EDITOR:
The Airtraq® (Prodol Meditec, Vizcaya, Spain) [Reference Maharaj, Higgins, Harte and Laffey1,Reference Maharaj, Costello, Higgins, Harte and Laffey2] is an optical laryngoscope which obtains views of the glottis without the need for alignment of the oral, pharyngeal and laryngeal axes (Fig. 1). It consists of two channels, one which houses an endotracheal tube and another which contains an optical system. The device is inserted in a similar fashion to insertion of an intubating laryngeal mask airway with the tip of the Airtraq® eventually sitting in the vallecula. In this position, the glottis is viewed indirectly through a proximal viewfinder and the endotracheal tube advanced through the vocal cords. Recently, there have been two manikin studies that have described its performance. The device was evaluated in normal and simulated difficult airways. Until now, there have been no descriptions of its use in live subjects. We describe two patients in whom the Airtraq®, compared with the Macintosh blade, provided superior views of the larynx facilitating endotracheal intubation.
Figure 1 The Airtraq.
The first case was an anxious 59-yr-old male who was to undergo a total laryngectomy for cancer of the larynx. Anaesthetics had been complicated previously by Grade 4 views at direct laryngoscopy necessitating awake intubations. Initially, topical anaesthesia was applied to the upper airway and glycopyrolate administered intravenously. A target controlled infusion of propofol and remifentanil was commenced at a sedation dose. A Grade 4 view was confirmed at direct laryngoscopy using a Macintosh laryngoscope. The Airtraq® was subsequently used providing Grade 1 views of the glottis and easy passage of an endotracheal tube.
The second case was a 42-yr-old female who presented for a routine septoplasy. Past medical history included pain in the temperomandibular joint during mastication and reduced mouth opening was noted on examination. Following induction of anaesthesia with propofol, fentanyl and atracurium, a Grade 3 view of the glottis was achieved at direct laryngoscopy using the Macintosh laryngoscope. When the Airtraq® was employed, a Grade 1 view of the glottis was observed and endotracheal intubation allowed to proceed uneventfully.
The Airtraq® is cheap and extremely easy to use, and we believe it should be included in the anaesthetist’s armamentarium for the difficult airway. Unlike the intubating laryngeal mask, endotracheal intubation using the Airtraq® is achieved under direct visualization; however, more patient studies are required.
