ISPUB.COM The Internet Journal of Anesthesiology Volume 29 Number 1 1 of 8 The Airtraqtm Optical Laryngoscope: A Retrospective Audit Of Optimal Usage Characteristics In Clinical Practice A Joffe, H Olivar, A Dagal, R Raver, A Grabinsky Citation A Joffe, H Olivar, A Dagal, R Raver, A Grabinsky. The Airtraqtm Optical Laryngoscope: A Retrospective Audit Of Optimal Usage Characteristics In Clinical Practice. The Internet Journal of Anesthesiology. 2010 Volume 29 Number 1. Abstract Purpose: To describe intubation success and the device manipulations needed to obtain adequate glottic views to facilitate successful first attempt tracheal tube passage with the Airtraq.Methods: Retrospective audit of anonymously collected prospective data from a departmental equipment purchasing committee sponsored device trial. Descriptive data is provided. The odds of successful passage of the tracheal tube on the first attempt without repositioning when the posterior arytenoids cleft was in the left lower quadrant of the view from the Airtraq was compared to its location in any of the other quadrants using a contingency table and presented as OR (95% CI).Results: All patients were successfully intubated with the Airtraq (median time 28 seconds). Device repositioning to attain adequate view of the glottis occurred in 30-48% of insertions depending on whether it was a back-up or rotational motion. The odds of successful intubation on first attempt was thirty times higher when the posterior interarytenoid cleft was in the lower left quadrant of the operators view (95% CI [4-300], p<.0001.Conclusions: Our results support the ease of use and attainment of skills of the Airtraq in inexperienced users. More importantly, our results suggest that maneuvering the device to obtain a view of the glottic structures in the lower left quadrant of operator’s view leads to the highest likelihood of first attempt intubations success. INTRODUCTION The Airtraq TM optical larygnoscope (AT, ProMedic, Inc., Bonita Springs, FL, USA) is an indirect optical larygoscope, which incorporates a guide channel into the blade of the device. Thus, it is classified as a “non-steering” device. That is to say that, in contrast to devices such as the Glidescope TM (Verathon, Inc., Bothell, WA, USA) where a laryngeal view is obtained with one hand and the tracheal tube is “steered” to the target with the other, the tracheal tube residing within a preformed guide channel will go where the tip of the device is aimed and cannot, itself, be “steered” without also maneuvering the device. The AT has an anatomically shaped blade, which provides a view angle of approximately 260-270 degrees and a wide visual field at the tip of the blade of approximately 4-6 cm [1]. In its current form, the device consists of a two-piece molded plastic housing, a power source consisting of small batteries wired through the device to supply a light source at the distal end, which also acts as a heating/defogging mechanism. Inside the housing, images obtained at the viewing tip are transmitted to a hooded eyepiece at the proximal end via a series alignment of prism-mirror-prism-prism-mirror-prism-prism (figure 1).