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James Doyle wrote 03-31-2011 02:45:46 pm
Firstly I am in agreement that direct laryngsocopy will remain an essential skill to be deemed a competent airway clinican.

I would suggest that the use of an airway scope (eg the Penatx AWS) is useful in more than just limited neck moveoment. A mouth opening of 20mm is required for use of the AWS, this is fairly impressive as even with direct laryngoscopy and a bougie many clinicans would be hard pressed to be successful with less than 20mm mouth opening.

I recently had a demo Pentax AWS and using it on our Laerdal ALS simman with pharyngeal oedema on (giving most clinicans a grade 4 view) I was able to teach my intern to intubate using the AWS on the first and every subsequent go, meanwhile laryngoscopy didnt get her far at all. This is just anecdotal but...

If there arnt contraindications for its use, and there is emerging evidence of being easy to use and teach [Anaesthesia of Great Britain & Ireland, 2008 (63), 641-647] - why isnt there an AWS in every MET bag??

wrote 04-01-2011 04:15:40 pm

Anthony Tzannes wrote 02-16-2011 02:07:40 am
I think that direct laryngoscopy will still have a place for some time to come. I have used both the Airtraq and the very similar Pentax video laryngoscopes. The two things both have in common is that they require greater mouth opening than a standard laryngoscope and they don't enable direct vision.

For those patients with limited mouth opening or abnormal anatomy limiting the amount of space, direct laryngoscopy is more likely to be successful than using indirect video laryngoscopy.

And for those situations where either a foreign body needs to be removed or where there is supraglottic oedema (where intubation over a bougie is more easily achieved then pushing a much larger ETT against oedematous tissue and hoping it finds the gap..) direct vision can't be beat.

The place for these devices in my mind is in the setting of either a high anterior larynx or limited neck movement (either actual or to protect possible C Spine injury). Here they are extremely useful and can convert a grade IV brown pants moment into a grade I view.

In my opinion direct laryngoscopy is thus an essential skill that does require a significant amount of experience and ongoing use to be most effective. The indirect videolaryngoscopes do make intubation easier in certain circumstances and are more easily learnt than direct laryngoscopy (plus are easily learnt if already familiar with direct laryngoscopy) and thus I believe that direct laryngoscopy should remain the mainstay of airway management so th

Todd Fraser wrote 02-25-2011 03:29:10 pm
Just to stoke the fires of debate a bit, a recent observational trial found a high success rate for Glidoscope in theatre, including those in patients where traditional methods had failed, and for relatively untrained users.

Aziz MF et al. Routine clinical practice effectiveness of the Glidescope in difficult airway management: An analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology 2011 Jan; 114:34.

Todd Fraser wrote 04-18-2011 04:41:50 pm
We had a look at the Pentax AWS a few weeks ago and I was extremely impressed. It's so easy, my 8 year old could do - if only we had "Crash Airway" on Playstation!

Jo Butler wrote 07-29-2011 12:53:34 pm
God no.

I'm a firm believer in doing what is familiar when you are in a crisis. Using those things to dig yourself out of trouble should really only come after you have exhausted all other possibilities.

If you are going to use them, you would need plenty of practice in very ordinary situations.

Rutger van Raalte wrote 03-28-2011 12:47:56 pm
I agree that direct laryngoscopy will not be replaced by the AIRTRAQ although evidence for its usefulness is increasing. Interestingly, in a prehospital setting success rate for intubation performed by experienced anesthesiologists or EMS physicians using the AIRTRAQ was far less successful than direct laryngoscopy.
The success rate of endotracheal intubation with direct laryngoscopy was 105 of 106 intubations vs. 50 of 106 intubations when the AIRTRAQ was used. Personally I would like to be able to use the AIRTRAQ in difficult airways if direct laryngoscopy fails although I have never used it.
Crit care med. 39(3) March 2011