Abstract :
Background: The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to
facilitate tracheal intubation. The Airtraq is a new, single use, indirect laryngoscope introduced into clinical practice in 2005.
It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of
the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis.
We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful
intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation. Difficult or
unsuccessful tracheal intubation is one of the important causes for morbidity and mortality in susceptible patients. Almost
30% of the anaesthesia-related deaths are induced by the complications of difficult airway management and more than
85% of all respiratory related complications cause brain injury or death. Nowadays, due to the advances in technology, new
video laryngoscopic devices became available. Endotracheal intubation of patients is an effective method for controlling
airway and breathing. However, laryngoscopy and Endotracheal Intubation is not easy in every case. This study was
carried out to evaluate and compare the efficacy of Airtraq (AL) and Macintosh Laryngoscopes (ML) in intubating patients.
Methods: This randomized controlled study was carried out in 40 adult ASA I and II patients after written informed consent
and approval of the ethical committee, randomly categorized into two equal groups. All patients were subjected to same
anaesthetic protocol. Group I patients were intubated using AL and group II patients were intubated using ML.
Hemodynamic measurements and oxygen saturation were recorded. Intubation criteria for both groups including (duration
of intubation procedure, number of attempts, number of optimization maneuvers, Cormack and Lehane grade at
laryngoscopy, Intubation Difficulty Scale score (IDS), rate of successful placement of endotracheal tube, neck mobility
during laryngoscopy and intubation complications were recorded. Data statistically analyzed using SPSSR software using
(t and v2 tests) and P < 0.05 considered significant. Results: There was statistically significant increase in both heart rate
and mean arterial blood pressure values following intubation in ML group than AL, oxygen saturation showed no significant
difference between the two groups. Duration of intubation was statistically significant longer in ML group and needed more
optimization maneuvers than the AL group, while for the number of intubation attempts; there was no statistically significant
difference between the two groups. Both the Cormack and Lehane grading and IDS score values have shown statistically
significant higher values in ML group. Conclusion: The Airtraq Laryngoscope offers a new approach for the management
of difficult airway like patients with potential cervical spine injury, it is fast, easy to use, gets an easy view of the larynx
without moving the cervical spines or causing hemodynamic stimulation.
Keyword :
laryngoscope, Airtraq, Endotracheal intubation, Cormack and Lehane grading.