Success Rate Of Blind Intubation Research Articles

Comparison of blind intubation and a smartphone-based endoscope-assisted intubation in rabbits

ObjectiveTo compare between blind and smartphone-based endoscope-assisted techniques for endotracheal intubation in rabbits. Study designProspective clinical study. AnimalsA total of 34 rabbits. MethodsRabbits were assigned to four groups: intubation by a veterinary anesthesiologist (VA) or an exotic pet medicine specialist (EPS) using blind or endoscope-assisted techniques. Propofol dose, number of attempts until successful intubation, total time for intubation, duration of the successful attempt and occurrence of lingual cyanosis/laryngeal lesions were recorded. Data were analyzed by t test, Wilcoxon–Mann–Whitney U test or chi-square test. Pearson correlation for body weight was performed. ResultsThe success rate of blind intubation was 88.9% and 77.8% for VA and EPS, respectively. Propofol dose, total and median number of attempts, total time for intubation and duration of the successful attempt were 3.1 (0–6.2) mg kg–1, 19, 2 (1–5), 79 ± 65 and 30 ± 20 seconds for VA and 1.5 (0–4.5) mg kg–1, 24, 3 (1–5), 136 ± 92 and 38 ± 16 seconds for EPS. The success rate of endoscope-assisted intubation was 87.5% for both operators. Propofol dose, total and median number of attempts, total time for intubation and duration of the successful attempt were 2.5 (1.3–7.4) mg kg–1, 22, 3 (1–5), 170 (65–368) and 46 (22–150) seconds for VA and 3.2 (0–6) mg kg–1, 11, 1 (1–4), 56 (27–432) and 55 (26–79) seconds for EPS. VA performed blind intubation more quickly, propofol dose was lower and cyanosis was less frequent than in the endoscope-assisted group. Conclusions and clinical relevanceBoth techniques were reliable for rabbit endotracheal intubation. Best results were achieved when the operator was experienced in the technique. The smartphone-based endoscope is a useful aid for rabbit intubation.

A comparison of blind intubation with the intubating laryngeal mask FASTRACH\u2122 and the intubating laryngeal mask Ambu Aura-i\u2122 a prospective randomised clinical trial

BackgroundThe intubating laryngeal mask Fastrach™ is considered a gold standard for blind intubation as well as for fibreoptic guided intubation via a laryngeal mask. Recently, a single use version of the mask has been introduced. We compared the Fastrach single use with the new, low-priced single use intubating laryngeal mask Ambu Aura-i™.We hypothesised that the LMA Ambu Aura-i and the LMA Fastrach are comparable with respect to success rates for mask placement and blind tracheal intubation through the LMA device.MethodsA prospective, randomised clinical trial. University Hospital Schleswig-Holstein, Campus Kiel, from April 2011 to April 2012.Eighty patients undergoing general anaesthesia with planned tracheal intubation were randomised and enrolled in the study. Blind intubation was performed with either laryngeal mask using two different tracheal tubes (Rüsch Super Safety Silk™ and LMA ETT™). A crossover-design was performed after an unsuccessful procedure.Primary outcome measure was the overall success rate of blind intubation. Secondary outcome measures were the time to the first adequate ventilation, a subjective handling score, and a fibreoptic control of placement, as well as the success rate of mask placement, time for mask removal after successful intubation, differences in airway leak pressure, and the incidence of postoperative sore throat and hoarseness.ResultsThe success rate of tracheal intubation with the Fastrach for the first and second attempt was significantly better compared with the Ambu Aura-i. Tracheal intubation was also significantly faster (14.1 s. ±4.4 versus 21.3 s. ±9.0; p < 0.01), and the time interval for mask removal after successful intubation was significantly shorter using the Fastrach device (24.0 s. ±8.2 versus 29.4 s. ±7.5; p < 0.001). There were no significant differences between groups regarding the incidence of postoperative sore throat and hoarseness.ConclusionBoth laryngeal mask devices are suitable for ventilation and oxygenation. Blind intubation remains the domain of the LMA Fastrach, the Ambu Aura-i is not suitable for blind intubation.Trial registrationClinicaltrials.gov Identification Number NCT03109678, retrospectively registered on April 12, 2017.

