We read with interest Arslan et al’s paper [1], which aimed to evaluate the effectiveness of Airtraq ® and LMA CTrach^TM  in patients with simulated cervical spine injury. Their results suggested that the Airtraq appears to be more beneficial than the LMA CTrach in situations where it is necessary to secure the airway quickly. We describe an optional technique which may shorten endotracheal intubation time even further.

The Airtraq® optical laryngoscope (Prodol Ltd, Vizcaya, Spain) is a useful tool during difficult intubation,  and provides the operator with an improved view of the glottis [2]. However, tracheal tube placement using the Airtraq requires extra time to prepare the tracheal tube (lubrication and placement in the Airtraq lateral channel with the tip aligned with the end). For this reason, when we encounter a patient needing urgent tracheal intubation, we hesitate to use an Airtraq.

 We speculated that positioning the Airtraq first, and then advancing the tracheal tube via the lateral channel may shorten intubation time.  Therefore, we compared the time required for tracheal tube placement in a manikin using this latter technique and compared it to the time taken to intubate with the conventional Airtraq technique. We also measured the time taken to position the Airtraq first in the oropharynx (placement first technique) to Airtraq withdrawal from the oral cavity and compared this to the time taken for tracheal tube preparation (conventional technique) to Airtraq withdrawal from the oral cavity. Five anaesthetists performed both methods three times each, in a random order. They used the same Airtraq size and a 7mm internal diamerter tracheal tube (Parker medical, Highlands Ranch,CO,USA). 

All attempts resulted in successful tracheal intubation with smooth tube advancement along the lateral channel. The results showed that less time was required to achieve tracheal intubation by positioning the Airtraq first, compared with the conventional technique (8.5±0.5 s vs. 16.6 ±2.4 s respectively, mean±SD, P=0.001, using Student’s T test).

The weaknesses of the study include its unblinded nature, and small sample size. However, our results suggest that the Airtraq first technique results in faster tracheal intubation than the conventional technique. Therefore, we speculate that positioning the Airtraq first may be helpful in patients requiring urgent tracheal intubation.

Y Imashuku  

H Kitagawa 

Y Ishikawa

Department of Anesthesiology, Shiga University of Medical Science,

Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan

E-mail: imashuku@belle.shiga-med.ac.jp