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Airway Adjuncts

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Abstract

Airway management is an important skill required to be mastered by anesthesiologists, intensivists, and emergency physicians and learnt by all clinicians and paramedical staff. Placement of ETT correctly into the laryngeal inlet is the first step for ventilation and oxygenation. Use of direct laryngoscope is an age-old technique to pass the ETT into the laryngeal inlet. Incidence of difficult airway varies from 0.5% to 10% [1–5]. Worst case scenario in any airway management is “cannot intubate and cannot ventilate,” which ranges from 0.001% to 0.007% [3]. Managing this life-threatening situation can be quite challenging and can lead to traumatic injuries and catastrophic events [6–8]. Several airway adjuncts like tracheal tube introducers, stylets, and tube exchangers are available to aid in such clinical scenarios. Intubation can be performed mainly by two methods while facing difficult intubation with direct laryngoscopy; first is intubating blindly or under vision using a bougie [9] and second, by passing tracheal tube introducer (TTI) blindly [10] and then railroading endotracheal tube (ETT). In view of their good success rate, these aids are highly recommended by guidelines throughout the world [11, 12].

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References

  1. Shah PN, Sundaram V. Incidence and predictors of difficult mask ventilation and intubation. J Anaesthesiol Clin Pharmacol. 2012;28:451–5.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kheterpal S, Han R, Tremper KK, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006;105:885–91.

    Article  PubMed  Google Scholar 

  3. Crosby E. The unanticipated difficult airway–evolving strategies for successful salvage. Can J Anaesth. 2005;52:562–7.

    Article  PubMed  Google Scholar 

  4. Arne J, Descoins P, Fusciardi J, et al. Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index. Br J Anaesth. 1998;80:140–6.

    Article  CAS  PubMed  Google Scholar 

  5. Rose DK, Cohen MM. The incidence of airway problems depends on the definition used. Can J Anaesth. 1996;43:30–4.

    Article  CAS  PubMed  Google Scholar 

  6. Hove LD, Steinmetz J, Christoffersen JK, Moller A, Nielsen J, Schmidt H. Analysis of deaths related to anesthesia in the period 1996–2004 from closed claims registered by the Danish Patient Insurance Association. Anesthesiology. 2007;106(4):675–80.

    Article  PubMed  Google Scholar 

  7. Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103(1):33–9.

    Article  PubMed  Google Scholar 

  8. Cook TM, Woodall N, Frerk C. Fourth National Audit P. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society Part 1: anaesthesia. Br J Anaesth. 2011;106(5):617–31.

    Article  CAS  PubMed  Google Scholar 

  9. Stasiuk RB. Improving styletted oral tracheal intubation: rational use of the OTSU. Can J Anaesth. 2001;48(9):911–8.

    Article  CAS  PubMed  Google Scholar 

  10. Kidd JF, Dyson A, Latto IP. Successful difficult intubation. Use of the gum elastic bougie. Anaesthesia. 1988;43(6):437–8.

    Article  CAS  PubMed  Google Scholar 

  11. Difficult Airway Society. Unanticipated difficult tracheal intubation during routine induction of anaesthesia in an adult patient. 2015.

    Google Scholar 

  12. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A, American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251–70.

    Article  PubMed  Google Scholar 

  13. Macintosh RR. An aid to oral intubation. BMJ. 1949;1:28.

    Google Scholar 

  14. Henderson JJ. Development of the ‘gum-elastic bougie’. Anaesthesia. 2003;58(1):103–4.

    Article  CAS  PubMed  Google Scholar 

  15. Nolan JP, Wilson ME. An evaluation of the gum elastic bougie. Intubation times and incidence of sore throat. Anaesthesia. 1992;47(10):878–81.

    Article  CAS  PubMed  Google Scholar 

  16. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39:1105–11.

    Article  CAS  PubMed  Google Scholar 

  17. Kidd JF, Dyson A, Latto IP. Successful difficult intubation: use of the gum elastic bougie. Anaesthesia. 1988;43:437–8.

    Article  CAS  PubMed  Google Scholar 

  18. Hagberg CA. Special devices and techniques. Anesthesiol Clin North America. 2002;20:907–32.

    Article  PubMed  Google Scholar 

  19. Arisaka H, Sakuraba S, Furuya M, et al. Application of gum elastic bougie to nasal intubation. Anesth Prog. 2010;57:112–3.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Paul A, Gibson AA, Robinson OD, Koch J. The traffic light bougie: a study of a novel safety modification. Anaesthesia. 2014;69(3):214–8.

    Article  CAS  PubMed  Google Scholar 

  21. Evans H, Hodzovic I, Latto IP. Tracheal tube introducers: choose and use with care. Anaesthesia. 2010;65(8):859.

    Article  CAS  PubMed  Google Scholar 

  22. Hodzovic I, Latto IP, Wilkes AR, et al. Evaluation of Frova, singleuse intubation introducer, in a manikin: comparison with Eschmann multiple-use introducer and Portex single-use introducer. Anaesthesia. 2004;59:811–6.

