ABSTRACT

We herein report two expected difficult intubation cases that failed with an angulated-type video laryngoscope (C-MAC D-blade) and were rescued with a channelled-type Airtraq® device. The common signs and characteristics which indicated difficult ventilation and intubation in these patients were Mallampati 4 (with phonation), mandibular protrusion of B, obstructive sleep apnoea disorder, male gender, and thick neck (>46 cm). We had aids ready in the operating theatre for the anticipated difficult intubation. We first attempted to intubate the trachea in two patients with direct laryngoscopy; as expected, the Cormack-Lehane (CL) grades of the two patients were 4, even cricoid pressure was applied. Second, we attempted to intubate with the angulated-type C-MAC D-blade; the CL grades improved to 2. However, despite tube adjustment manoeuvres and use of a rigid stylet, we were unable to insert the tube into the trachea. Then, we attempted to intubate with a channelled-type Airtraq® device. Consequently, without need for a stylet or use of any manoeuvres, we were able to intubate the tracheas at the first attempt.

Keywords: Airtraq®, C-MAC D-blade, difficult ventilation, difficult intubation