The air-Q� intubating laryngeal airway for endotrachealintubation in children with difficult airway: our experience

SIR—We read with interest and true appreciation both

the article by Jagannathan N et al. (1) and the com-

ment by Parotto M et al. (2) as well as the recent arti-

cle by Jagannathan N et al. (3) where they reported

their experience with air-Q� intubating laryngeal air-

way (ILA) (Cookgas�, LLC St Louis, MO, Mercury

Medical�, Clearwater, FL, USA) as a conduit for lar-

yngeal mask-assisted tracheal intubation in patients

with difficult airway.

It is a novel supraglottic airway device recently

introduced into the anesthesia’s market, designed to

perform a guidance for tracheal intubation with a

cuffed tracheal tube and to facilitate its removal by a

custom stylet.

At once, we were intrigued by the described easy use

of this novel device to perform a fiberoptic intubation

in pediatric patients with difficult laringoscopy.

Therefore, we also begun to employ it from March

2009 to September 2011 in infants and children with

documented or predictable difficult direct laryngoscopy

scheduled for surgery where it was indispensable to

perform an endotracheal intubation, especially for cra-

niomaxillo-facial reconstructive surgery of congenital

malformations.

We are describing our experience in anesthesia care

of 12 patients with difficult airways.

The median age was 78.7 (1–160) months and the

median weight was 23.8 (2.5–50) kilograms.

All patients (ASA I-II) were premedicated by oral

midazolam 0.2 mgÆkg)1 4500 prior to their admittance

into the operating room and received 0.01 mgÆkg)1 of

IV atropine sulfate to minimize secretions as soon as a

vascular access was established after performing gene-

ral anesthesia by volatile agents such as sevoflurane

3–5% in 40% oxygen/60% nitrous oxide gas mixture

via face mask, while patients breathe spontaneously.

The air-Q� ILA, without deflating cuff, was easily

inserted with the index finger of the right hand, while

the anesthetist performed jaw’s lift with left hand,

without a rotational technique. A flexible fiberoptic

bronchoscope (FOB), preloaded with a well lubricated

by KY� Jelly (Johnson & Johnson Medical, New

Brunswick, NJ, USA) cuffed oral endotracheal tube

(ETT), was inserted into the lumen of the air-Q� ILA

after removing the circuit connector. The larynx was

always easily visualized as the bronchoscope traveled

outside the air-Q� ILA. Before going beyond vocal

cords, an IV bolus of propofol 2 mgÆkg)1 was injected

prior to advance FOB to carina. Then, ETT was slid

over the scope through the air-Q� ILA into trachea.

Positioning of ETT was confirmed by FOB visualiza-

tion, end-tidal C02 and lung sounds.

In case of craniomaxillo-facial surgery, we easily

removed air-Q� ILA using a specially designed

removal stylet to prevent dislodging the ETT during

this maneuvre. Otherwise the laryngeal mask was left

in the mouth.

In summary, we fully agree with Authors that air-

Q� ILA may be a well-suited alternative to the classic

laryngeal mask in children with difficult airway, espe-

cially when an ETT is required.

Conflict of interest

No conflicts of interest declared.

Fabio Ferrari & Raoul LavianiDepartment of Anesthesiology and Intensive care,

Children’s Hospital‘Bambino Gesu’ of Rome, ItalyEmail: fabio.ferrari@opbg.net

doi:10.1111/j.1460-9592.2011.03792.x

References

1 Jagannathan N, Roth AG, Sohn LE et al.

The new air-Q intubating laryngeal airway

for tracheal intubation in children with

anticipated difficult airway: a case series.

Pediatr Anesth 2009; 19: 618–622.

2 ParottoM,MicaglioM, Armellin G et al. The

new air-Q intubating laryngeal airway for tra-

cheal intubation in children with anticipated

difficult airway: comment. Pediatr Anesth

2009; 19: 1028–1029, author reply 1029–30.

3 JagannathanN, KhoMF, Kozlowski RJ et al.

Retrospective audit of the air-Q intubating

laryngeal mask as a conduit for tracheal intu-

bation in pediatric patients with a difficult air-

way.Pediatr Anesth 2011; 21: 422–427.

Correspondence

500 ª 2012 Blackwell Publishing Ltd

Pediatric Anesthesia 22 (2012) 490–507