Comparison of success rate of BlockBuster® versus Fastrach® LMA as conduit for blind endotracheal intubation: A prospective randomised trial.

Background and Aims:BlockBuster® Laryngeal Mask Airway, a newer supraglottic airway device, is claimed to be an efficient conduit for endotracheal intubation. Intubating laryngeal mask airway (LMA) is an established device for the same. This randomised study was undertaken to evaluate the success rate of blind intubation using either of these LMAs.Methods:Sixty patients of age group 20-60 years undergoing general anaesthesia were randomised in 2 groups, of 30 patients each, for tracheal intubation using either BlockBuster® LMA (Group B) or the Intubating LMA Fastrach® (Group F). After induction of anaesthesia, LMAs were inserted and on achieving adequate ventilation with the device, fibreoptic scopy was performed to assess the glottis visualisation score. Blind intubation was attempted through the supraglottic airway devices (SAD). The primary objective was first pass successful intubation and secondary outcomes were ease, time for LMA insertion, oropharyngeal seal pressure (OSP), LMA removal time, fibreoptic scoring and complications. Data was analysed using SPSS V22 software.Results:The first-attempt success rate of tracheal intubation was 90% in Group B and 66.6% in Group F (P = 0.028), while the overall success rate of intubation was 96.6% in Group B and 89.9% in Group F (P = 0.3). The OSP in Group B was 33.7 ± 1.8 and 22.7 ± 1.5 cm H2O in Group F (P = 0.001). Complications such as sore throat and blood stain were reduced with BlockBuster® LMA.Conclusion:BlockBuster® LMA provides higher first pass success rate of blind tracheal intubation with less complications like sore throat and blood staining.

Comparative evaluation of Ambu Aura-i and Fastrach™ intubating laryngeal mask airway for tracheal intubation: A randomized controlled trial.

Background and aims:Ambu Aura-i was compared with Fastrach™ (FT)-laryngeal mask airway (LMA) as a conduit for tracheal intubation.Material and Methods:A hundred consenting patients were randomly allocated into two groups of 50 patients each in a prospective randomized study. Standard anesthesia technique was used for all patients and FT-LMA or Ambu Aura-i was selected. After insertion of airway device, the cuff was inflated and ventilation was attempted. Once satisfactory ventilation was achieved, with or without maneuvers, a fiberoptic scoring for glottis view was noted. A polyvinylchloride (PVC) tracheal tube of appropriate size was inserted through the airway device as per procedure. If no resistance was felt while advancing the tracheal tube, it was fully inserted into the device and tracheal tube cuff was inflated. The device was removed and tracheal tube was left in situ. If the first attempt failed during tracheal tube insertion, the recommended maneuvers were used. A maximum of three attempts were allowed for intubation. First attempt for tracheal intubation attempt was a blind, second attempt was made with maneuver. If second attempt of intubation was unsuccessful, fiberoptic-guided intubation was performed as a third attempt. When tracheal intubation was unsuccessful, it was performed by direct laryngoscopy and considered as failed intubation. Rest of the anesthesia management was as per the discretion of attending anesthesiologists. The success rate of device insertion, fiberoptic score of glottis view, tracheal intubation via FT-LMA or Aura-i and time were recorded.Results:Both FT-LMA and Aura-i were successfully placed within two attempts. The success rate of blind intubation was 92% in FT-LMA and 76% in Aura-i (P < 0.01). Time taken for tracheal intubation at first attempt was lesser in group FT-LMA and Aura-i, respectively (P < 0.01). Fiberoptic-guided intubation success rate was higher with Aura-i than with FT-LMA.Conclusions:FT-LMA had a higher success rate in facilitating blind tracheal intubation compared with Ambu Aura-i.

Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand

Background:Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation.Methods:The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression.Results:Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42 seconds, 35–49), compared with Air-Q (21 seconds, 18–32) and I-Gel (19 seconds, 17–27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22 seconds) but was significantly shorter compared with endotracheal intubation (50 seconds, P < .001).Conclusions:Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy.

