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Table of Contents
Year : 2015  |  Volume : 31  |  Issue : 1  |  Page : 134-136

The A.P. Advance video laryngoscope as a rescue airway device in an unpredicted difficult airway

1 Department of Emergency, Anaesthesia and Intensive Care ≠Section, GB Morgagni-L Pierantoni Hospital, Forli, Italy
2 Anaesthesia and Intensive Care Department, Lentini Hospital, Siracusa, Italy
3 Anaesthesia and Intensive Care Department, AOU Policlinico Vittorio Emanuele, Catania, Italy

Date of Web Publication3-Feb-2015

Correspondence Address:
Dr. Salvatore Zampone
Department of Emergency, Anaesthesia and Intensive Care Section, G. B. Morgagni-L. Pierantoni Hospital, Viale Forlanini 34, 47100, Forlž
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9185.150589

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How to cite this article:
Zampone S, Corso RM, Parrinello L, Gambale G, Sorbello M. The A.P. Advance video laryngoscope as a rescue airway device in an unpredicted difficult airway. J Anaesthesiol Clin Pharmacol 2015;31:134-6

How to cite this URL:
Zampone S, Corso RM, Parrinello L, Gambale G, Sorbello M. The A.P. Advance video laryngoscope as a rescue airway device in an unpredicted difficult airway. J Anaesthesiol Clin Pharmacol [serial online] 2015 [cited 2020 Jun 1];31:134-6. Available from:


Direct laryngoscopy using Macintosh (MAC) blades remains the standard technique for securing airways during anesthetic practice. However, performing a direct laryngoscopy may be difficult or impossible in a percentage of cases that depends on the definition given, ranging from 0.3% to 13%. [1] Difficulty in airway management often leads to serious harm. [2] The Venner AP Advance video laryngoscope (APA) (Venner Medical Ltd., Singapore) [Figure 1] is a video laryngoscope functionally similar to standard MAC laryngoscopes. It is a hand held portable device provided with a rechargeable, high resolution 86 mm (3.5") LCD color display that can be attached to the top of the handle of the laryngoscope. The blades are mounted onto the camera module and three types of single use cover-blades are available: MAC 3, MAC 4 for routine laryngoscopy and a difficult airway blade (DAB) for difficult laryngoscopy. The DAB blade is more acutely curved in shape than the MAC blades, obeying the "look around the corner" philosophy and is designed with a guiding channel in its distal one third, to facilitate passage of the tracheal tube into the glottis. We describe the case of a 44-year-old man (body mass index: 25 kg/m 2 ) scheduled for uvulopalatopharyngoplasty. He had no significant medical history and the preoperative airway evaluation did not foresee difficulties in airway management, the preoperative El-Ganzouri Risk Index score being 3 (Thyromental distance: 62 mm, Mallampati score 2, negative upper lip bite test). After preoxygenation, the induction of anesthesia was performed with propofol 160 mg intravenous (IV), fentanyl 100 mcg and atracurium 40 mg IV. Direct laryngoscopy using a MAC blade showed a Cormack-Lehane Grade 3e view [3] despite external laryngeal manipulation and correct sniffing position. After confirmation of easy ventilation by face mask, we decided to perform a second laryngoscopy using the APA mounted with the DAB. Once the epiglottis was visualized (Cormack-Lehane: 2) on the video viewer of the laryngoscope, the APA was advanced further to obtain an optimal view of the larynx. Next, a sized seven cuffed reinforced tracheal tube was directed into the glottic aperture via the DAB guide channel. The endotracheal intubation was then confirmed by capnography and auscultation of the chest. The surgery proceeded uneventfully and the patient underwent a protected extubation using an airway exchange catheter (Cook Critical Care, Bloomington, IN). Several types of video laryngoscopes [4] have been reported to have been used for airway rescue after a direct laryngoscopy failure, but to our knowledge, this is the first report about the APA. In our opinion, the APA has several advantages. First, it can be used as a standard MAC laryngoscope, making video laryngoscopy more familiar and encouraging its diffusion among experienced anesthetists. The DAB offers the opportunity, with the same device, to use a blade for the management of difficult airway in case of failure of the MAC blades. In our experience, the DAB immediately offered a good view of the glottis, and safely allowed the insertion of the tracheal tube sliding in the channel guide. To conclude, in our opinion, the Venner APA video laryngoscope has a potential role in managing difficult airway, [5],[6] however further studies and clinical experience are necessary to establish its role in difficult airway management.
Figure 1: Venner AP Advance: (a) note single parts, (b) Macintosh (MAC) 3 assembly, (c) blades configuration and MAC blades comparison, (d) Venner MAC 3 and difficult airway blade (DAB) comparison, (e) simulation of tube passage via DAB channel

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  References Top

Rose DK, Cohen MM. The incidence of airway problems depends on the definition used. Can J Anaesth 1996;43:30-4.  Back to cited text no. 1
Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. Br J Anaesth 2011;106:617-31.  Back to cited text no. 2
Petrini F, Accorsi A, Adrario E, Agrò F, Amicucci G, Antonelli M, et al. Recommendations for airway control and difficult airway management. Minerva Anestesiol 2005;71:617-57.  Back to cited text no. 3
Niforopoulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in the adult airway management: A topical review of the literature. Acta Anaesthesiol Scand 2010;54:1050-61.  Back to cited text no. 4
Butchart A, Young P. Use of a Venner A.P. Advance videolaryngoscope in a patient with potential cervical spine injury. Anaesthesia 2010;65:953-4.  Back to cited text no. 5
Frova G. Do videolaryngoscopes have a new role in the SIAARTI difficult airway management algorithm? Minerva Anestesiol 2010;76:637-40.  Back to cited text no. 6


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