Evaluation of air-QTM intubating laryngeal airway as a conduit for tracheal intubation in infants - a pilot study (original) (raw)
Related papers
Anesthesia & Analgesia, 2011
BACKGROUND: The air-Q™ Intubating Laryngeal Airway (ILA) (Cookgas LLC, Mercury Medical, Clearwater, FL) is a supraglottic airway device available in pediatric sizes, with design features to facilitate passage of cuffed tracheal tubes when used to guide tracheal intubation. We designed this prospective observational study of the ILA to assess the ease of its placement in paralyzed pediatric patients, determine its position and alignment to the larynx using a fiberoptic bronchoscope, gauge its efficacy as a conduit for fiberoptic intubation with cuffed tracheal tubes, and evaluate the ability to remove the ILA without dislodgement of the tracheal tube after successful tracheal intubation. METHODS: One hundred healthy children, aged 6 months to 8 years, ASA physical status I to II, and scheduled for elective surgery requiring general endotracheal anesthesia were enrolled in this prospective study. Based on the manufacturer's guidelines, each patient received either a size 1.5 or 2.0 ILA according to their weight. The number of attempts for successful insertion, leak pressures, fiberoptic grade of view, number of attempts and time for tracheal intubation, time for ILA removal, and complications were recorded. RESULTS: ILA placement, fiberoptic tracheal intubation, and ILA removal were successful in all patients. The size 1.5 ILA cohort had significantly higher rates of epiglottic downfolding compared with the size 2.0 ILA cohort (P Ͻ 0.001), despite adequate ventilation variables. When comparing fiberoptic grade of view to weight, a moderate negative correlation was found (r ϭ Ϫ0.41, P Ͻ 0.001), indicating that larger patients tended to have better fiberoptic grades of view. The size 1.5 ILA cohort had a significantly longer time to intubation (P ϭ 0.04) compared with the size 2.0 ILA cohort. However, this difference may not be clinically significant because there was a large overlap of confidence bounds in the average times of the size 1.5 ILA (27.0 Ϯ 13.0 seconds) and size 2.0 ILA cohorts (22.7 Ϯ 6.9 seconds). When comparing weight to time to tracheal intubation, a weak correlation that was not statistically significant was found (r ϭ Ϫ0.17, P ϭ 0.09), showing that time to intubation did not differ significantly according to weight, despite higher fiberoptic grades in smaller patients. CONCLUSIONS: The ILA was easy to place and provided an effective conduit for tracheal intubation with cuffed tracheal tubes in children with normal airways. Additionally, removal of the ILA after successful intubation could be achieved quickly and without dislodgement of the tracheal tube. Because of the higher incidence of epiglottic downfolding in smaller patients, the use of fiberoptic bronchoscopy is recommended to assist with tracheal intubation through this device.
A Novel Method of Intubation Using a Laryngeal Mask Airway and a Bronchoscope in a Premature Infant
2016
We present a novel technique for securing an endotracheal tube after using a #1 Classic laryngeal mask airway (LMA) as a conduit for intubating the trachea of a premature infant. During induction of anesthesia for inguinal hernia repair in an ex- 23-week infant, an unanticipated difficult airway was encountered. After several unsuccessful attempts of intubating via direct laryngoscopy, we placed the endotracheal tube (ETT) into the trachea using a fiberoptic bronchoscope through a #1 LMA. A pediatric stylette, with Hytape TM wrapped around the distal tip, was then used as a plunger to safely and easily remove the LMA from the mouth while maintaining the ETT in proper position. This technique is applicable in cases of a difficult neonatal airway where even a #1, the smallest LMA, is used.
Pediatric Anesthesia, 2012
Objectives: To assess the clinical performance of the Ambu Aura-i (Aura-i) in children. Aim: To compare the Aura-i with the air-Q intubating laryngeal airway (air-Q) for the purposes of fiberoptic-guided tracheal intubation. Background: The Aura-i is a new supraglottic airway designed for tracheal intubation. Materials/Methods: One hundred twenty children, ages 1 month to 6 years, were randomized to receive either the Aura-i or air-Q, and divided into three equal subgroups (Group 1, 2, 3) based on weight. The time for successful tracheal intubation was primarily assessed. The ease, time, and number of attempts for successful device insertion, leak pressures, fiberoptic grade of laryngeal view, number of attempts time for removal of the device after tracheal intubation, and complications were secondarily assessed. Results: Device placement, tracheal intubation, and removal after tracheal intubation were successful in all patients. There were no differences in the time to successful tracheal intubation through the Aura-i (32.9 ± 13.3 s), and the air-Q (33.9 ± 13 s; P = 0.68), or fiberoptic grade of view between devices. There was not a statistically significant correlation between the time to intubation and the fiberoptic grade of laryngeal view in any of the groups. There were no statistically significant differences in the overall leak pressures, air-Q (18.3 ± 6.1 cm H 2 O) vs Aura-i (16 ± 5.1 cm H 2 O; P = 0.05). In Group 1 (5-10 kg), leak pressures were higher with the air-Q (23.4 ± 7.2 cm H 2 O) than the Aura-i (16.1 ± 5.2 cm H 2 O; P = 0.001). There were no statistically significant differences in the time for removal between the two devices (P = 0.11). However, with the size 1.5 Aura-i, the pilot balloon of the tracheal tube was removed in order to facilitate the removal of the device after tracheal intubation. Conclusions: Both devices served as effective conduits for fiberoptic-guided tracheal intubation. The limitation of the narrower proximal airway tube of the size 1.5 Aura-i should be considered if cuffed tracheal tubes are to be utilized.
