A useful suggestion to facilitate tracheal intubation using the Airtraq® laryngoscope in the infants with difficult airways

Xue, Fu Shan; Liu, He P.; Xiong, Jie; Liao, Xu

doi:10.1111/j.1460-9592.2010.03337.x

Cited by 3 publications

(3 citation statements)

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“…This has been highlighted with a variety of suggestions to facilitate intubation, including withdrawing the device slightly and lifting the device upward to ensure that the glottis is central in the view finder. Others have suggested using an introducing stylet or a gum-elastic bougie, or even the use of fibreoptic bronchoscopy guided through the Airtraq's tracheal tube channel [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…There are reports that describe posterior positioning of the tracheal tube as it exits the Airtraq tracheal tube channel, causing the tracheal tube to pass posterior to the glottis. This may be due to the fact that the paediatric Airtraq has a relatively wide tracheal tube channel and a relatively long blade compared with adult sizes, and thus there is more space between the tracheal tube and the tip of the laryngoscope [19,20]. Two case reports describe using the Airtraq in difficult paediatric airways and report excellent views of the laryngeal structures but failure to intubate due to posterior displacement of the tracheal tube [21].…”

Section: Discussionmentioning

confidence: 99%

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A randomised, controlled trial comparing the Airtraq^™ optical laryngoscope with conventional laryngoscopy in infants and children*

et al. 2012

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SummaryThe Airtraq TM optical laryngoscope became available in paediatric sizes in the UK in May 2008. We conducted a randomised, controlled trial comparing the Airtraq with conventional laryngoscopy during routine anaesthesia in children. We hypothesised that the Airtraq laryngoscope would perform as well as conventional laryngoscopy. Sixty patients (20 infants and 40 children) were recruited. The mean (SD) intubation time using the Airtraq was longer than conventional laryngoscopy overall (

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A randomised, controlled trial comparing the Airtraq^™ optical laryngoscope with conventional laryngoscopy in infants and children*

et al. 2012

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“…Flexible intubating stylet was used successfully to complete the tracheal intubation in seven infants aged 3–12 months with normal and difficult airways after a failed attempt using the AT because of a posterior ETT tip location. [ 23 ] We did not use stylet as it was not included in our study methodology. In addition, combining the AT with a stylet or bougie can increase the risk of injuring the airway and their use is questionable.…”

Section: Discussionmentioning

confidence: 99%

An observational study of feasibility of tracheal intubation using Airtraq in pediatric population

Thakare

Malde

2017

J Anaesthesiol Clin Pharmacol

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Background and Aim:There is a paucity of observational studies for the use of Airtraq (AT) in children, especially infants. We undertook a prospective observational study to compare ease of use of infant (size 0), pediatric (size 1), and small (size 2) AT.Material and Methods:AT was used for endotracheal intubation in healthy pediatric patients of 3 months to 18 years age. The primary outcome was success of intubation which was noted as number (%) and analyzed using Fisher's exact test. The secondary outcomes were percentage of glottis opening (POGO) score, visual analog scale (VAS) for field of view, time to best view (TTBV), time to intubation (TTI), and VAS for ease of use and were presented as median (interquartile range) in each subgroup of sizes and analyzed using Kruskal–Wallis test.Results:Overall POGO score was 100 (100, 100 [50–100]) %, VAS field of view was 10 (10, 10 [5–10]), and TTBV was 6 (4, 10 [1.5–24]) s. There was no statistically significant difference in any of the subgroups. The success rate of intubation with AT was 100% with AT size 1 and 2, whereas 45% with AT 0, P < 0.001. VAS for ease of use was 5 (4, 10 [3-10]) with AT 0 compared to 10 (10, 10 [9–10]) with AT 1 and 10 (10, 10 [6–10]) with AT 2 (P < 0.001). TTI was 28 (20, 36 [11.8-59]) s in those who could be successfully intubated.Conclusions:All sizes of AT provide quick, easy, and excellent glottic visualization. However, failure rate for intubation with infant (size 0) is high compared to nil with pediatric (size 1) and small (size 2).

