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Correspondence |
Jichi Medical University, Tochigi, Japan, E-mail: yhira{at}jichi.ac.jp
To the Editor:
Rigid fibreoptic laryngoscopes provide a non-line-of-sight view of the airway. Tracheal intubation using a rigid laryngoscope is one of the alternative methods used for rescue intubation when physicians encounter a difficult airway. However, the device is not widely used, in part because it is perceived as being difficult to use.1 The Airway Scope (AWS; Pentax Corp., Tokyo, Japan) is a new intubation device that allows visualization of the glottis without requiring alignment of the oral, pharyngeal and tracheal axes.2 We recently compared the ease of intubation with the AWS compared to the Bullard laryngoscope (BLS; Circon ACMI, Stamford, CT, USA), as used by novice personnel with a manikin model.
Nine anesthesia residents, with no prior experience using either the AWS or the BLS, were given a standardized demonstration of both devices. Each participant was then allowed to practice intubations using each device on an Intubation Trainer (Laerdal Medical, Tokyo, Japan). At each stage, all participants could successfully perform tracheal intubation with both devices. Each participant performed tracheal intubation using a 7-mm cuffed tracheal tube on a SimMan manikin (Laerdal Medical, Tokyo, Japan) in the following laryngoscopy scenarios: 1) normal airway with neutral head and neck position, 2) difficult laryngoscopy scenario with rigid cervical spine, and 3) difficult laryngoscopy scenario with tongue edema. The sequence in which each participant used the AWS and the BLS was randomly assigned using numbers drawn from a random numbers table. Each intubator repeated the examination protocol three times, and the sequence of the devices was alternated at the second airway instrumentation. The duration of each tracheal intubation attempt was defined as the time taken from insertion until removal of the blade from between the teeth. Participants scored the ease of use of each device on a visual analogue scale (VAS; from 0 = extremely easy to 100 mm = extremely difficult). The quality of the laryngeal view and intubation status using each device was also scored on a VAS scale (0 = extremely good to 100 mm = extremely poor). The two groups were compared using Student’s t test, and data are presented as mean ± SD. A P value < 0.05 was considered statistically significant.
For each scenario, the duration of intubation was significantly shorter with the AWS compared to the BLS (Table
) and the degree of intubation difficulty was less with the AWS compared to the BLS (18 ± 14 vs 72 ± 13, P < 0.0001). The quality of the laryngeal view based on VAS scores was also better with the AWS compared to the BLS (15 ± 16 vs 74 ± 25, P < 0.0001)
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Footnotes
Support was provided solely from institutional and/or departmental sources. The author has no affiliation with any manufacturer of any devices described in the manuscript.
Accepted for publication January 11, 2007.
References
1 Wong DT, Lai K, Chung FF, Ho RY. Cannot intubate-cannot ventilate and difficult intubation strategies: results of a Canadian national survey. Anesth Analg 2005; 100: 1439–46.
2 Koyama J, Aoyama T, Kusano Y, et al. Description and first clinical application of AirWay Scope for tracheal intubation. J Neurosurg Anesthesiol 2006; 18: 247– 50.[Medline]
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