    Article  CAS  PubMed  Google Scholar 

  23. Muallem M. Endotracheal tube introducer: an aid for the difficult airway. Middle East J Anaesthesiol. 2000;15(6):687–92.

    CAS  PubMed  Google Scholar 

  24. Muallem MK, Azar MS, Gerges FJ, Nasr VG, Baraka A. Muallem endo-tracheal tube introducer: (METTI)–an aid for the difficult airway. Middle East J Anaesthesiol. 2005;18(2):385–9.

    PubMed  Google Scholar 

  25. Levitan R, Ochroch EA. Airway management and direct laryngoscopy: a review and update. Crit Care Clin. 2000;6:v:373–88.

    Article  Google Scholar 

  26. Weiss M. Management of difficult tracheal intubation with a video-optically modified Schroeder intubation stylet. Anesth Analg. 1997;85:1181–2.

    Article  CAS  PubMed  Google Scholar 

  27. McLean S, Lanam CR, Benedict W, Kirkpatrick N, Kheterpal S, Ramachandran SK. Airway exchange failure and complications with the use of the Cook Airway Exchange Catheter: a single center cohort study of 1177 patients. Anesth Analg. 2013;117(6):1325–7.

    Article  PubMed  Google Scholar 

  28. Choi EK, Kim JE, Soh SR, Kim CK, Park WK. Usefulness of a Cook airway exchange catheter in laryngeal mask airway-guided fiberoptic intubation in a neonate with Pierre Robin syndrome—a case report. Korean J Anesthesiol. 2013;64(2):168–71.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Atherton DP, O’Sullivan E, Lowe D, Charters P. A ventilation exchange bougie for fibreoptic intubations with the laryngeal mask airway. Anaesthesia. 1996;51(12):1123–6.

    Article  CAS  PubMed  Google Scholar 

  30. Heard AM, Lacquiere DA, Riley RH. Manikin study of fibreoptic-guided intubation through the classic laryngeal mask airway with the Aintree intubating catheter vs the intubating laryngeal mask airway in the simulated difficult airway. Anaesthesia. 2010;65(8):841–7.

    Article  CAS  PubMed  Google Scholar 

  31. Malcharek MJ, Rockmann K, Zumpe R, Sorge O, Winter V, Sablotzki A, Schneider G. Comparison of Aintree and Fastrach techniques for low-skill fibreoptic intubation in patients at risk of secondary cervical injury: a randomised controlled trial. Eur J Anaesthesiol. 2014;31(3):153–8.

    Article  PubMed  Google Scholar 

  32. Cook TM, Seller C, Gupta K, Thornton M, O’Sullivan E. Nonconventional uses of the Aintree Intubating Catheter in management of the difficult airway. Anaesthesia. 2007;62(2):169–74.

    Article  CAS  PubMed  Google Scholar 

  33. Levitan RM, Pisaturo JT, Kinkle WC, et al. Stylet bend angles and tracheal tube passage using a straight-to-cuff shape. Acad Emerg Med. 2006;13:1255–8.

    Article  PubMed  Google Scholar 

  34. Macintosh R, Richards H. Illuminated introducer for endotracheal tubes. Anaesthesia. 1957;12:223–5.

    Article  CAS  PubMed  Google Scholar 

  35. Yamamura H, Yamamato T, Kamiyama M. Device for blind nasal intubation. Anesthesiology. 1959;20:221.

    Article  Google Scholar 

  36. Vollmer TP, Stewart RD, Paris PM, et al. Use of a lighted stylet for guided orotracheal intubation in the prehospital setting. Ann Emerg Med. 1985;14:324–8.

    Article  CAS  PubMed  Google Scholar 

  37. Ellis DG, Stewart RD, Kaplan RM, et al. Success rates of blind orotracheal intubation using a transillumination technique with a lighted stylet. Ann Emerg Med. 1986;15:138–42.

    Article  CAS  PubMed  Google Scholar 

  38. Ainsworth QP, Howells TH. Transilluminated tracheal intubation. Br J Anaesth. 1989;62:494–7.

    Article  CAS  PubMed  Google Scholar 

  39. Weis FR, Hatton MN. Intubation by use of the light wand: experience in 253 patient. J Oral Maxillofac Surg. 1989;47:577–80.

    Article  CAS  PubMed  Google Scholar 

  40. Masso E, Sabate S, Hinojosa M, Vila P, Canet J, Langeron O. Lightwand tracheal intubation with and without muscle relaxation. Anesthesiology. 2006;104:249–54.

