A randomized trial comparing the <scp>A</scp>mbu®<scp>A</scp>ura‐i™ with the air‐<scp>Q</scp>™ intubating laryngeal airway as conduits for tracheal intubation in children

Jagannathan, Narasimhan; Sohn, Lisa; Sawardekar, Amod; Gordon, J. R.; Shah, Ravi D.; Mukherji, Isabella I.; Roth, Andrew G.; Suresh, Santhanam

doi:10.1111/pan.12024

Cited by 66 publications

(121 citation statements)

References 25 publications

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“…8 The air-Q TM SGA (Mercury Medical; Clearwater, FL, USA) is designed for tracheal intubation and has been shown to be an effective conduit for FOB-guided tracheal intubation in children. [9][10][11][12][13] The i-gel TM (Intersurgical; Wokingham, UK) is a newer SGA that has been shown to be effective for primary anesthetic maintenance, exhibiting higher airway leak pressures compared with other commonly utilized SGAs in children. 14,15 Additionally, some studies have also found similarly favourable fibreoptic views of the larynx through the igel when compared with other SGAs, 16,17 making it potentially useful for facilitating tracheal intubations.…”

Section: Résumémentioning

confidence: 99%

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

Jagannathan

Sohn

Ramsey

et al. 2014

Can J Anesth/J Can Anesth

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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).Author contributions Narasimhan Jagannathan, Lisa Sohn, Andrea Huang, and Luis Sequera-Ramos participated in the conception and design of the study. Narasimhan Jagannathan, Lisa Sohn, Melissa Ramsey, Andrea Huang, Amod Sawardekar, and Loryn Kromrey participated in acquiring the data. Narasimhan Jagannathan, Andrea Huang, and Gildasio S. De Oliveira participated in the analysis of the data. Narasimhan Jagannathan, Lisa Sohn, Andrea Huang, and Gildasio S. De Oliveira participated in the interpretation of the data. Narasimhan Jagannathan, Lisa Sohn, Melissa Ramsey, Luis Sequera-Ramos, and Gildasio S. De Oliveira contributed to drafting the article. Conclusions Contrary to our hypothesis, both the air-Q and i-gel supraglottic airways served as effective conduits for FOB-guided tracheal intubation in children when performed by trainees with limited prior experience. The i-gel, however, was associated with more problems during device removal following tracheal intubation. This study was registered at http://clinicaltrials.gov/show/NCT02189590. RésuméObjectif Les voies aériennes supraglottiques sont fréquemment utilisées comme conduits pour l'intubation guidée par bronchoscopie à fi...

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Section: Résumémentioning

confidence: 99%

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

Jagannathan

Sohn

Ramsey

et al. 2014

Can J Anesth/J Can Anesth

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“…42 It is important to note that a clear view of any glottic structure may be lacking in up to 18% of cases, even though there is no evidence of airway obstruction. [44][45][46][47] This finding highlights the value of the SAD in maintaining upper airway patency but also reflects inherent limits to success of this tracheal intubation technique. in adult subjects with difficult airways.…”

Section: Fiberoptic-guided Tracheal Intubation Through Supraglottic Amentioning

confidence: 90%

Supraglottic Airway DevicesDiscussion

Ramachandran

Kumar

2014

Respir Care

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SummarySupraglottic airway devices (SADs) are used to keep the upper airway open to provide unobstructed ventilation. Early (first-generation) SADs rapidly replaced endotracheal intubation and face masks in > 40% of general anesthesia cases due to their versatility and ease of use. Second-generation devices have further improved efficacy and utility by incorporating design changes. Individual second-generation SADs have allowed more dependable positive-pressure ventilation, are made of disposable materials, have integrated bite blocks, are better able to act as conduits for tracheal tube placement, and have reduced risk of pulmonary aspiration of gastric contents. SADs now provide successful rescue ventilation in > 90% of patients in whom mask ventilation or tracheal intubation is found to be impossible. However, some concerns with these devices remain, including failing to adequately ventilate, causing airway damage, and increasing the likelihood of pulmonary aspiration of gastric contents. Careful patient selection and excellent technical skills are necessary for successful use of these devices.

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“…Several studies have demonstrated the efficacy of supraglottic airway device assisted fibreoptic-guided tracheal intubation in children [6,13,15,[19][20][21], even when traditional techniques have failed [6,22], suggesting that this technique may be an indispensable anaesthetic skill [23]. Successful placement of the air-Q on the first attempt may suggest that most clinicians, regardless of experience, should not have difficulty with its insertion.…”

Section: Discussionmentioning

confidence: 99%

“…It is also important for the clinician to rehearse the removal process of the supraglottic airway device after tracheal intubation to ensure familiarity. We have previously demonstrated that the air-Q may be safely removed without dislodgement of the tracheal tube in children [15,16,21].…”

Section: Discussionmentioning

confidence: 99%

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A randomised comparison of free-handed vs air-Q™ assisted fibreoptic-guided tracheal intubation in children < 2 years of age

et al. 2014

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A randomized trial comparing the Ambu^®Aura‐i^™ with the air‐Q^™ intubating laryngeal airway as conduits for tracheal intubation in children

Abstract: 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.

Cited by 66 publications

References 25 publications

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

Supraglottic Airway DevicesDiscussion

A randomised comparison of free-handed vs air-Q™ assisted fibreoptic-guided tracheal intubation in children < 2 years of age

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A randomized trial comparing the Ambu®Aura‐i™ with the air‐Q™ intubating laryngeal airway as conduits for tracheal intubation in children

Abstract: 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.

Cited by 66 publications

References 25 publications

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children

Supraglottic Airway DevicesDiscussion

A randomised comparison of free-handed vs air-Q™ assisted fibreoptic-guided tracheal intubation in children < 2 years of age

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A randomized trial comparing the Ambu^®Aura‐i^™ with the air‐Q^™ intubating laryngeal airway as conduits for tracheal intubation in children