MAGNET ASSISTED ENDOTRACHEAL INTUBATION AS AN ALTERNATIVE APPROACH TO DIFFICULT
AIRWAY MANAGEMENT

Background and Goal of Study: The absence of a universal method or device for successful management of difficult airway stimulates ongoing interest and research on this issue. The main reason behind the difficult airway management failure is impossibility of glottis chink visualization and poor negotiation of the S-shaped anatomical pathway by the tip of endotracheal tube and (or) stylet. The relative unavailability of equipment recommended by  ASA algorithms also contributes to the search of practical solutions in developing countries. Our study aimed at overcoming these hindrances by proposing an alternative approach.
 
Materials and methods: Magnet assisted endotracheal intubation technique implies non-invasive access to patient's airway through endotracheal intubation using a specifically designed flexible stylet with movable steel tip. The stylet is introduced into the oropharynx and blindly goes through the glottis chink down the trachea with the help of neodymium magnet D -70-40 (adhesive force 180 kg) placed on the anatomical projection of the larynx. The endotracheal tube is then slid down the stylet into trachea.

Results and discussion: The technique was applied in 67 patients, who had a history of failed direct laryngoscopy on second attempt. There were 42 cases of elective surgery and 25 cases of urgent surgery. Difficult airway was anticipated in 49 and unanticipated in 18 cases. 63 patients presented Cormack and Lehane classification grade 3 and 4 patients presented grade 4. Magnet assisted approach was effective in 93% of patients who were successfully intubated on first attempt (48%), second attempt (36%) and third attempt (9%). No specific complications were observed.

Conclusion(s): This was a pilot study to examine the feasibility of magnet assisted endotracheal intubation in management of difficult airway. The technique proved to be a safe and cost-effective alternative approach. Yet there is a need for technical improvement such as upgrading stylet steel tip maneuverability and optimal redesigning of the magnet shape. We welcome any bioengineering solutions, expert feedback or critical analysis on our study. Further research might be focused on comparing its use with other devices.

Magnet assisted endotracheal intubation as an alternative approach to difficult airway management