Endotracheal intubation through the intubating laryngeal mask airway (LMA-Fastrach™): A randomized study of LMA- Fastrach™ wire-reinforced silicone endotracheal tube versus conventional polyvinyl chloride tracheal tube

Abstract

Context:A wire-reinforced silicone tube (LMA-Fastrach™ endotracheal tube) is specially designed for tracheal intubation using intubating laryngeal mask airway (ILMA). However, conventional polyvinyl chloride (PVC) tracheal tubes have also been used with ILMA to achieve tracheal intubation successfully.Aim:To evaluate the success of tracheal intubation using the LMA-Fastrach™ tracheal tube versus conventional PVC tracheal tube through ILMA.Settings and Design:Two hundred adult ASA physical status I/II patients, scheduled to undergo elective surgery under general anaesthesia requiring intubation, were randomly allocated into two groups.Methods:The number of attempts, time taken, and manoeuvres employed to accomplish tracheal intubation were compared using conventional PVC tubes (group I) and LMA-Fastrach™ wire-reinforced silicone tubes (group II). Intraoperative haemodynamic changes and evidence of trauma and postoperative incidence of sore throat and hoarseness, were compared between the groups.Statistical Analysis:The data was analyzed using two Student's t test and Chi-square test for demographics and haemodynamic parameters. Mann Whitney U test was used for comparison of time taken for endotracheal tube insertion. Fisher's exact test was used to compare postoperative complications.Results:Rate of successful tracheal intubation and haemodynamic variables were comparable between the groups. Time taken for tracheal intubation and manoeuvres required to accomplish successful endotracheal intubation, however, were significantly greater in group I than group II (14.71±6.21 s and 10.04±4.49 s, respectively (P<0.001), and 28% in group I and 3% in group II, respectively (P<0.05)).Conclusion:Conventional PVC tube can be safely used for tracheal intubation through the ILMA.

Comparison Between Poly Vinyl Chloride (Pvc) Tube and Intubating Laryngeal Mask Airway (Ilma) Tube for Intubation Through Intubating Laryngeal Mask Airway (Ilma / Lma - Fastrach) in Mallampati (Mp) 3 and 4 Patients

“…High incidence of oesophageal intubation was observed with ILMA tube in our study as also observed by Kundra et al [12,20] Higher success of intubation with ILMA was noted when least resistance is felt in reservoir bag, maximum chest expansion is seen and optimum end tidal carbon dioxide (ETCO2) is observed on monitor during maneuvering of ILMA. [12,14,17,21] The limitations of our study is, it lacked blinding and a small study group. Lack of visualization of position of ILMA and the exact reason for unsuccessful passage of tracheal tube was not clear with ILMA.…”

“…Time for intubation was higher with conventional PVC ET tube as observed because of the stiffness of the tube. [12,14,21] Cost of normal single use conventional PVC (Portex ET tube) is around Rs.180 per tube. Cost incurred for purchasing reusable (multiple use) ILMA tube is Rs.3900, recommended for thirty uses costing Rs.130 per use, making ILMA tube economical than PVC tube.…”

Comparative evaluation of two techniques of LMA CTrach^TM insertion on manoeuvres required to obtain optimal laryngeal view

“…Previous studies have also shown that silicon reinforced tracheal tubes are better than polyvinylchloride tubes for intubation through LMA CTrach ™ . [10][11][12][13] Lopez AM et al studied 21 patients in which 12 patients required 24 manoeuvres for getting the good laryngeal view with the standard technique of insertion. Each patient required between 1 and 4 manoeuvres on an average.…”

Comparision of intubation with polyvinyl chloride tracheal tubes and silicone wire reinforced tubes through LMA CTrach^tm

“…The mean number of attempts at intubation was also significantly lower with silicone wire reinforced tubes in these studies. 8,[10][11][12] When the angle of emergence of the polyvinyl chloride tracheal tubes from various manufactures had been compared by Brain and his colleagues, the Portex PVC tube had an angle of emergence of 50 o . The angle of emergence with a straight silicone tube was 36 o .…”