [2]. Four experienced anaesthetists in our department received training in the use of the Airtraq laryngoscope using a manikin and unfixed cadavers. Following 2 months of experience using the Airtraq laryngoscope in patients undergoing bariatric surgery, the major factor determining the time for tracheal intubation appeared to be difficulty in placing the laryngoscope in the pharynx of some obese patients. We postulated that tracheal intubation might be facilitated if the Airtraq laryngoscope was inserted 180°opposite to that recommended and, once in place, rotated into the conventional pharyngeal position (reverse manoeuvre). After testing the reverse manoeuvre in cadavers, we decided to compare its effectiveness with the standard technique of insertion in lean and morbidly obese patients undergoing elective surgery. ) and 40 morbidly obese (BMI > 35 kg.m )2 ) patients were enrolled in this prospective study. Randomisation of the technique for inserting the Airtraq laryngoscope was performed at the pre-operative anaesthetic visit. Patients were assigned to the standard technique or the reverse manoeuvre using sealed envelopes opened by the anaesthetist in the operating room. The four trained anaesthetists involved in the study were experienced in tracheal intubation using the Airtraq laryngoscope. They all performed the same number of tracheal intubations in lean and morbidly obese patients. Patients with limited mouth opening (< 3 cm), suffering from symptomatic gastric reflex or hiatus hernia, and those in whom suxamethonium was contra-indicated, were not included.