In-line head and neck positioning facilitates tracheal intubation with the Airway Scope.

摘要

To the Editor: The Airway Scope, a new videolaryngoscope for tra-cheal intubation, has an anatomically shaped blade that provides a view of the glottis through a non-line-of sight view with minimal airway manipulation. In contrast, the conventional Macintosh laryngoscope requires certain airway manipulation for laryngeal exposure, which involves alignment of the oral, pha-ryngeal and tracheal axes. To align these three axes, a pillow is placed under the head to facilitate direct exposure of the larynx. With respect to the Airway Scope, the importance of such a step is not clear. We report here the results of a study performed on a manikin to describe the preferable head and neck positioning for laryngeal exposure using the Airway Scope. This evaluation was performed as a part of our previously reported investigation. In all, 40 operators intubated a 7-mm tracheal tube into the trachea of a manikin (Airway Management Trainer, Laerdal Medical Japan). Intubations with the aid of the Airway Scope were performed in both an in-line head and neck position without a pillow and in the sniffing position with a pillow (occipital elevation by 7 cm). The mean time required for accurate instrumentation was significantly shorter in an in-line head and neck position (8.9 +- 3.1 sec) than in the sniffing position (14.0 +- 10.8 sec, P< 0.01, +- SD, paired t test). Our finding suggests that the device is particularly well suited for use in patients with an in-line head and neck position for proper airway management especially in trauma patients with possible injury of the cervical spine where movement of the head and neck might be undesirable. Placement of a pillow under the head for the sniffing position during tracheal intubation with the Airway Scope does not seem to provide any advantage or speedier instrumentation.