• T Kariya, G Inagawa, K Nakamura, J Fujimoto, Y Aoi, S Morita, and T Goto.
• Department of Anesthesiology and Critical Care Medicine, Yokohama City University School of Medicine, Japan. karix@cl.cilas.net
• Acta Anaesthesiol Scand. 2011 Feb 1; 55 (2): 223-7.

BackgroundThe Pentax-AWS (AWS(®)), a new video laryngoscope, has been shown to be useful in cases of difficult intubation. We hypothesized that the AWS(®) would be more useful in the settings of a narrow upper airway than the Macintosh laryngoscope. We compared each device in simulated scenarios of representative difficulty of tracheal intubation using a manikin. The primary endpoint was the rate of successful intubation.MethodsWith each device, 23 anesthesiologists performed tracheal intubation in a SimMan(®) manikin in the following scenarios: (1) normal airway, (2) tongue edema, (3) cervical spine rigidity, (4) pharyngeal obstruction, (5) jaw trismus, (6) tongue edema with pharyngeal obstruction. The intubation time and success rate were measured. Each participant was asked to rate the difficulty of intubation (1=very easy; 5=very difficult).ResultsIn the scenarios of tongue edema and tongue edema with pharyngeal obstruction, the AWS(®) yielded a higher success rate (100% vs. 34.8%; P<0.001, 65.2% vs. 21.7%; P=0.006), a shorter intubation time [14.6 (7.0) vs. 33.4 (13.0) s; P<0.001, 24.5 (12.0) vs. 37.6 (11.9); P=0.047; mean (standard deviation)], and a lower difficulty score [2 (1-4) vs. 5 (1-5); P<0.001, 4 (2-5) vs. 5 (3-5); P<0.001; median (range)], compared with the Macintosh laryngoscope.ConclusionThe AWS(®) has an advantage over the Macintosh laryngoscope in simulated tongue edema and tongue edema with pharyngeal obstruction. Further studies in a clinical setting are necessary to confirm these findings.© 2011 The Authors. Journal compilation © 2011 The Acta Anaesthesiologica Scandinavica Foundation.

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