title: An observational study of the feasibility of Airtraq guided intubations with Ring Adair Elvin tubes in pediatric population with cleft lip and palate.
abstract: BACKGROUND
  The airway management requires refined skills and technical help when associated with cleft lip and palate. Airtraq has improved our airway management skills and has been successfully used for rescue intubation in difficult pediatric airways.
  
  
  OBJECTIVE
  This study was to evaluate the efficacy of Airtraq as the primary intubation device in patients with cleft lip and palate. The study adheres to the STrengthening the Reporting of OBservational Studies Epidemiology Statement.
  
  
  METHODS
  A total of 85 children posted consecutively for lip and palate repair were enrolled. Children were intubated with Ring Adair Elvin (RAE) tube using size 1 and 2 of Airtraq device. The design of Airtraq has an anatomical limitation to hold RAE tubes. The preformed bend of the tube was straightened with a malleable stylet. The intubations were assessed for device manipulations and time taken for glottis visualization and intubation, airway complications such as bleeding, laryngospasm and failed intubations.
  
  
  METHODS
  The outcome data were reported as numbers and percentages or range with identified median value, where applicable.
  
  
  RESULTS
  The success rate of Airtraq guided intubations was 98.21%. The cumulative insertion times and intubation times were 31.50 ± 12.57 s and 48.04 ± 35.73 s respectively. Airtraq manipulations were applied in 25.45% subjects.
  
  
  CONCLUSIONS
  The presence of cleft lip or palate did not hamper the insertion of Airtraq. The use of malleable stylet to facilitate the loading of the preformed tube into the guide channel is a simple and efficacious improvisation. Airtraq can be utilized as a primary intubation device in children with orofacial clefts.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Ashima
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Durga
authors.affiliation: Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Indira
authors.initials: I
authors.lastname: Gurajala
authors.affiliation: Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
authors.forename: Gopinath
authors.initials: G
authors.lastname: Ramchandran
keywords: Airtraq; Ring Adair Elvin tubes; cleft palate; intubation; pediatric