Effect of Head Position on the Success Rate of Blind Intubation through Air Q Laryngeal Mask in Morbidly Obese Patients

Aim: To evaluate the effect of head positioning whether neutral or sniffing position on the conduct of intubation through air Q in morbidly obese patients. Patients and method: This study was conducted on 90 patients with body mass index equal or above 40 who were scheduled for surgery under GA and were randomly divided into 2 equal groups: Group N (Gn) in which blind intubation through air Q was done in neutral position. Group S (Gs) in which blind intubation was done in sniffing position. Proper airway assessment of the patients was done. Basic monitoring was attached; Induction of anaesthesia was achieved by Fentanyl 2 ug/kg, Propofol 1.5 - 2.5 mg/kg and Atracurium 0.5 mg/kg. Maintenance of anaesthesia was achieved by Sevoflurane, Atracurium, oxygen and air. When neuromuscular blockade was complete, the head of the patient was adjusted according to their group. The supraglottic device was inserted and connected to capnography, thereafter a well lubricated proper sized ETT was passed through the air Q. We recorded a baseline reading of HR, SBP, DBP, MBP, and oxygen saturation. A second reading was taken after induction of anesthesia, just before intubation. The third reading was recorded after intubation while further readings were measured 1, 3, 5, 10, 15 min after intubation. After ETT removal, we observed the patients in the recovery room at 0, 3 & 24 hours for possible postoperative complications. Results: There was no statistical difference between the two groups regarding the demographic data. Although the intubation in sniffing position has a higher success rate from the first time than the neutral position, the results were statistically insignificant, regarding the mean duration of blind intubation trials through the Air Q and postoperative complications. Conclusion: Although the sniffing position improves glottic visualization, the change of head position had no effect on the success rate of blind intubation through air Q in obese patients.

Comparison of Ambu® AuraGain™ laryngeal mask and air-Q™ intubating laryngeal airway for blind tracheal intubation in adults: A randomized controlled trial

BackgroundThis study has been designed to compare the performance of Ambu® AuraGain™ laryngeal mask with the air-Q™ as a conduit for blind tracheal intubation in adult patients.MethodsIn this prospective randomized controlled trial blind endotracheal intubation success rates were compared between Ambu® AuraGain™ and air-Q™ intubating laryngeal airway in 90 adult patients. Patients were randomized in two equal groups: Group Ambu® AuraGain™ (n = 45) and Group air-Q™ (n = 45).ResultsTime to insert the laryngeal airway was similar between Ambu® AuraGain™ and air-Q™ (median [IQR] 13[12–14] s versus 14[12–16] s) and in all cases laryngeal mask insertion was possible in first attempt. Intubation success rate at first attempt was significantly higher in air-Q™ group compared to in Ambu® AuraGain™ group (68.9% versus 35.6%; p = 0.002). Overall blind intubation success rate was significantly higher in air-Q™ group in comparison to Ambu® AuraGain™ (80% versus 53.3%; p = 0.007). Intubation time was significantly higher with Ambu® AuraGain™ (p < 0.0001; median difference 4.0 s, 95% CI 2.7, 5.3 s). Blind intubation was significantly easier in air-Q™ group compared to in Ambu® AuraGain™ (42.2% intubation was graded as easy in air-Q™ instead of 22.2% in Ambu® AuraGain™, p = 0.04). Comparison of fibreoptic bronchoscopic glottis view was similar between the two devices (p = 0.07). Reported complications were infrequent and similar between the two devices.ConclusionWe conclude that air-Q™ laryngeal airway is superior to Ambu® AuraGain™ when used as a conduit for blind endotracheal intubation in adult patients.Trial registrationClinical Trial Registry of India (CTRI/2015/02/005553).

