Presented at Society for Technology in Anesthesia annual meeting, FL, USA 13th-16th january 2010 (poster)

A disposable flexible intubation videoscope, the Ambu® aScope™, and thefirst experiences with awake intubation in patients with difficult airways
Michael S. Kristensen, MD⊇, Birgitte B. Fredensborg, MD⊄, Christian M. Hansen, MD⊂ and Michael F. Tvede, MD⊆⊇⊄⊂

Department of Anaesthesia and Operating Theatre Services 4231, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet,⊂Denmark and Department of Anaesthesia and Intensive Care, Herlev Hospital, Denmark. E-mail: michael.seltz.kristensen@rh.regionh.dkIntroduction®

The Ambu aScope™ is a disposable flexible videoscope for endotracheal(ET) intubation. It has a camera at the tip of the 5.3mm wide and 63 cm long
insertion cord and accommodates a 6.0mm tube. The aScope™ has a channel
for injection of local anesthetics but no suction-channel. During theendoscopy the scope is connected to a reusable 6.5″ color TFT 640*480 LCD
monitor (photo). The aScope™ is introduced in our armamentarium for
management of the difficult airway as an equivalent to our non-disposablefiberscopes and flexible video-scopes. The patients were all selectedfollowing standard departmental procedure, ie intubated awake if a difficultmask-ventilation or ET intubation was predicted. We present retrospective
case-reports of the first five patients with difficult airways intubated withthis device.

Case reports
Patient 1. Male, 59 yrs, with a tumor of the hard palate. Mallampati class (MC) 3, limited neck-extension and inability toprognath. The patient received glycopyrrolate 0.2mg and light sedation with 2mg midazolam and infusion of remifentanil
0,08µg/kg/min, spontaneous ventilation was maintained and the patient was fully cooperative during the procedure. Local
anesthesia (LA) using lidocaine 10% was administered by spray application to the mouth and subsequently “spray-as-yougo” injection of lidocaine 4% via the injection port of the aScope™. The patient was intubated orally with an 8.0mm internal
diameter (i.d.) ET-tube (ETT) slided over the insertion cord of an aScope™ via a Berman™ airway. After intubation direct
laryngoscopy revealed a Cormack-Lehane (CL) grade 4 (no part of epiglottis visible).
Patient 2. Male, 68 yrs, with oral cancer. Three weeks previously anesthetized were difficulty with mask-ventilation wasexperienced and direct larnyngoscopy had revealed a CL grade 3. Following light sedation and LA as in case 1, he wasintubated orally awake with a 7.0mm i.d. ETT over the aScope™.
Patient 3. Male, 60 yrs, suspected oropharyngeal cancer. MC 3, severely decreased neck extension and thyromental
distance of 6cm. The patient received light sedation and LA as in case 1. He had copious secretions and suctioning wasapplied via a suction catheter before intubation. The patient was intubated orally with a 6.0mm i.d. ETT over the aScope™.
Following intubation and induction of general anesthesia, accidental extubation was performed by the surgeon. Mask
ventilation proved impossible, direct laryngoscopy revealed CL grade 3 and re-intubation was performed “blindly” with great
difficulty. Three weeks later the patient underwent another uncomplicated awake aScope™-intubation.
Patient 4. Patient with an intra-thoracic goiter severely compressing the trachea. Following light sedation and LA as in case 1
he was intubated awake with the aScope™ thus allowing the tip of the tube to be positioned distally to the tracheal
compression.
Patient 5. Patient with MC 3, inter-incisor distance 2.7cm and inability to prognathe. Intubated orally awake (6.0mm i.d.
ETT) with the aScope™ by a first year resident after light sedation and LA. Subsequent direct laryngoscopy revealed a CL
grade 3.

Discussion
The availability of a disposable flexible optical scope has several possible advantages for the anesthesiologist: No1
cumbersome cleaning, no repair costs, avoidance of the small, but existing, risk of cross-contamination and the possibility of2
always having access to a flexible scope, which is not the case with the expensive reusable scopes . However, it is mandatorythat the clinical performance of a disposable flexible scope is so good that it can be used for managing patients presenting
with severely difficult airways

Conclusion
The first disposable fl exible intubation videoscope, the Ambu® aScope™, was successfully used for awake intubation in six
cases in five patients with severely difficult airways and seems to offer a valuable supplement, or maybe even alternative, tothe existing flexible fiber-and video-scopes.
1 Mehta AC et al. American College of Chest Physicians and American Association for Bronchology Consensus statement. CHEST 2005;128:1742-1755
2 Kristensen MS, Møller J. Airway management behavior, experience and knowledge among Danish anaesthesiologists--room for improvement. Acta
Anaesthesiol Scand. 2001;45(9):1181-5