Evaluation of tracheal intubation in several positions by the Pentax-AWS Airway Scope: a manikin study.
OBJECTIVE
In emergency situations, rescuers must occasionally secure the airway while the patient is in a restricted position rather than in the ideal supine position. We hypothesized that the Pentax-AWS Airway Scope (AWS) may be useful for emergent tracheal intubation in such positions.


METHODS
Thirteen non-anesthesia residents performed tracheal intubation on a simulated manikin in the supine (Supine), left-lateral decubitus (Left-LT), right-lateral decubitus (Right-LT), prone (Prone), and sitting (Sitting) position, respectively, to assess AWS performance.


RESULTS
Intubations were successful in all five positions. The time needed to secure the airway did not differ significantly between the Left-LT and Supine positions. Doctors required significantly more time to secure the airway in the Prone, Sitting, and Right-LT positions than in the Supine position. Visual analog scale (VAS) scoring of the subjective difficulty of laryngoscopy was lower in the Supine position rather than in the Right-LT, Prone, and Sitting positions. The VAS score of subjective difficulty of tracheal tube passage through the glottis was significantly higher in the Sitting position than in the other four positions.


CONCLUSIONS
Although tracheal intubations with AWS in all five positions tested were successful, intubation with the patient in the Sitting, Right-LT, and Prone positions was more difficult and required more time than that in the Supine position.
Komasawa
Nobuyasu
N
Department of Anesthesiology, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya, Hyogo 663-8501, Japan. nkomazaw@hyo-med.ac.jp
Ueki
Ryusuke
R
Itani
Motoi
M
Nomura
Hajime
H
Nishi
Shin-ich
SI
Kaminoh
Yoshiroh
Y
D000776:Anesthesiology / Q000193:education; D002983:Clinical Competence; D018592:Cross-Over Studies; D005931:Glottis / Q000033:anatomy & histology; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy; D008348:Manikins; D011187:Posture / Q000502:physiology*; D016684:Prone Position / Q000502:physiology; D016683:Supine Position / Q000502:physiology