Usefulness of the Airtraq DL™ videolaryngoscope for placing a double-lumen tube

Endotracheal insertion of a double-lumen tube (DLT) may be difficult because of its size and shape. The Airtraq™ is a new videolaryngoscope that allows supraglottis exposure without needing to align the oro-pharyngo-laryngeal axis. A specific model (Airtraq DL™), with a large diameter, has been specifically designed to insert a DLT. We have tested the efficiency of this device on the quality of supraglottis exposure and the endotracheal position of the DLT.

This was a prospective and observational study.

This study included 37 consecutive patients with no risk for difficult intubation and who required insertion of a DLT for one-lung ventilation. The main outcomes were the success rate of endotracheal intubation within 120 s, the quality of glottis exposure, the position of the tube within the trachea and the occurrence of any complications.

All patients were safely intubated, but only 33 (89%) were successfully intubated within 120 s (mean time: 44±27 s). Using the Airtraq DL™ videolaryngoscope, significantly more patients were graded Cormack and Lehane I as compared to the Macintosh laryngoscope (97% vs. 73%, P<0.05). Overall, fiberoptic bronchoscopy detected 62% of incorrectly positioned DLTs. Blood was noted on the blade of the videolaryngoscope in seven patients, desaturation occurred in two patients and labial trauma in one patient.

The use of the Airtraq DL™ improves exposure of the supraglottis during insertion of a DLT. However, previous removal of the stylet could increase the risk of incorrectly positioning the tube.