The use of the Airtraq® optical laryngoscope for routine tracheal intubation in high-risk cardio-surgical patients

Abstract

Background: The Airtraq® optical laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel disposable device facilitating tracheal intubation in routine and difficult airway patients. No data investigating routine tracheal intubation using the Airtaq® in patients at a high cardiac risk are available at present. Purpose of this study was to investigate the feasibility and hemodynamic implications of tracheal intubation with the Aitraq® optical laryngoscope, in high-risk cardio-surgical patients.

Methods: 123 consecutive ASA III patients undergoing elective coronary artery bypass grafting were routinely intubated with the Airtraq® laryngoscope. Induction of anesthesia was standardized according to our institutional protocol. All tracheal intubations were performed by six anesthetists trained in the use of the Airtraq® prior.

Results: Overall success rate was 100% (n = 123). All but five patients trachea could be intubated in the first attempt (95,9%). 5 patients were intubated in a 2nd (n = 4) or 3rd (n = 1) attempt. Mean intubation time was 24.3 s (range 16-128 s). Heart rate, arterial blood pressure and SpO2 were not significantly altered. Minor complications were observed in 6 patients (4,8%), i.e. two lesions of the lips and four minor superficial mucosal bleedings. Intubation duration (p = 0.62) and number of attempts (p = 0.26) were independent from BMI and Mallampati score.

Conclusion: Tracheal intubation with the Airtraq® optical laryngoscope was feasible, save and easy to perform in high-risk patients undergoing cardiac surgery. In all patients, a sufficient view on the vocal cords could be obtained, independent from BMI and preoperative Mallampati score.

Trial registration: DRKS 00003230.

Figure 1

The duration of intubation did not correlate with the BMI (p = 0.34) (Figure 1A) or the Mallampati score (p = 0.14) (Figure 1B). Data are presented as means ± standard deviation.

Figure 2

No significant correlation between the number of attempts and the BMI (P = 0.70) (Figure 2A) or the Mallampati score (P = 0.69) (Figure 2B) could be shown. Data are presented as means ± standard deviation.

Figure 3

At T3-one minute after intubation-heart rate increased (P < 0.029) (Figure 3A) and ABP decreased (P < 0.001) (Figure 3B). Both changes were judged clinically irrelevant. Five minutes after tracheal intubation (T4) no more differences to the baseline values could be detected (n.s.). Data are presented as means ± standard deviation.

Figure 4

Oxygen saturation [SpO₂] during tracheal intubation: After initial pre-oxygenation and bag valve ventilation (T2), SpO₂ remained stable at T3 and T4. Data are means +/- standard deviation.