title: Tracheal intubation of a difficult airway using Airway Scope, Airtraq, and Macintosh laryngoscope: a comparative manikin study of inexperienced personnel.
abstract: BACKGROUND
  The Airway Scope (AWS) (Pentax-AWS, Hoya Corp., Tokyo, Japan) and the Airtraq (ATQ) (Prodol, Vizcaya, Spain) have similarities in the novel structures of their blades. In this study, we evaluated the ease of use of the AWS and ATQ compared with the Macintosh laryngoscope (ML) by inexperienced personnel in a simulated manikin difficult airway.
  
  
  METHODS
  Twenty-four fifth-year medical students with no previous experience in tracheal intubation participated in this study. We used an advanced patient simulator (SimMan(R), Laerdal Medical, Stavanger, Norway) to simulate difficult airway scenarios including cervical spine rigidity, limited mouth opening, and pharyngeal obstruction. The sequences in selecting devices and scenarios were randomized. Success rates for tracheal intubation, and the time required for visualization of the glottis, tracheal intubation, and inflation of the lungs, and the number of optimization maneuvers and dental click sounds were analyzed. The 3 different intubation devices were tested in 4 different scenarios by 24 students.
  
  
  RESULTS
  Both the AWS and ATQ had very high success rates of tracheal intubation compared with the ML (AWS 100%*; ATQ 98%*; and ML 89%; *P < 0.05 AWS, ATQ versus ML). The time to intubation with the AWS was significantly shorter than with the ATQ and ML (AWS 11 +/- 6 seconds; ATQ 16 +/- 12 seconds; and ML 16 +/- 11 seconds; *P < 0.05 AWS versus ATQ, ML). The number of optimization maneuvers with the AWS was significantly lower than with the ATQ and ML. There were significantly more audible dental click sounds with the ML than with the AWS and ATQ.
  
  
  CONCLUSIONS
  Both the AWS and ATQ may be suitable devices for difficult intubation by inexperienced personnel in this manikin simulated scenario. Further studies in a clinical setting are necessary to confirm these findings.
authors.affiliation: Department of Emergency and Critical Care Medicine, Hiroshima University, Hiroshima 734-8551, Japan. tanigawa@hiroshima-u.ac.jp
authors.forename: Liangji
authors.initials: L
authors.lastname: Liu
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanigawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Kusunoki
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tamura
authors.forename: Kohei
authors.initials: K
authors.lastname: Ota
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamaga
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Kida
authors.forename: Tadatsugu
authors.initials: T
authors.lastname: Otani
authors.forename: Takuma
authors.initials: T
authors.lastname: Sadamori
authors.forename: Taku
authors.initials: T
authors.lastname: Takeda
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hirohashi
mesh_terms: D000402:Airway Obstruction / Q000628:therapy; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D004558:Electric Stimulation; D006801:Humans; D007431:Intraoperative Complications; D007442:Intubation, Intratracheal / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D007830:Larynx / Q000033:anatomy & histology; D008348:Manikins; D009055:Mouth / Q000033:anatomy & histology; D010608:Pharyngeal Diseases / Q000628:therapy; D013334:Students