Nasal tracheal intubation improves the success rate when the Airway Scope blade fails to reach the larynx
Hualien, Taiwan
* E-mail: hamalai{at}yahoo.com.tw
Editor—The Pentax-AWS® (Airway Scope®, AWS; Pentax Corporation, Tokyo, Japan) is a video laryngoscope designed to facilitate tracheal intubation under direct vision.1 Several articles demonstrate it is a potentially useful device for orotracheal intubation in patients with difficult airways,2 because it provides a better view of the glottis than conventional laryngoscopy. However, one of the disadvantages of this device is that in some cases the blade, known as an INTLOCK, fails to reach the larynx3 and intubation is not possible.
We have used the AWS in routine orotracheal intubation in 100 consecutive cases; the failure of the AWS to reach the larynx made intubation impossible in 17 cases. This may be due to there being one fixed-size blade with an anatomically curved shape that seems to fit most, but not all, adult patients. To resolve this problem, and in view our previous experience with another video-laryngoscope4 5 (GlideScope®), we tried nasotracheal intubation in these patients. An intubating stylet was inserted into the endotracheal tube to facilitate curving of the tube. All 17 patients were intubated successfully and smoothly without difficulties. We feel that the AWS is potentially a useful device for management of a difficult airway, but the lack of different-sized INTLOCKs may limit its clinical application. Nasotracheal intubation may be an alternative choice in such a situation and help to resolve this problem at the present time.
References
1 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.[CrossRef][Web of Science][Medline]
2 Koyama Y, Inagawa T, Miyashita T, et al. Comparison of the Airway Scope, gum elastic bougie and fibreoptic bronchoscope in simulated difficult tracheal intubation: a manikin study. Anaesthesia (2007) 62:936–9.[CrossRef][Web of Science][Medline]
3 Sasano N, Yamauchi H, Fujita Y. Failure of the Airway Scope to reach the larynx. Can J Anaesth (2007) 54:774–5.[Web of Science][Medline]
4 Lai HY, Wong PK, Yang YL, et al. Facilitated insertion of a nasogastric tube in tracheal intubated patients using the GlideScope. Br J Anaesth (2006) 97:749–50.
5 Lai HY, Chen IH, Chen A, et al. The use of the GlideScope for tracheal intubation in patients with ankylosing spondylitis. Br J Anaesth (2006) 97:419–22.
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