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Awake AirTraq Intubation
The clinician may be confronted with special situations where the airway must
be secured while the patient is spontaneously breathing and maintaining their
own airway. Such cases include patients suspected or known to be difficult
to intubate and ventilate or patients in whom a neurological exam is desired
after intubation or prone positioning as may occur in the patient with a broken
and unstable spine.
An intubation undertaken with a spontaneously breathing patient
is often referred to as an “awake” intubation. However,
some patients may be so sedated as to become unresponsive whereupon
the intubation is more properly termed an “asleep, spontaneously
Before undertaking the intubation, the patient must be prepared
for airway instrumentation. There are many methods for preparing
the oral (and nasal) airway (antisialagogue, local anesthetic
injections, nebulized local anesthesia, benzodiazepine, narcotic
infusion, dexmetatomadine, transtracheal local, gargle and spit,
spray-and-go through the scope).
This patient has a large paratracheal mass. He is 5’9” and
98 Kg. He was a Mall II class airway, 3 finger-breadth mouth
opening and was able to prognath. He had an adequate hyoid-mental
A nasal cannula with continuous O2 and CO2 monitoring was placed.
His airway was prepared with glycopyrrolate (0.2 mg), midazolam
5 mg in divided doses and fentanyl 50 mcg, viscous lidocaine
2% gargle (3 min) and spit, and 10 mL topical lidocaine 4%.
This intubation is done while facing the patient thus reversing
the usual orientation which is from the head of the bed. The
patient is cooperative, opening his mouth upon request and the
AirTraq is gently advanced. Some manipulation is necessary to
find and then align the scope and ETT with the glottic opening.
The application of cricoid pressure by the assistant allows the
ETT to be advanced into the trachea. One may notice the condensation
on the ETT wall with every exhalation.
The AIRTRAQ is a single-use rigid optical laryngoscope and requires
a minimal mouth opening of 18 mm.
A battery operated low temperature LED light at the blade tip
provides illumination for up to 90 minutes. The image is transmitted
to a proximal viewfinder through a combination of lenses and
a prism allowing visualization of the glottis and surrounding
structures, and the tip of the tracheal tube. For the
inbuilt anti-fogging system to be effective, the LED must be
turned on at least 30 seconds before use.
Any style of endotracheal tube of inner diameter sizes 7.0 mm
through 8.5 mm can be used with the regular size and 6.0 to 7.5
mm for the planned small size (16 mm minimum mouth opening).
An optional color video camera clips onto the proximal viewfinder
and via a lightweight cable transmits to a display (such as a
TV), a useful feature for teaching purposes.
These features likely make the AIRTRAQ a good airway management
option for difficult airway scenarios where conventional direct
laryngoscopy might prove to be difficult or dangerous: patients
with anterior larynx, unstable cervical spine fracture, patients
in the sitting position, upper body burns, trauma, TMJ immobility,