Bosnian Journal of Basic Medical Sciences, 2016
We aimed to compare cuffed and uncuffed endotracheal tubes (ETTs) with ProSealTM laryngeal mask airway (PLMA) in terms of airway security and extubation, starting out from the hypothesis that PLMA will provide alternative airway safety to the endotracheal tubes, and that airway complications will be less observed. After obtaining approval from the local Ethics Committee and parental informed consent, 120 pediatric patients 1-24 months old, American Society of Anesthesiologists physical status I-II, requiring general anesthesia for elective lower abdominal surgery, were randomized into PLMA (Group P, n = 40), cuffed ETT (Group C, n = 40), and uncuffed ETT (Group UC, n = 40) groups. The number of intubation or PLMA insertion attempts was recorded. Each patient's epigastrium was auscultated for gastric insufflation, leak volumes and air leak fractions (leak volume/inspiratory volume) were recorded. Post-operative adverse events related to airway management were also followed up during the first post-operative hour. Demographic and surgical data were similar among the groups. There were significantly fewer airway manipulations in the Group P than in the other groups (p < 0.01), and leak volume and air leak fractions were greater in the Group UC than in the other two groups (p < 0.01). Laryngospasm was significantly lower in the Group P during extubation and within the first minute of post-extubation than in the other groups (p < 0.01). Based on this study, PLMA may be a good alternative to cuffed and uncuffed ETTs for airway management of infants due to the ease of manipulation and lower incidence of laryngospasm.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2014
A randomized comparison between the i-gel TM and the air-Q TM supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children Comparaison randomisée entre les voies aériennes supraglottiques i-gel TM et air-Q TM quand elles sont utilisées par des résidents en anesthésiologie comme conduits pour intubation trachéale chez des enfants Abstract Purpose Supraglottic airways are commonly used as conduits for fibreoptic bronchoscopy (FOB)-guided intubation in pediatric patients. We hypothesized that anesthesiology trainees with limited prior experience with FOB-guided intubation through a supraglottic airway in children would intubate the trachea faster through the air-Q TM supraglottic airway than through the i-gel TM . Methods Ninety-six children aged one month to six years were randomized to receive either the i-gel or air-Q for FOB-guided tracheal intubation by anesthesiology trainees. Time for successful tracheal intubation was the primary endpoint. Secondary endpoints included: time for device insertion, number of attempts for successful device insertion, airway leak pressures, FOB grade of laryngeal view, total number of attempts for tracheal intubation, time for removal of the device after tracheal intubation, and associated complications. Results The median (interquartile range [IQR]) times to successful tracheal intubation for the air-Q (62.5 [47.9-77] sec) and the i-gel (55.9 [48.5-81.8] sec) were not significantly different (median difference 6.6 sec; 95% confidence interval [CI] -13.3 to 8.7; P = 0.53). The median (IQR) time to insertion for the air-Q (16.7 [14.4-20.0] sec) was shorter than for the i-gel (19.6 [16.7-23.0] sec) (median difference 2.9 sec; 95% CI 0.8 to 4.7; P = 0.005). There were no differences between devices with respect to airway leak pressures, success rates, and time to removal. Compared with the air-Q, the i-gel was associated with more problems during device removal after tracheal intubation, including breakage of the tracheal tube pilot balloon (n = 0 vs n = 13, respectively; P \ 0.001), inadvertent extubation (n = 1 vs n = 5, respectively; P \ 0.001), and difficulty controlling the tracheal tube (n = 0 vs n = 21, respectively; P \ 0.001).
