Introduction After failed mask ventilation and tracheal intubation, guidelines issued by the Difficult Airway Society recommend placing a second generation supraglottic airway device to secure oxygenation. Ultimately, a secure airway can be obtained by tracheal intubation through the supraglottic airway device using a bronchoscope. In this randomised trial, we compared the AuraGain™ with the i‐gel™ as conduit for bronchoscopic intubation under continuous oxygenation performed by a group of anaesthesiologists with variable experience in a general population of patients. Method We randomised one hundred patients who were equally allocated to flexible bronchoscopic intubation through the i‐gel™ or the AuraGain™. In a random order, 25 anaesthesiologists each performed four intubations, two using the i‐gel™ and two using the AuraGain™. Our primary outcome was ‘total time for airway management’; i.e. total time from manually reaching the SAD to successful FBI confirmed at the end of the first inspiratory downstroke on the capnography curve. Results In total, 87% (95% CI, 79%–92%) of the patients were successfully intubated through the allocated supraglottic airway device. There was no difference in total time for airway management between the i‐gel™ and the AuraGain™ (199 vs. 227 s, p = .076). However, there was a difference in time for placement of the i‐gel™, compared to the AuraGain™, (37 vs. 54 s, p < .001). There were nine failed intubations in the AuraGain™ group compared to four in the i‐gel™ group (p = .147). Conclusion We found no difference in total time for airway management between using the i‐gel™ and using the AuraGain™.

Systematic reviews associate peripheral nerve blocks based on anatomic landmarks or nerve stimulation with reduced pain and need for systemic analgesia in hip fracture patients. We aimed to investigate the effect of ultrasound-guided nerve blocks compared to conventional analgesia for preoperative pain management in hip fractures. Five databases were searched until June 2021 to identify randomised controlled trials. Two independent authors extracted data and assessed risk of bias. Data was pooled for meta-analysis and quality of evidence was evaluated using Grades of Recommendation Assessment, Development and Evaluation (GRADE). We included 12 trials (976 participants) comparing ultrasound-guided nerve blocks to conventional systemic analgesia. In favour of ultrasound, pain measured closest to two hours after block placement decreased with a mean difference of -2.26 (VAS 0 to 10); (p < 0.001) 95% CI [–2.97 to –1.55]. In favour of ultrasound, preoperative analgesic usage of iv. morphine equivalents in milligram decreased with a mean difference of –5.34 (p=0.003) 95% CI [–8.11 to –2.58]. Time from admission until surgery ranged from six hours to more than three days. Further, ultrasound-guided nerve blocks may be associated with a lower frequency of delirium: risk ratio 0.6 (p = 0.03) 95% CI [0.38 to 0.94], fewer serious adverse events: risk ratio 0.33 (p = 0.006) 95% CI [0.15 to 0.73] and higher patient satisfaction: mean difference 25.9 (VAS 0 to 100) (p < 0.001) 95% CI [19.74 to 32.07]. However, the quality of evidence was judged low or very low. In conclusion, despite low quality of evidence, ultrasound-guided blocks were associated with benefits compared to conventional systemic analgesia.

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Systematic reviews associate peripheral nerve blocks based on anatomic landmarks or nerve stimulation with reduced pain and need for systemic analgesia in hip fracture patients. We aimed to investigate the effect of ultrasound-guided nerve blocks compared to nerve blocks without the use of ultrasound and to conventional analgesia for preoperative pain management in hip fractures. Five databases were searched until June 2021 to identify randomised controlled trials. Two independent authors extracted data and assessed risk of bias. Data was pooled for meta-analysis and quality of evidence was evaluated using Grades of Recommendation Assessment, Development and Evaluation (GRADE). Our search did not identify trials comparing ultrasound-guided nerve blocks to different block techniques without use of ultrasound. However, we included 12 trials (976 participants) comparing ultrasound-guided nerve blocks to conventional systemic analgesia. In favour of ultrasound, pain after block placement decreased with a mean difference of -2.35 (VAS 0 to 10); (p<0.001) 95% CI [–3.07 to –1.62]. In favour of ultrasound, preoperative analgesic usage of iv. morphine equivalents in milligram decreased with mean difference of –5.34 (p=0.003) 95% CI [–8.11 to –2.58]. Further, ultrasound-guided nerve blocks may be associated with a lower frequency of delirium, fewer serious adverse events and higher patient satisfaction. However, the quality of evidence was judged low or very low. In conclusion, no trials comparing ultrasound to other block techniques were found, thus not permitting conclusions on our primary aim. Despite low quality of evidence, ultrasound-guided blocks were associated with benefits compared to conventional systemic analgesia.