Comparsion of the airtarq video laryngoscope vs Macintosh laryngoscope for tracheal intubation in the pediatric patients

Airway management is an important aspect of anaesthesiaadministration. Tracheal intubation is often required in general anaesthesia.Failure to achieve intubation may lead to various complications like inadequateoxygen delivery, hypoxia, aspiration of gastric contents and is one of theimportant causes of morbidity and mortality in susceptible patients.

For tracheal intubation laryngoscopy is to be done. Macintoshlaryngoscope is still considered the gold standard for endotracheal intubationsince it was first used in 1943. Its useful in both adults and paediatricpatients. Use of this laryngoscope requires a particular morning sniffingposition of the patient leading to alignment of three axises(oral, pharyngealand tracheal). There is movement at atlanto-occipital joint. Hence in caseswith cervical vertebrae fractures, it is hazardous to achieve this position.Laryngoscopy by this laryngoscope also requires adequate mouth opening whichmay not be there in each and every paient. View of the vocal cords is also fromdistance and we have to keep our eyes near to patients mouth.

In last few years efforts have been made to overcome theseproblems and to evolve a device which can be used in all such situations whereMacinosh laryngoscope is not much helpful. Videolaryngoscope (VL) is developedthis way. The device was originally designed to handle difficult intubation butwith passage of time these are becoming more common in regular use forlaryngoscopy and tracheal intubation in normal airways.

Advantages of videolaryngoscope(VL) are that they can be used inneutral position, view is clear and can be seen on a big screen (no need tokeep eyes near to patients mouth) and even in small mouth openings these arehelpful. Various types of VLs are now a days available in market. They aremainly with side channel for endotracheal tube or without channel. Commonlyused VLs are Airtraque and King vision.

Two types of Airtraq VLare available in which one has reusable optics and disposable channeled blade withrechargeable battery and another one having disposable rigid opticallaryngoscope. The blade of the Airtraq consists of two side by side channels,one channel act as a conduit through which endotracheal tube can be passed,while the other channel contains a series of lenses, prisms and mirrors thattransfers the image from the illuminated tip to a proximal viewfinder, giving ahigh quality wide-angle view of the glottis, surrounding structures and the tipof the tracheal tube. A battery powered light source is located on the edge ofthe blade. It has an anti fog system for optics. It can be connected to theAirtraq Wireless display recorder. The CMOS Camera automatically transmitsimages by Radiofrequency at 5.8Ghz, making it possible to work wireless whenusing the Airtraq wireless Display Recorder. The Airtraq Camera is powered byits internal rechargeable battery.

Considering the advantages of Airtraq VL, we wish to carry out thisstudy to evaluate and compare the efficacy of Airtraq video laryngoscope with conventionallyused  Macintosh laryngoscope forintubation in pediatric patients posted for elective surgery under generalanaesthesia

•      The aims of the study are –

-          To compare Airtraq video laryngoscope with Macintosh laryngoscope in terms of following parameters:

  1.      Intubation Time

2.      No. of attempts of device insertion

3.      Quality of visualization of Glottic aperture

4.      Optimization maneuvers required for intubation

5.      Hemodynamic parameters

6.      Airway trauma and complications