Nasotracheal Intubation Using the Airtraq Versus Macintosh Laryngoscope: A Manikin Study
The Airtraq laryngoscope is a new intubation device that provides a non–line-of-sight view of the glottis. We evaluated this device by comparing the ease of nasotracheal intubation on a manikin with the use of Airtraq versus the Macintosh laryngoscope with and without Magill forceps. Nasotracheal intubation on a manikin was performed by 20 anesthesiologists and 20 residents with the Airtraq or Macintosh laryngoscope. The mean (± SD) time required for nasotracheal intubation by the residents was significantly shorter with the Airtraq laryngoscope than with the Macintosh laryngoscope (16 ± 7 sec vs 22 ± 10 sec; P < .001), but no difference in intubation time was observed between Airtraq (15 ± 11 sec) and Macintosh (13 ± 6 sec) laryngoscopy by the anesthesiologists. The Magill forceps was used more frequently to facilitate intubation with the Macintosh laryngoscope than with the Airtraq laryngoscope in both groups of operators 7(P < .001). The Airtraq laryngoscope scored better on the visual analog scale than did the Macintosh laryngoscope in both groups of operators (P < .05). The Airtraq laryngoscope offers potential advantages over standard direct laryngoscopy for nasotracheal intubation.Abstract
Lateral view of the Airtraq laryngoscope. A close proximity view of the vocal cords is transmitted to a viewfinder at the top of the scope through a conventional optical system. The device includes a battery-powered light source and an anti-fogging system.
The image of the glottis in the AirSim manikin. The device is passed into the mouth over the tongue, and the tip of the scope is placed in the vallecula.
Lateral radiographs of the manikin taken during nasotracheal intubation. ETT indicates tip of an endotracheal tube; M, tip of the Macintosh blade; A, tip of the Airtraq; and *, vocal cords. (a) The endotracheal tube was nasally advanced in the pharynx before laryngoscopy. (b) Intubation with the Macintosh laryngoscope. The Macintosh laryngoscope significantly elevates the glottis; consequently, the nasally introduced tube slides upward and then downward in sequence. To align the tube tip with the glottic inlet, the Magill forceps is often used. (c) Intubation with the Airtraq. The Airtraq laryngoscope preserves the configuration of the airway in its original position. Pushing the nasally introduced tube allows it to advance smoothly into the glottic inlet.
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