Intubation through air-Q and LMA-Excel using Shikani optical stylet in normal versus simulated difficult airway

Abstract

Background Unanticipated difficult mask ventilation and difficult intubation may cause serious complications, and airway management in such cases is challenging. Shikani seeing optical stylet (SOS) is a semirigid fiber-optic stylet used to manage difficult airway. Aims The current study aimed to assess and compare the intubation procedure through different intubating supraglottic devices (AIR-Q and LMA-Excel) while using the SOS in anesthetized patients with normal or simulated difficult airway scenario. Patients and methods This study was carried out on 120 adult female patients scheduled for elective abdominal hysterectomy under general anesthesia. All patients were intubated using the SOS through the supraglottic airways: 30 patients through Air-Q (group A-N), 30 patients through Air-Q while applying a neck collar (group A-D), 30 patients through LMA-Excel (group L-N), and 30 patients through LMA-Excel while applying a neck collar (group L-D). Evaluation parameters were as follows: airway score, hemodynamic parameters, leak pressure, laryngeal view grade, time to successful endotracheal tube insertion and number of attempts, and complications. Results The laryngeal view grade of the A-D group was significantly higher than that of the A-N group (P1) and L-D group (P4), and there was no significant difference when comparing group L-N with L-D (P2) and group A-N with L-N (P3). The mean successful time for intubation of group A-D (100.50±42.63 s) was significantly longer than that of group A-N (62±21.20 s) and group L-D (72±31.39 s), with a P value of 0.001. The number of intubation attempts ranged from 1 to 2 in groups A-N, L-N, and L-D, whereas 1 to 3 in group A-D. Conclusion The intubation through supraglottic airways (Air-Q and LMA-Excel) using the SOS is a feasible technique. The SOS can be used as an alternative apparatus for intubation through device when the flexible fiber-optic bronchoscope is not available. Laryngeal view grade is better with LMA-Excel when using the SOS. Intubation through LMA-Excel is easier than through Air-Q when using the SOS.