Bibliografia 1

Copyright © 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology 2011; 114: 25–33

An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrachTM)

A 2-Year Prospective Validation in Patients for Elective Abdominal, Gynecologic, and Thyroid Surgery

Roland Amathieu, M.D.,* Xavier Combes, M.D.,* Widad Abdi, M.D.,† Loutfi El Housseini, M.D.,† Ahmed Rezzoug, M.D.,† Andrei Dinca, M.D.,† Velislav Slavov, M.D.,† Se ́ bastien Bloc, M.D.,† Gilles Dhonneur, M.D., Ph.D.‡

ABSTRACT

Background: Because algorithms for difficult airway man- agement, including the use of new optical tracheal intubation devices, require prospective evaluation in routine practice, we prospectively assessed an algorithm for difficult airway management that included two new airway devices. Methods: After 6 months of instruction, training, and clin- ical testing, 15 senior anesthesiologists were asked to use an established algorithm for difficult airway management in anesthetized and paralyzed patients. Abdominal, gyneco- logic, and thyroid surgery patients were enrolled. Emer- gency, obstetric, and patients considered at risk of aspiration were excluded. If tracheal intubation using a Macintosh laryngoscope was impossible, the Airtraq laryngoscope (VYGON, Ecouen, France) was recommended as a first step and the LMA CTrachTM (SEBAC, Pantin, France) as a second. A gum elastic bougie was advocated to facilitate tracheal access with the Macintosh and Airtraq laryngoscopes. If ven- tilation with a facemask was impossible, the LMA CTrachTM was to be used, followed, if necessary, by transtracheal oxy- genation. Patient characteristics, adherence to the algorithm, efficacy, and early complications were recorded.

Results: Overall, 12,225 patients were included during 2 yr. Intubation was achieved using the Macintosh laryngoscope in 98% cases. In the remainder of the cases (236), a gum elastic bougie was used with the Macintosh laryngoscope in 207 (84%). The Airtraq laryngoscope success rate was 97% (27 of 28). The LMA CTrachTM allowed rescue ventilation (n 􏰀 2) and visually directed tracheal intubation (n 􏰀 3). In one patient, ventilation by facemask was impossible, and the LMA CTrachTM was used successfully.

What We Already Know about This Topic

• Uniform application of a difficult airway algorithm might de- crease the incidence of hypoxic brain damage during anes- thesia induction

What this Article Tells Us that is New

• In a large prospective study, application of a simple airway algorithm, including use of new visual intubation devices, achieved high adherence rate and successful tracheal intuba- tion in all patients with difficult airways􏰆

This article is accompanied by two Editorial Views. Please see: Schmidt U, Eikermann M: Organizational aspects of dif- ficult airway management: Think globally, act locally. ANESTHE- SIOLOGY 2011; 114:3–6; Isono S, Ishikawa T: Oxygenation, not intubation, does matter. ANESTHESIOLOGY 2011; 114:7–9.