[Successful tracheal intubation using the pediatric Airtraq optical laryngoscope in a pediatric patient with Robin sequence].

We report a successful use of pediatric Airtraq optical laryngoscope in a pediatric patient with Robin sequence. Robin sequence accompanies a characteristic facies and its clinical presentation is marked by micrognathia, retrognathia, glossoptosis, and respiratory obstruction. A 1-year-5 month-old boy with Robin sequence was scheduled for palate repair under general anesthesia. After anesthetic induction with thiopental and neuromuscular paralysis with rocuronium, initial laryngeal view with the conventional Macintosh laryngoscope was Cormack-Lehane grade II due to restricted mouth opening and micrognathia. The Airtraq Pedi provided the glottic view with Cormack-Lehane grade I and a preformed tracheal tube (ID 4 mm) was placed correctly into the trachea through the built-in tube channel. We conclude that the pediatric Airtraq has potential advantages over conventional direct laryngoscopy in children with difficult airway.

[Evaluation of 100 anesthetic incidents].

BACKGROUND: The anesthetic incident-reporting scheme in the department of anesthesia, Jichi Medical School Hospital, has been running for 3 years and 100 incidents have now been reported. METHODS: An 'anesthetic incident' was defined as any incident related to anesthesia which either caused harm, or if uncorrected might have caused harm, to a patient. RESULTS: There were 26 problems involving drugs, 18 airway and respiratory problems, 15 dental damages, 11 cardiovascular problems, 8 problems related epidural anesthesia, and 22 others. CONCLUSIONS: The scheme has successfully highlighted weaknesses of the department.

In-line head and neck position is preferable for tracheal intubation with the Airtraq laryngoscope compared to the sniffing position.

We aimed to determine which position, the in-line head and neck position or the sniffing position, was preferable for tracheal intubation with the Airtraq laryngoscope. In all, 20 anesthetists performed tracheal intubations on a manikin with either an in-line head and neck position or the sniffing position. There were no differences in the success rate and the time to intubation between the two positions. The overall number of teeth clicks was lower in the in-line head and neck position than in the sniffing position (P < 0.05). The score for preference of position, on a visual analogue scale, was better for the in-line head and neck position than for the sniffing position (P < 0.01). We concluded that the in-line head and neck position was preferable for tracheal intubation with the Airtraq laryngoscope compared to the sniffing position.

Airway Scope: early clinical experience in 405 patients.

The Airway Scope (Pentax, Tokyo, Japan) is a new device used for tracheal intubation. It allows visualization of the glottis through a non-line-of sight view. The aim of the present study was to evaluate the suitability of this device for the tracheal intubation of surgical patients. In this prospective study, the Airway Scope was used for the endotracheal intubation of 405 patients by 74 airway operators. The Airway Scope allowed visualization of the glottis in all 405 patients, including those with a Cormack-Lehane view of grade III (n = 15) or grade IV (n = 1) on Macintosh laryngoscopy. All tracheal intubations using the Airway Scope were successful. The mean time to complete tracheal intubation was 42.4 +/- 19.7 s (+/-SD; range, 13-192 s). No dental damage was encountered, though minor mucosal injury caused by the blade was experienced in 2 patients. The Airway Scope consistently permitted a better intubation environment. With its potential advantages, the Airway Scope could be an effective aid to airway management in surgical patients.