title: An algorithm for difficult airway management, modified for modern optical devices (Airtraq laryngoscope; LMA CTrach™): a 2-year prospective validation in patients for elective abdominal, gynecologic, and thyroid surgery.
abstract: BACKGROUND
  Because algorithms for difficult airway management, including the use of new optical tracheal intubation devices, require prospective evaluation in routine practice, we prospectively assessed an algorithm for difficult airway management that included two new airway devices.
  
  
  METHODS
  After 6 months of instruction, training, and clinical testing, 15 senior anesthesiologists were asked to use an established algorithm for difficult airway management in anesthetized and paralyzed patients. Abdominal, gynecologic, and thyroid surgery patients were enrolled. Emergency, obstetric, and patients considered at risk of aspiration were excluded. If tracheal intubation using a Macintosh laryngoscope was impossible, the Airtraq laryngoscope (VYGON, Ecouen, France) was recommended as a first step and the LMA CTrach™ (SEBAC, Pantin, France) as a second. A gum elastic bougie was advocated to facilitate tracheal access with the Macintosh and Airtraq laryngoscopes. If ventilation with a facemask was impossible, the LMA CTrach™ was to be used, followed, if necessary, by transtracheal oxygenation. Patient characteristics, adherence to the algorithm, efficacy, and early complications were recorded.
  
  
  RESULTS
  Overall, 12,225 patients were included during 2 yr. Intubation was achieved using the Macintosh laryngoscope in 98% cases. In the remainder of the cases (236), a gum elastic bougie was used with the Macintosh laryngoscope in 207 (84%). The Airtraq laryngoscope success rate was 97% (27 of 28). The LMA CTrach™ allowed rescue ventilation (n = 2) and visually directed tracheal intubation (n = 3). In one patient, ventilation by facemask was impossible, and the LMA CTrach™ was used successfully.
  
  
  CONCLUSIONS
  Tracheal intubation can be achieved successfully in a large cohort of patients with a new management algorithm incorporating the use of gum elastic bougie, Airtraq, and LMA CTrach™ devices.
authors.affiliation: Anaesthesia and Intensive Care Unit Department, Jean Verdier University Hospital of Paris, Bondy, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Amathieu
authors.forename: Xavier
authors.initials: X
authors.lastname: Combes
authors.forename: Widad
authors.initials: W
authors.lastname: Abdi
authors.forename: Loutfi El
authors.initials: LE
authors.lastname: Housseini
authors.forename: Ahmed
authors.initials: A
authors.lastname: Rezzoug
authors.forename: Andrei
authors.initials: A
authors.lastname: Dinca
authors.forename: Velislav
authors.initials: V
authors.lastname: Slavov
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bloc
authors.forename: Gilles
authors.initials: G
authors.lastname: Dhonneur
mesh_terms: D000005:Abdomen / Q000601:surgery; D000402:Airway Obstruction / Q000628:therapy*; D000465:Algorithms; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D017214:Laryngeal Masks; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D013961:Thyroid Gland / Q000601:surgery