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Anesthesia Challenges for the Difficult and Critical Neonatal Airway

Fiadjoe

Isserman

McCloskey

2014

Disorders of the Neonatal Airway

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The larynx descends as children grow and is most cranially positioned in the neonate [ 1 ]. The high cervical position of the larynx is often described as being "anterior" because of the view obtained with direct laryngoscopy. Because of the high location of the glottis, straight blades are thought to offer better exposure of the larynx because of the ability to elevate the base of the tongue. Despite this, some clinicians prefer curved blades and use them successfully. Other consequences of the high location of the neonate's glottis include the tendency for laryngeal masks to become dislodged and inadvertent compression of the airway in the neck during bag-mask ventilation.The tongue in the neonate is relatively large and may obstruct the airway by adhering to the palate; relief can be obtained by opening the mouth or by applying continuous positive airway pressure (CPAP), to the airway via a bagmask device. An oral airway is rarely needed to open the airway of a neonate. The neonatal epiglottis is relatively short. This allows one to elevate the tip by simply placing the straight laryngoscope blade in the vallecula much like how a curved blade is used. The glossoepiglottic ligament located in the vallecula should be engaged with the tip of the straight blade in order to gain adequate glottic exposure. The vocal cords in the neonate are slanted rostrally as compared to the vocal cords in the adult. This can cause diffi culties in passing an endotracheal tube because the tip is already directed in an upward fashion to the anteriorly located larynx causing it to have a greater chance of being hung up at the anterior commissure or anterior tracheal wall. Classically, it has been taught the neonatal airway is funnel shaped, but a recent study suggests it may be tubular much like the adult airway [ 2 ]. Traditionally teaching is that the narrowest part of the neonatal/pediatric airway is at the cricoid ring and not at the vocal cords like the adult airway.Normal cardiopulmonary physiology can also make the management of the neonatal airway diffi cult.In the operating room (OR), the initial approach to a patient with a diffi cult airway is to perform an inhalational induction with a volatile anesthetic agent to allow for spontaneous ventilation. This can be done successfully in a neonate; however, the response is different due to differences in physiology. Theoretically, uptake of the volatile anesthetic can be delayed due to the relatively higher cardiac output; however, the higher minute ventilation and increased proportion of cardiac output to the brain in the neonate can actually increase the rate of induction. The faster rate of induction and effects on the neonatal brain subsequently leads to a faster decrease in respiratory function as compared to older children and adults (Fig. 1a ).Neonates are also more prone to develop hypoxia during the process of securing the airway due to differences in lung volumes and metabolic rate as compared to children and adults. In neonates, the functional residual capacity is ap...

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A useful suggestion to facilitate tracheal intubation using the Airtraq® laryngoscope in the infants with difficult airways

Cited by 3 publications

References 5 publications

A randomised, controlled trial comparing the Airtraq^™ optical laryngoscope with conventional laryngoscopy in infants and children*

A randomised, controlled trial comparing the Airtraq^™ optical laryngoscope with conventional laryngoscopy in infants and children*

An observational study of feasibility of tracheal intubation using Airtraq in pediatric population

Anesthesia Challenges for the Difficult and Critical Neonatal Airway

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A useful suggestion to facilitate tracheal intubation using the Airtraq® laryngoscope in the infants with difficult airways

Cited by 3 publications

References 5 publications

A randomised, controlled trial comparing the Airtraq™ optical laryngoscope with conventional laryngoscopy in infants and children*

A randomised, controlled trial comparing the Airtraq™ optical laryngoscope with conventional laryngoscopy in infants and children*

An observational study of feasibility of tracheal intubation using Airtraq in pediatric population

Anesthesia Challenges for the Difficult and Critical Neonatal Airway

Contact Info

Product

Resources

About

A randomised, controlled trial comparing the Airtraq^™ optical laryngoscope with conventional laryngoscopy in infants and children*

A randomised, controlled trial comparing the Airtraq^™ optical laryngoscope with conventional laryngoscopy in infants and children*