    Article  PubMed  Google Scholar 

  41. Hung OR. Nasal intubation with the Trachlight. Can J Anaesth. 1999;46:907–8.

    Article  Google Scholar 

  42. Hung OR, Pytka S, Morris I, et al. Lightwand intubation: II. Clinical trail of a new lightwand to intubate patients with difficult airways. Can J Anaesth. 1995;42:826–30.

    Article  CAS  PubMed  Google Scholar 

  43. Rhee KY, Lee JR, Kim J, et al. A comparison of lighted stylet (Surch-Lite) and direct laryngoscopic intubation in patients with high Mallampati scores. Anesth Analg. 2009;108:1215–9.

    Article  PubMed  Google Scholar 

  44. Favaro R, Tordiglione P, Di Lascio F, et al. Effective nasotracheal intubation using a modified transillumination technique. Can J Anaesth. 2002;49:91–5.

    Article  PubMed  Google Scholar 

  45. Bhardwaj A, Kidwai SN, Verma V, et al. Continuous anesthetic insufflation and topical anesthesia of the airway using Trachlight in chronic facial burns. Anesth Analg. 2006;102:334.

    Article  PubMed  Google Scholar 

  46. Iseki K, Watanabe K, Iwama H. Use of the Trachlight for intubation in the Pierre-Robin syndrome. Anaesthesia. 1997;52:801–2.

    CAS  PubMed  Google Scholar 

  47. Xue FS, Yang QY, Lio X, et al. Lightwand guided intubation in paediatric patients with a known difficult airway: a report of four cases. Anaesthesia. 2008;63:520–5.

    Article  CAS  PubMed  Google Scholar 

  48. Gille A, Komar K, Schmidt E, Alexander T. Transillumination technique in difficult intubations in heart surgery. Anasthesiol Intensivmed Notfallmed Schmerzther. 2002;37:604–8.

    Article  CAS  PubMed  Google Scholar 

  49. Garg R. Trachlight for airway management in tongue flap division surgery. Paediatr Anaesth. 2009;19:279–80.

    Article  PubMed  Google Scholar 

  50. Aoyama K, Takenaka I, Nagaoka E, et al. Potential damage to the larynx associated with light-guided intubation: a case and series of fiberoptic examinations. Anesthesiology. 2001;94:165–7.

    Article  CAS  PubMed  Google Scholar 

  51. Debo RF, Colonna D, Dewerd G, Gonzalez C. Cricoarytenoid subluxation: complication of blind intubation with a lighted stylet. Ear Nose Throat J. 1989;68:517–20.

    CAS  PubMed  Google Scholar 

  52. Shikani AH. New “seeing” stylet-scope and method for the management of the difficult airway. Otolaryngol Head Neck Surg. 1999;120:113–6.

    Article  CAS  PubMed  Google Scholar 

  53. Agrò F, Cataldo R, Carassiti M, Costa F. The seeing stylet: a new device for tracheal intubation. Resuscitation. 2000;44:177–80.

    Article  PubMed  Google Scholar 

  54. Bonfils P. Difficult intubation in Pierre-Robin children, a new method: the retromolar route [in German]. Anaesthesist. 1983;32:363–7.

    CAS  PubMed  Google Scholar 

  55. Mihai R, Blair E, Kay H, Cook TM. A quantitative review and meta-analysis of performance of non-standard laryngoscopes and rigid fibreoptic intubation aids. Anaesthesia. 2008;63:745–60.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Onco-Anaesthesiology and Palliative Medicine, RBRAIRCH, AIIMS, New Delhi, India

    Pratishtha Yadav

  2. Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Anju Gupta

  3. Department of Anesthesiology (BRA-IRCH), All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Nishkarsh Gupta

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  1. Pratishtha Yadav
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  2. Anju Gupta
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Editor information

Editors and Affiliations

  1. Department of Anaesthesiology, Jerudong Park Medical Centre, Jerudong Park, Brunei Darussalam

    Raveendra Shankaranarayana Ubaradka

  2. Department of Anesthesiology (BRA-IRCH), All India Institute of Medical Sciences, New Delhi, Delhi, India

    Nishkarsh Gupta

  3. Division of Neuroanesthesiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, Pondicherry, India

    Prasanna Udupi Bidkar

  4. Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Debendra Kumar Tripathy

  5. Department of Anaesthesia Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Anju Gupta

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Yadav, P., Gupta, A., Gupta, N. (2023). Airway Adjuncts. In: Ubaradka, R.S., Gupta, N., Bidkar, P.U., Tripathy, D.K., Gupta, A. (eds) The Airway Manual. Springer, Singapore. https://doi.org/10.1007/978-981-19-4747-6_11

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  • DOI: https://doi.org/10.1007/978-981-19-4747-6_11

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  • Online ISBN: 978-981-19-4747-6

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