Endotracheal intubation in patients with difficult airway: Using laryngeal mask airway with bougie versus video laryngoscopy

Abstract

Airway management is essential for safe anesthesia and endotracheal intubation is the most important procedure by which critically ill patients can be better managed, especially if done quickly and successfully. This study aimed to compare the techniques of intubation through laryngeal mask airway (LMA) using a bougie versus video laryngoscopy (VL) regarding to intubation success and the quality of intubation indices in patients with difficult airways. This randomized clinical trial was performed on 96 patients aged 16–76 years with Mallampati class 3 or 4 who underwent elective surgery. Once the demographics were recorded, patients were randomly divided into two groups and the first group intubated with VL, and the second group intubated through laryngeal mask using a bougie. Then vital signs, arterial oxygen saturation, the time required for successful intubation, and ease of intubation were recorded. Here t-tests, chi-square, Fisher exact tests, and analysis of variance for repeated measurement were used to analyze the data in SPSS software. The overall success rates of intubation in VL and LMA groups were 46 (96%) and 44 (92%), respectively. The mean duration of intubation for the LMA and VL groups was 18.70 ± 6.73 and 14.21 ± 4.14 seconds, respectively (P < 0.001). Moreover, visual analogue scale score for pain in throat was significantly lower in VL group than LMA (1.65 ± 0.76 vs. 1.33 ± 0.52). Moreover, easy intubation in bougie group was 50%, while the easy intubation in VL was 73% (P = 0.023). In addition, incidence of cough was 31% in the LMA with bougie group and 9% in VL group (P = 0.005). The VL technique is an easier method and has a shorter intubation time than LMA using bougie, and causes a lower incidence of coughing, laryngospasm in patients that need intubation. Moreover, cough and discomfort in the throat tend to be less in VL, and the LMA could be used as replacement of VL in hard situations.

The teaching order of using direct laryngoscopy first may improve the learning outcome of endotracheal incubation

“…VL is a newer, more advanced intubation tool than DL and there is no doubt of its superiority when dealing with difficult airways. [19–21] In addition, many studies have proven its advantages for teaching ETI. [6–8,21] Nevertheless, ETI with VL can be more time-consuming because of the need to align the optical axis of the pharynx and mouth and the video laryngoscope might be too big for the patient's mouth.…”

Massive ameloblastoma: A case report of difficult fiberoptic intubation

“…There are options other than fiberoptic intubation, video-laryngoscopes and its combination about dealing with difficult airway. Using laryngeal mask with bougie technique, the intubation success rate and qualities of intubation indices were assessed in patient with difficult airway, and the overall success rate was reported to be 92% [ 13 ]. We did not plan using laryngeal mask with bougie because we are not very familiar with this technique.…”

Comparing the efficacy and safety of laryngeal mask airway, streamlined liner of the pharyngeal airway and I-gel following tracheal extubation

“…Age of patients between 15–70 years old, ASA I–II, 19 supine position, surgery duration between 120 to 180 minutes were the inclusion criteria. However, patients with body mass index (BMI) > 30, difficult airway (Mallampati Class III and IV), 20 21 history of gastric reflux, chronic obstructive pulmonary disease (COPD), head and neck surgery, pregnancy and operation that taken lower 120 minutes or higher 180 minutes were excluded from the study. The eligible patients were enrolled in study after receiving written informed consent according to inclusion and exclusion criteria.…”