Patient‐inserted awake Airtraq ® ‐assisted intubation

I read with interest the article by Moore et al. regarding awake videolaryngoscopy-assisted tracheal intubation and note that gagging was observed in at least 50% of the enrolled patients [1]. When I read of a method using the Airtraq® laryngoscope (Prodol Meditec S.A., Vizcaya, Spain) in awake patients [2], I recalled the description of a patient self-inserting an oral airway [3]. What immediately occurred to me was that these two concepts could be combined in order to make the procedure more acceptable and better tolerated. Since adopting this idea, we have performed more than 25 successful patient-inserted awake Airtraq intubations at our institution. Below is a case report to outline the technique. A 69-year-old female with suspected recurrent laryngeal carcinoma was scheduled for microlaryngoscopy. One year previously intubation had been documented as grade-3, and she had received radiation therapy. There was no stridor. After obtaining consent for the planned intubation technique, it was explained that she would control insertion of the device and be able to remove it at any time if she was uncomfortable. On arrival in the anaesthetic room, standard monitoring was applied and oxygen was administered via nasal cannulae. The patient received glycopyrronium 200 μg intravenously and ‘conscious sedation’ was achieved using a target controlled infusion of remifentanil (2.0–3.0 ng.ml−1). Following two 60-s periods of gargling 5 ml lidocaine 2%, the Airtraq, connected to a monitor, was handed to the patient to insert. Optimisation manoeuvres were guided by gently placing a hand on the patient’s hand (Fig. 1). Topicalisation of the larynx was achieved using four sprays of 10% lidocaine (40 mg) under direct vision. An attempt to pass a 4.5-mm laser tracheal tube was unsuccessful and so a 10-Ch tracheal tube guide was introduced, over which a 5.0-mm microlaryngeal tube was passed. The patient tolerated the procedure well. General anaesthesia was then induced intravenously and the case proceeded uneventfully. Patient-controlled Airtraq insertion. From our experience, patients perform this task with remarkable ease. It appears that the gag reflex poses fewer problems by allowing the patient to be in control of Airtraq insertion.