Effect of head position on the success rate of blind intubation using intubating supraglottic airway devices

BackgroundTo evaluate the effect of head position on the performance of intubating supraglottic airway devices, we compared the success rate of blind intubation in the head-elevated and the pillowless head positions with the LMA Fastrach and the air-Q, and the change of glottic visualization through the air-Q. MethodsWe assigned 193 patients to two groups according to the device used and subgrouped by head position used for intubation: Fastrach/pillowless, Fastrach/head-elevated, air-Q/pillowless, and air-Q/head-elevated. Blind intubation through the Fastrach or the air-Q was attempted up to twice after induction of general anesthesia. Before the attempt at blind intubation with the air-Q, the percentage of glottic opening (POGO) score was also fiberscopically evaluated at the outlet of the device in both head positions in a cross-over fashion. ResultsThe Fastrach significantly facilitated blind intubation compared with the air-Q in both the pillowless and head-elevated positions: 87.2% in Fastrach/pillowless vs 65.9% in air-Q/pillowless (P=.048), 90% in Fastrach/head-elevated vs 53.7% in air-Q/head-elevated (P<.001). The head-elevated position did not significantly affect the success rate of blind intubation for either device (P=.97 in Fastrach, P=.37 in air-Q). Although the head-elevated position significantly improved the POGO score from the median (10–90 percentile) 60% (0–100%) in the pillowless position to 80% (0–100%) (P=.008), it did not contribute to successful blind intubation with the air-Q. ConclusionAlthough the head-elevated position improved glottic visualization in the air-Q, the head position had minimal influence on the success rate of blind intubation with either the Fastrach or the air-Q.

Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes.

Background and Aims:Air-Q™ is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this study was to assess whether use of two different endotracheal tubes (ETTs) (standard polyvinyl chloride [PVC] and reinforced PVC) increases the success rate of blind intubation through Air-Q™ (Group Q) when compared with intubating laryngeal mask airway (ILMA- Fastrach™) keeping ILMA as control (Group I).Methods:One hundred and twenty patients aged between 18 and 60 years with American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, case–control study to compare the success rate of tracheal intubation between ILMA (Fastrach™) and Air-Q™ intubating laryngeal airway. Those patients with anticipated difficult airway were excluded from the study. All the recruited patients completed the study. Reinforced PVC ETT was used in both airway devices to secure intubation. Since standard PVC tube is recommended for use in Air-Q, when first intubation attempt failed, second or third attempt was made with standard PVC ETT. Total of three attempts were made for each procedure: Whereas in ILMA group, only reinforced tube was used in all three attempts.Results:The overall success rate after three attempts was more with Air-Q (96.6%) in our study compared with ILMA (91.6%) but no significant difference was seen between the groups (P = 0.43).Conclusion:The present study shows that when intubation with reinforced tube fails, the success rate with use of conventional PVC tube is more with Air-Q when compared with ILMA.

Comparison of 4 Supraglotttic Devices Used by Paramedics During Simulated CPR : A Randomized Controlled Crossover Trial

BackgroundEnsuring an open airway during cardiopulmonary resuscitation is fundamental. The aim of this study was to determine the success rate of blind intubation during simulated cardiopulmonary resuscitation by untrained personnel. MethodsFour devices were compared in a simulated resuscitation scenario: ILMA (Intavent Direct Ltd, Buckinghamshire, United Kingdom), Cobra PLA (Engineered Medical Systems Inc, Indianapolis, IN), Supraglottic Airway Laryngopharyngeal Tube (SALT) (ECOLAB, St. Paul, MN), and Air-Q (Mercury Medical, Clearwater, FL). A group of 210 paramedics intubated a manikin with continuous chest compressions. ResultsThe mean times to intubation were 40.46 ± 4.64, 33.96 ± 6.23, 17.2 ± 4.63, and 49.23 ± 13.19 seconds (SALT vs ILMA, Cobra PLA, and Air-Q; P < .05). The success ratios of blind intubation for the devices were 86.7%, 85.7%, 100%, and 71.4% (SALT vs ILMA, Cobra PLA, and Air-Q; P < .05). ConclusionThe study showed that the most efficient device with the shortest blind intubation time was the SALT device.

