EVALUATION OF THE AUGUSTINE-GUIDE(TM) FOR DIFFICULT TRACHEAL INTUBATION

Successful tracheal intubation with Augustine Guide(TM) (Augustine Med ical, Inc., Eden Prairie, MN) in patients with normal airways has rece ntly been described. There are no studies describing Augustine Guide ( AG) use in patients with difficult airways. Accordingly, we studied AG intubation in a population of patients with expected difficult airway s due to cervical spine pathology, limited mouth opening, obesity, fac ial trauma or deformity due to previous operation or radiation and in patients with unexpectedly difficult airways. A total of 44 patients w ere studied. The AG was used as a primary intubating tool in patients with known difficult airways (n = 36) and as a secondary intubating to ol in patients with unexpected inability to intubate using conventiona l direct laryngoscopy (n = 8). Airway difficulty war predicted by hist ory and physical examination. Intubations were performed tender genera l anaesthesia in 40 of the 44 patients studied. In four patients with predictably difficult airways, topical anaesthesia and sedation were u sed. Backup methods to achieve intubation were available. Thirty-two o f the 36 with known or suspected difficult airways were classified as Mallampati Class III or IV. In the remaining eight patients the preope rative examination suggested an easy airway; however, after induction of general anaesthesia, their laryngeal inlet could not be seen using direct laryngoscopy. Using the AG all were intubated successfully (36/ 44 at the first attempt, in 8/44 repositioning of the AG to allow succ essful laryngeal entry of the stylet war necessary). There were no fai lures or complications secondary to AG use. This study shows that the AG is a useful device for oral tracheal intubation in patients with kn own or unexpectedly difficult airways.