Awake Orotracheal Intubation with the McGrath Mac X-Blade in a Patient with Expected Difficult Airway

Abstract

he McGrath MAC (Medtronic Medical; Minneapolis, USA) is a portable videolaryngoscope with a slim designed X-Blade to improve difficult intubation situations without occupying much space. Its effectiveness in failed direct laryngoscopy in patients with limited mouth opening under general anaesthesia was demonstrated previously with case reports. 1,2 However, its performance in awake oro-tracheal intubation has not been validated. We have documented a successful awake orotracheal intubation in a truly difficult intubation who had cardiac arrests during his previous two operations under general anesthesia. CASE REPORTWe have documented a successful awake intubation with the McGrath MAC X-Blade ( Figure 1) in a patient with an expected difficult airway with a history of two cardiac arrests due to hypoxia during the previous two operations in a private hospital. His anesthesiologist reported that the patient had no hypoxia tolerance. The patient was also working as a member of the medical team. His preoperative visit in our hospital revealed that; he was a 25-year-old male patient with a weight of 58 kg and a height of 168 cm. He was undergoing laparoscopic abdominal testis exploration. He had Klinefelter disease (chromosomal condition) and growth disorder. He had no his-A AB BS S T TR RA AC CT T We managed a 25 year-old male undergoing laparoscopic abdominal testis exploration using awake McGrath MAC X-Blade videolaryngoscopy. He had Mallampati IV (with phonation), macroglossia, mandibular protrusion B, no ability for jaw thrust maneuver, limited head flexion and a wing scapula. Cardiac arrest had occurred during his previous surgery related to his impossible mask ventilation. The oropharynx was topicalized with a 10% lidocaine spray. Three ml of 2% lidocaine was administered from the cricothyroid membrane. A continuous remifentanil infusion was started at the same time. The patient was intubated successfully with a McGrath MAC X-Blade at the first attempt and with a stylet inserted into a standard polyvinylchloride endotracheal tube under cricoid pressure with a Cormack-Lehane grade 2a and minimal gag reflex. He was transferred to the intensive care unit with an airway exchange catheter in place. He was discharged in good condition into his service the day after surgery. K Ke ey yw wo or rd ds s: : Awake intubation; difficult; video laryngoscope; McGrath MAC; X-Blade; expected