Face-to-face tracheal intubation in adult patients: a comparison of the Airtraq™, Glidescope™ and Fastrach™ devices

Airway management in emergency settings can be difficult due to limited access to the patient. The use of video laryngoscopes along with the Fastrach (TM) device improves tracheal intubation; however, the use of such devices in a face-to-face intubation model has not been evaluated in adult patients. After obtaining official approval from the Local Research Ethics Committee and written informed consent from the patients, 120 patients were enrolled in this prospective randomized study. The patients were ASA I and ASA II according to the American Society of Anesthesiologists Physical Status Classification System. Rocuronium was administered for neuromuscular blockade following standard anesthesia monitoring and induction. The patients were divided into three groups (40 patients per group) and their tracheas were intubated via a face-to-face approach with the Airtraq (TM), Glidescope (TM) or Fastrach (TM) devices. The intubation success rates of the Airtraq (TM), Glidescope (TM) and Fastrach (TM) devices were similar (100, 98 and 90 %; p = 0.07). The insertion time for the Airtraq (TM) [8.5 (6-11) s] was the shortest followed by the Glidescope (TM) [11 (7-19) s] and the Fastrach (TM) [16.5 (14.3-21.8) s; p < 0.001]. The intubation time for the Airtraq (TM) [14 (10.3-18.8) s] was shorter than the Glidescope (TM) [25 (18-45) s], and Fastrach (TM) devices [46.5 (40-65) s; p < 0.001]. The Glidescope (TM) device required a greater number of optimization maneuvers (p = 0.009) and intubation attempts than the Airtraq (TM) (p = 0.004). Esophageal intubation (p = 0.001) and mucosal damage were more common in the Fastrach (TM) group (p = 0.03). The Airtraq (TM) device provided faster insertion and intubation times and enabled better Cormack-Lehane grades. Additionally, the Airtraq (TM) device required the minimum number of optimization maneuvers and was associated with fewer complications and fewer intubation attempts than the Glidescope (TM) and Fastrach (TM) devices during face-to-face tracheal intubation.