Evaluación del tubo laringofaríngeo supraglótico como un dispositivo útil para intubación endotraqueal a ciegas, en personal no experimentado, utilizando maniquíes

IntroductionOne of the key objectives in the pre-hospital environment is to control and secure the airway. Supraglottic airway laryngopharyngeal tube (SALT) is a basic device designed to ventilate and guide the blind introduction of the endotracheal tube. It has not yet been approved in our environment. ObjectiveTo determine the blind intubation success rate of non-trained personnel. ResultsA descriptive trial with 90 participants in a simulated environment with dummies. In 96.7% of the cases, the intubation procedure with the device was perceived as easy. In all, 90% had a successful intubation in the first attempt in 16 s, which is a shorter time period as compared to intubation with other devices. ConclusionSALT could be an effective airway management device for non-trained individuals.

Evaluating supraglottic airway laryngopharyngeal tube as a practical device for blind endotracheal intubation by non-experienced personnel in dummies

IntroductionOne of the key objectives in the pre-hospital environment is to control and secure the airway. Supraglottic airway laryngopharyngeal tube (SALT) is a basic device designed to ventilate and guide the blind introduction of the endotracheal tube. It has not yet been approved in our environment. ObjectiveTo determine the blind intubation success rate of non-trained personnel. ResultsA descriptive trial with 90 participants in a simulated environment with dummies. In 96.7% of the cases, the intubation procedure with the device was perceived as easy. In all, 90% had a successful intubation in the first attempt in 16s, which is a shorter time period as compared to intubation with other devices. ConclusionSALT could be an effective airway management device for non-trained individuals.

Evaluation of chest compression effect on airway management with air-Q®, aura-i®, i-gel®, and Fastrack® intubating supraglottic devices by novice physicians: a randomized crossover simulation study

In the 2010 American Heart Association guidelines, supraglottic devices (SGDs) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation. Some SGDs can also serve as a means for tracheal intubation after successful ventilation. The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs, aura-i (aura-i), air-Q (air-Q), i-gel (i-gel), and Fastrack (Fastrack), during cardiopulmonary resuscitation using a manikin. Twenty novice physicians inserted the four intubating SGDs into a manikin with or without chest compression. Insertion time and successful ventilation rate were measured. For cases of successful ventilation, blind tracheal intubation via the intubating SGD was performed with chest compression and success or failure within 30 s was recorded. Chest compression did not decrease the ventilation success rate of the four intubating SGDs (without chest compression (success/total): air-Q, 19/20; aura-i, 19/20; i-gel, 18/20; Fastrack, 19/20; with chest compression: air-Q, 19/20; aura-i, 19/20; i-gel, 16/20; Fastrack, 18/20). Insertion time was significantly lengthened by chest compression in the i-gel trial (P < 0.05), but not with the other three devices. The blind intubation success rate with chest compression was the highest in the air-Q trial (air-Q, 15/19; aura-i, 14/19; i-gel, 12/16; Fastrack, 10/18). This simulation study revealed the utility of intubating SGDs for airway management during chest compression.

Tips and tricks to increase the success rate of blind tracheal intubation through the Air-Q™ versus the intubating laryngeal mask airway Fastrach™

BackgroundThe Air-Q intubating laryngeal airway is a new supraglottic airway device which overcomes some of the limitations inherent to the intubating laryngeal mask airway (ILMA Fastrach™) for tracheal intubation. Previous studies showed lower success rate of the Air-Q™ versus ILMA Fastrach™. This study was conducted to illustrate new maneuvers for increasing the success rate of Air-Q™ versus ILMA Fastrach™ and compare between both devices.MethodsOne-hundred and seventy adult patients, ASA I or II, aged >16 years old undergoing elective surgery under general anesthesia were divided randomly into 2 equal groups (85 each). Group A: using Air-Q ILA size 3.5 or size 4.5 Group B: using ILMA size 4 or size 5 according to the manufacturer’s recommendations for body weight in both groups. The time and the total success rate of blind intubation through them in 2 attempts only were recorded. In Group A, extension of the head with cricoid pressure was applied. The hemodynamic response to devices insertion and the complications related to both devices were compared.ResultsIn Group A, the total success rate in 2 attempts was 94.12%, while in Group B, it was 96.47%. However, this difference was not statistically significant. The first attempt success rate was 81.18% in Group A, while it was 82.35% in Group B. The total time to intubate the hemodynamic response to device insertion and the incidence of complications (sore throat, trauma and hoarseness of voice) showed no statistically significant difference between both groups.ConclusionThis study showed that extension of the head with cricoid pressure greatly increases the success rate of blind intubation through the Air-Q to 94.12% versus the ILMA Fastrach 96.47% with no statistically significant difference between both devices.

