Conversion of I-gel to definitive airway in a cervical immobilized manikin: Aintree intubation catheter vs long endotracheal tube

Abstract

Background: After prehospital insertion of i-gel, a popular supraglottic airway (SGA), fiberoptic-guided intubation through i-gel is often required to switch the i-gel to a definitive airway for anticipated difficult airway. The Aintree intubation catheter (AIC) was developed for this purpose yet it requires many procedural steps during which maintenance of adequate ventilation is difficult. We custom-made a long endotracheal tube (LET) which may facilitate this procedure and compared the efficacy of the AIC and LET in a cervical immobilized manikin. Methods: In this 2 × 2 crossover manikin-based trial, 20 anaesthesiologists and residents performed both methods in random order. Total intubation time, fiberoptic time, and procedure time were recorded. The ease of insertion, procedure failure rate, difficulty score, and participants' preference were recorded. Results: Total intubation time was significantly shorter for the LET than the AIC group (70.8 ± 16.4 s vs 94.0 ± 28.4 s, P = 0.001). The procedure time was significantly shorter in the LET group (51.9 ± 13.8 s vs 76.5 ± 25.4 s, P < 0.001). The ease of insertion score was lower, i.e., easier, in the AIC than the LET group (2.

EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology

“…We recommend the suggested approach by SIAARTI and UK joint societies ( 23 ) ( 24 ) as follows: The first laryngoscopy attempt should be performed with an endotracheal tube pre-loaded on a stylet. If it fails, a re-oxygenation period can be needed, which has to be applied with a low tidal volume/pressure to avoid leakage of contaminated air If a 3rd attempt is necessary, an early switch to a second-generation intubating supraglottic airway device should be considered ( 25 ). Intubation through this device should be performed with a flexible (preferably disposable) endoscope, again with a separate remote screen.…”

“…If a 3rd attempt is necessary, an early switch to a second-generation intubating supraglottic airway device should be considered ( 25 ). Intubation through this device should be performed with a flexible (preferably disposable) endoscope, again with a separate remote screen.…”