AirTraq Optical Laryngoscope

Two small mirrors within L-bend curve reflect image. By passing through two mirrors the image is right-left correct.  A magnifying lens within a black rubber “hood” expands the view. A small switch inside the rubber hood turns on an LED light.

The tracheal tube is pre-loaded using a right-sided track that follows the curvature of device.  It is important that the track be well lubricated to prevent the tube from sticking on insertion.

The intubation technique involves insertion of the device (and tube) using the operator’s left hand, going around the curve of the tongue. 

The tip of the AirTraq gets positioned into the vallecula (like a Macintosh blade) and the device is used as a tongue retractor to lift jaw and tongue.

Upward lifting elevates the epiglottis similar to a curved blade laryngoscope.  With the larynx sighted, the tube is pushed off directly at the target.  After intubation the tube is pulled out of the track laterally (rightward), and the device is rotated, in reverse, out of the patient’s mouth.

Sequential laryngeal landmarks as seen during  intubation with the AirTraq:

The combination of a right-angled imaging system and simple tube track delivery mechanism can make intubation easy in the vast majority of patients. While having an attached track for the endotracheal tube simplifies the procedure, it limits direct manipulation of the tube (i.e., twisting or turning the tube won’t substantially change where the tip is directed—this is determined by the track). If the tube tip is not going where desired, lift and adjust the tilt and orientation of the entire device (with the tube in the track).  In many instances it is helpful to tilt the device slightly forward (towards the patient’s feet) while pulling upward (to distract the jaw and tongue) and thereby change the direction to tube is directed. If the tube is going to the left of the glottic opening, turn the AirTraq slightly rightward. This moves the glottic opening slightly to the left of center in the imaging window, and often improves tube insertion. If a standard tracheal tube is used, it may also help to clockwise (rotate rightward) the tracheal tube off the device, as the tube is passed into the trachea.  This will cause the bevel of the tube to face upward and is less likely to cause the leading edge to catch on the tracheal rings.

A helpful tip with the AirTraq, (and true also of  the Glidescope) is to use a Parker tube that has a ski-tip shaped, symmetric tip design.  This not only helps with insertion into the glottis because the tip is centered, but also minimizes any impaction on the anterior tracheal rings as the tube is advanced.

The AirTraq has many advantages in pre-hospital care: minimal space requirement, intubation in any position, single use, and very low cost compared with other difficult airway imaging devices.

The lens element is warmed by the self-contained LED light and is set back from the device tip. Imaging works very well, even with blood and secretions. It is always best to suction the hypopharynx and dependent portions of the larynx before insertion, however.  If the tip of the device is swept through a large pool of fluids in the hypopharynx imaging will be compromised.  In situations this cannot be avoided (brisk GI bleeding, copious vomitus, etc.) any intubation device with obligatory non-direct imaging may be unusable.

A clip-on video system for supervision is also available. This camera attaches to the device by removing the rubber hood.  The camera clips directly over the switch and eyepiece.  A generous cable provides a long run for video connection to a monitor via a RCA video connection.

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