Comparison of success rate of blind intubation through Air-Q and LMA FastrachTM in sniffing position and neutral position

Comparison of success rate of blind intubation through Air-Q and LMA FastrachTM in sniffing position and neutral position

Roles of Cookgas and Fastrach intubating laryngeal mask airway for anticipated difficult tracheal intubation

To compare the clinical effectiveness of blind intubation through the Cookgas intubating laryngeal airway(CILA) or Fastrach intubating laryngeal mask airway(FT-LMA) for anticipated difficult tracheal intubation. Eighty-six patients with anticipated difficult tracheal intubation who were undergoing elective plastic surgery under general anesthesia were randomly allocated into CILA group(n=43) and FT-LMA group(n=43) . After general anesthesia being induced and CILA or FT-LMA being inserted, the patients were treated with blind intubation through CILA or FT-LMA. In each case, the number and the time of intubating laryngeal airway(ILA) insertion and blind intubation attempts and ILA removal were recorded. The view of glottis under fiberoptic bronchoscope(FOB) via CILA or FT-LMA was recorded. In addition, noninvasive blood pressure and heart rate were recorded before and after intravenous anesthetic induction, at ILA insertion, at intubation, at ILA removal and every minute thereafter for 5 minutes. CILA or FT-LMA was inserted successfully in all 86 patients. The rate of the first successful insertion was not significantly different between two groups(P>0.05) . In CILA group, the first intubation attempt succeeded in 35 patients;5 and 2 cases were intubated blindly at the second and the third attempt, one patient failed who was intubated successfully by FOB via CILA. In FT-LMA group, 32 patients were intubated successfully at the first attempt, 4 at the second attempt, 3 at the third attempt, and 4 cases failed, three of them were intubated smoothly with FOB through FT-LMA, one failed patient was intubated by FOB. The time of FT-LMA insertion(34.2∓13.9) s was significantly longer when compared with CILA(22.4∓18.9) s (P<0.05) . However, the time of blind intubation through CILA and FT-LMA [(46.0∓26.7) s vs.(51.8∓41.1) s]and the time of ILA removal[(39.3∓11.9) s vs.(35.3∓10.4) s] were not significantly different between groups(P>0.05) . Hemodynamic changes during blind intubation in the two groups showed no significant differences(P>0.05) . Blind intubation via CILA or FT-LMA is safe and effective for anticipated difficult tracheal intubation. Nevertheless, CILA is easier to be inserted, with relatively higher success rate of blind intubation.

Randomized Clinical Trial of the i-gel™ and Magill Tracheal Tube or Single-Use ILMA™ and ILMA™ Tracheal Tube for Blind Intubation in Anaesthetized Patients With a Predicted Difficult Airway

Theiler, L.*†; Kleine-Brueggeney, M.*‡; Urwyler, N.*; Graf, T.*; Luyet, C.*; Greif, R.*Author Information

Blind versus fiberoptic laryngoscopic intubation through air Q laryngeal mask airway

