Comparison of times to achieve tracheal intubation with three techniques using the laryngeal or intubating laryngeal mask airway*

Abstract

SummaryWe compared the times to intubate the trachea using three techniques in 60 healthy patients with normal airways: (i) ®breoptic intubation with a 6.0-mm reinforced tracheal tube through a standard laryngeal mask airway (laryngeal mask)®breoptic group); (ii) ®breoptic intubation with a dedicated 7.0-mm silicone tracheal tube through the intubating laryngeal mask airway (intubating laryngeal mask)®breoptic group); (iii) blind intubation with the dedicated 7.0-mm silicone tracheal tube through the intubating laryngeal mask airway (intubating laryngeal mask)blind group). Mean (SD) total intubation times were signi®cantly shorter in the intubating laryngeal mask)blind group (49 (20) s) than in either of the other two groups (intubating laryngeal mask)®breoptic 74 (21) s; laryngeal mask)®breoptic group 75 (36) s; p < 0.001). However, intubation at the ®rst attempt was less successful with the intubating laryngeal mask)blind technique (15 ¤ 20 (75%)) than in the other two groups (intubating laryngeal mask)®breoptic 19 ¤ 20 (95%) and laryngeal mask)®breoptic 16 ¤ 20 (80%)) although these differences were not statistically signi®cant. We conclude that in this patient group, all three techniques yield acceptable results. If there is a choice of techniques available, the intubating laryngeal mask)blind technique would result in the shortest intubation time.

Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i‐gel in a manikin*

“…We observed three failed intubations due to railroading difficulties. Other investigators have reported similar problems when the LMA Classic was used to assist fibrescope guided tracheal tube placement [20,21] or AIC assisted intubation via the LMA Classic [16]. The ease of railroading may be influenced by the differences in the design features between the i-gel and LMA Classic.…”

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

“…29 In a comparative study, Pandit et al found that the FOB-assisted tracheal intubation had a higher success rate (95%) through the FT-LMA than through the C-LMA (80%), 30 although the time to intubation was longer with the FOB-assisted technique compared with the blind technique (74 sec vs 49 sec, respectively). Unfortunately, the success rate of FOBassisted intubation through the FT-LMA is less predictable following a failed blind technique in patients with a difficult airway.…”

“…30,36,57,79,81 Since the bowl of the FT-LMA may include the esophagus and initial FT-LMA ventilation may be adequate, Dimitriou et al 81 suggest that, clinicians need increased assurance of tracheal placement (i.e., capnography, bilateral breath sounds) when the trachea is intubated blindly. A case of an esophageal perforation has also been reported after five blind intubation attempts were made through the FT-LMA.…”

A comparison of fibreoptic‐guided tracheal intubation through the Ambu®Aura‐i™, the intubating laryngeal mask airway and the i‐gel™: a manikin study

“…It has an anatomically curved rigid airway tube, a metal introducer handle and the bowl of the device contains an 'epiglottic elevator bar'. Although originally designed to facilitate 'blind' tracheal intubation, success is increased by using a fibrescope inserted through the ILMA [3][4][5] and it may be considered the standard device for fibreoptic-guided tracheal intubation.…”