The intubating LMA: a comparison of insertion techniques with conventional tracheal tubes
Canadian Journal of Anesthesia/ …, 2000
Purpose: To compare the performance of the intubating laryngeal mask airway (ILMA) in assisting blind tracheal intubation with conventional tracheal tubes of different curvatures and the frequency of possible associated complications. Methods: After informed consent, 240 ASA I-II adults undergoing elective surgery participated in a randomized, single blind clinical trial to receive blind trachea intubation via ILMA with a conventional tracheal tube curved with normal (Normal group) or reversed (Reverse group) direction. More than three attempts at intubation was regarded as failure. The lowest oxygen saturation during intubation was recorded and postintubation sore throat and hoarseness were evaluated with verbal analog scales. Results: The overall success rates of intubation with Normal and Reverse groups were not different (96.7% and 94.2% respectively). Successful intubation at the first attempt was higher in the Reverse group than in the Normal group (86.7% vs 75.0%, P=0.033). The incidence of sore throat was higher in the Normal group than in the Reverse group (19.2% vs 9.2% respectively, P =0.042). Conclusions: Blind trachea intubation via an ILMA with the conventional curved tracheal tube is feasible and highly successful. Reverse curve direction is preferable at the first attempt of intubation for its higher success rate and lower incidence of complications. Objectif : Comparer le fonctionnement du masque laryngé d'intubation (MLI) utilisé avec des tubes endotrachéaux de différentes courbures, pour faciliter l'intubation endotrachéale à l'aveugle, et la fréquence de complications possibles. Méthode : Ayant donné leur consentement éclairé, 240 adultes d'état physique ASA I-II devant subir une intervention planifiée ont participé à un essai clinique randomisé et à l'insu. L'intubation, à l'aveugle avec le MLI et un tube endotrachéal de courbure habituelle (groupe normal) ou par insertion inversée (groupe inversé), était notée comme un échec si elle exigeait plus de trois essais. On a enregistré la plus faible saturation en oxygène pendant l'intubation et évalué, selon une échelle verbale analogique, le mal de gorge et la raucité de la voix qui ont pu suivre l'intubation. Résultats : Le taux de succès de l'intubation n'a pas présenté de différence intergroupe significative (96,7 % et 94,2 % respectivement). Une intubation réussie au premier essai a été plus fréquente dans le groupe inversé que dans le groupe normal (86,7 % vs 75,0 %, P=0,033). L'incidence de mal de gorge a été plus élevée dans le groupe normal que dans le groupe inversé (19,2 % vs 9,2 % respectivement, P =0,042). Conclusion : L'intubation endotrachéale à l'aveugle avec un MLI et un tube endotrachéal de courbure habituelle est possible et fréquemment réussie. L'insertion par inversion de la courbure, préférable au premier essai d'intubation, présente un meilleur taux de réussite et moins de complications.
We aimed to compare cuffed and uncuffed endotracheal tubes (ETTs) with ProSealTM laryngeal mask airway (PLMA) in terms of airway security and extubation, starting out from the hypothesis that PLMA will provide alternative airway safety to the endotracheal tubes, and that airway complications will be less observed. After obtaining approval from the local Ethics Committee and parental informed consent, 120 pediatric patients 1-24 months old, American Society of Anesthesiologists physical status I-II, requiring general anesthesia for elective lower abdominal surgery, were randomized into PLMA (Group P, n = 40), cuffed ETT (Group C, n = 40), and uncuffed ETT (Group UC, n = 40) groups. The number of intubation or PLMA insertion attempts was recorded. Each patient’s epigastrium was auscultated for gastric insufflation, leak volumes and air leak fractions (leak volume/inspiratory volume) were recorded. Post-operative adverse events related to airway management were also followed up during the first post-operative hour. Demographic and surgical data were similar among the groups. There were significantly fewer airway manipulations in the Group P than in the other groups (p < 0.01), and leak volume and air leak fractions were greater in the Group UC than in the other two groups (p < 0.01). Laryngospasm was significantly lower in the Group P during extubation and within the first minute of post-extubation than in the other groups (p < 0.01). Based on this study, PLMA may be a good alternative to cuffed and uncuffed ETTs for airway management of infants due to the ease of manipulation and lower incidence of laryngospasm
Intubation via LMA in pediatric patients with difficult airways
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 1999
Purpose: To report two cases of successful tracheal intubation in difficult pediatric airways using a conventional laryngeal mask airway (LMA) with an extended polyvinyl chloride (PVC) tube after laryngeal assessment with a fibreoptic device. Clinical features: Two cases, Dandy-Walker and Pierre Robin syndromes, were scheduled for surgery. They were premedicated with 0.5 mg-kg -~ promethazine p0 90 min before surgery. Both patients arrived in the operating room sedated, with dry mouth, and without evidence of increased intracranial tension or airway obstruction. Inhalational induction with isoflurane 0.5-3% was commenced. Conventional tracheal intubation was impossible in both cases. In each an LMA was inserted to maintain ventilation, anesthesia, and to facilitate intubation. Fibreoptic bronchoscopy was used to assess the larynx, followed by blind intubation via the LMA using extended PVC tracheal tube 0-F). Anesthesia was maintained during intubation using Mapleson F anesthesia circuit attached to a connector with fibreoptic bronchoscope adapter. Conclusion: This report describes the assessment of the airway with fibreoptic bronchoscopy after LMA insertion facilitated blind tracheal intubation in two children with difficult airways.