BackgroundThe practice of airway management has become more advanced in recent years. This advancement is demonstrated by the introduction of many new airway devices, several of which have been included in the American Society of Anesthesiology (ASA).The most recently developed is air-Q which has special features and benefits that make it characteristic.The success rate of blind intubation versus fiberoptic intubation through air-Q was investigated in this study. Success rate and quality of fiberoptic guided intubations were assessed.MethodThis study was conducted on 80 patients who underwent urosurgical operations under general anesthesia. Patients were randomly allocated into two equal groups (n = 40): group I in which intubation was done blindly through air-Q, and group II in which intubation was done by FO through air-Q. All the patients were meticulously assessed by El Ganzouri score. Patients taking points from 0 to 4 were only allowed to be included in this study to avoid the use of the awake technique if the score was 5 or more. After induction of anesthesia patients were primarily ventilated with the air Q. Then the endotracheal tube was inserted either blindly or by FO through the air Q. Successful intubation was confirmed by chest wall movement, auscultation, and capnogram. After three trials of intubations the procedure was abandoned. Twenty-four hours post-intubation, patients were questioned on the occurrence of sore throat and hoarseness.ResultsThe success rate in blind intubation was 70% while in FO intubation was 97.5%.and this difference was statistically significant (p < 0.05). The total time to intubate in seconds was longer in group I than in group II and this difference was statistically significant (p < 0.05).ConclusionIn our patients the air Q appeared to be a safe supraglottic airway in general anesthesia with a low potential for trauma of the airway. It is used as a facilitator for blind intubation. It allowed successful blind intubation in 70% of the patients versus 97.5% using fiberoptic technique. Backed up by the presence of a flexible fiberscope, this device might be a useful alternative for the handling of difficult airway.

Randomized clinical trial of the i-gel™ and Magill tracheal tube or single-use ILMA™ and ILMA™ tracheal tube for blind intubation in anaesthetized patients with a predicted difficult airway

The single-use supraglottic airway device i-gel™ has been described in several case reports as a conduit for intubation, but no prospective data about success rates of blind intubation are available. Therefore, we performed this prospective randomized controlled trial to compare the success rate of blind tracheal intubation with a Magill PVC tube through the i-gel™ with intubation using an sILMA™ PVC tube through the single-use intubating laryngeal mask airway (sILMA™). With ethics committee approval and written informed consent, 80 patients with predictors of a difficult airway were computer randomized to either supraglottic airway device (SAD). The corresponding tracheal tube (TT) was introduced through the SAD under fibreoptic visualization but without fibreoptic guidance. Primary outcome was blind intubation success rate. Times, airway leak pressure, fibreoptic view, and adverse events were recorded. To control for the influence of the TT, we compared data from 40 patients described in an accompanying study (sILMA™ with Magill TT and i-gel™ with sILMA™ TT). Blind intubation success rate through the sILMA™ (69%) was higher than with the i-gel™ (15%, P<0.001). Data from the other patient group excluded the TT type as the primary cause for the difference in success rate. Removal of SADs was without problems with no difference between the type of SAD. Blind tracheal intubation using the sILMA™ tube through the sILMA™ is much more successful than blind intubation with a Magill PVC tube through the i-gel™. Because of its low success rate, we would not recommend blind intubation through the i-gel™.

A comparison of the I-gel supraglottic airway as a conduit for tracheal intubation with the intubating laryngeal mask airway: A manikin study

Background Insertion of a supraglottic airway and tracheal intubation through it may be indicated in resuscitation scenarios where conventional laryngoscopy fails. Various supraglottic devices have been used as conduits for tracheal intubation, including the intubating laryngeal mask airway (ILMA), the Ctrach™ laryngeal mask and the I-gel supraglottic airway. Methods A prospective study with 25 participants evaluated the success rate of blind intubation (using a gum-elastic bougie, an Aintree intubating catheter (AIC) and designated tracheal tube) and fibrescope-guided tracheal intubation (through the intubating laryngeal mask airway and the I-gel supraglottic airway) on three different airway manikins. Results Twenty-five anaesthetists performed three intubations with each method on each of three manikins. The success rate of the fibrescope-guided technique was significantly higher than blind attempts ( P < 0.0001) with both devices. For fibreoptic techniques, there was no difference found between the ILMA and I-gel ( P > 0.05). All blind techniques were significantly more successful in the ILMA group compared to the I-gel ( P < 0.0001 for bougie, Aintree catheter and tracheal tube, respectively). Conclusions The results of this study show that, in manikins, fibreoptic intubation through both ILMA and I-gel is a highly successful technique. Blind intubation through the I-gel showed a low success rate and should not be attempted.