Nasotracheal intubation using the Airtraq(R) optical laryngoscope in patients with a difficult airway.

摘要

We were interested in a recently published case report describing application of the Airtraq~R optical laryngoscope (Airtraq) for nasotracheal intubation (NTI) in a patient with a predicted difficult airway who was undergoing oral surgery. The authors are to be congratulated on their successful airway management in this challenging case. However, topical anesthesia was performed on only the naris and nasopharynx. In our experience, topical anesthesia of the trachea is also important for successful tracheal intubation and to ensure comfort of the awake patient. Moreover, insertion of a MADgic~R laryngotracheal atomizer (MAD-LTA) (Wolfe Tory Medical Inc., Salt Lake City, UT, USA) through the oral and nasal cavities for topical anesthesia of the supraglottic, glottic, and infraglottic areas can be performed quite easily under the visual field of the airway provided by the Airtraq. This technique is well tolerated by the awake sedated patient, possibly due to less stimulation of the oropharyngolaryngeal structures during laryngeal exposure using the Airtraq, as it does not require a "line of sight" to visualize the airway anatomy.