Airway Scope for Tracheal Intubation in the Lateral Position

Abstract

Tracheal intubation in the lateral position is difficult because the laryngeal view is compromised during direct laryngoscopy. The Airway Scope facilitates intubation even when laryngeal views are poor with direct laryngoscopy, as they often are in the lateral position. We thus compared the efficacy of the Airway Scope in supine patients with those in the left- and right-lateral positions. Anesthetized adults were randomly assigned to supine, left-lateral, or right-lateral position (n = 43 for each group). Laryngeal views were obtained in the designated position with a Macintosh laryngoscope, and patients' tracheas were subsequently intubated with the Airway Scope. Specifically, we tested the hypothesis that the time required for intubation in the left- and right-lateral positions is not increased by >10 seconds compared with tracheal intubation in the supine position. Overall intubation success was 100% in the 2 lateral positions, and 98% in the supine position. Intubation times were similar in the left-lateral (24 [5] seconds, mean [SD]), right-lateral (24 [6] seconds), and supine (22 [7] seconds) positions. The numbers of required intubation attempts were similar in the 2 lateral positions and in the supine and left-lateral positions. However, more intubation attempts were required in the supine position than in the right-lateral position (P = 0.004). The incidences of airway complications were similar in each position; no hypoxia, dental injury, or esophageal intubation was observed. Modified Cormack-Lehane and the percentage of glottic opening scores obtained with the Macintosh laryngoscope did not differ between the 2 lateral positions, but the modified Cormack-Lehane and percentage of glottic opening scores were superior in the supine position (all P < 0.001) compared with either of the lateral positions. Despite worse laryngoscopic views in either lateral position than when patients were supine, intubation with the Airway Scope offered high success rates. Furthermore, intubation time using the Airway Scope in either lateral position was not longer by >10 seconds than in the supine position. The Airway Scope thus seems to be a useful tool when tracheal intubation is required in a laterally positioned patient.