The 3.5/4.5 Modification for Fiberscope-Guided Tracheal Intubation Using the Laryngeal Mask Airway

Chadd, G. D.; Walford, A. J.; Crane, David L.

doi:10.1213/00000539-199208000-00036

Cited by 28 publications

(13 citation statements)

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“…The use of an airway exchange catheter or a double-tube assembly to create a ''longer ETT'' may help to overcome this challenge and decrease the risk of tracheal extubation. 27 Another reasonable option may be to leave both the ETT and the i-gel in place until the conclusion of the procedure. The increased potential for tracheal extubation or pilot balloon breakage associated with SGAs that have relatively long/ narrow airway tubes should be a consideration when choosing a device to facilitate tracheal intubation in patients with a difficult airway.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…Demographic data are presented in Table. The mean (range) number of cases conducted by each investigator was 19 (14)(15)(16)(17)(18)(19)(20). The size #4 was initially selected in 74 patients and the size #5 in 40 patients.…”

Section: Resultsmentioning

confidence: 99%

Use of a lighted stylet for intubation via the laryngeal mask airway

Brimacombe

Carassiti²,

Morelli³

et al. 1998

Can J Anaesth

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Purpose: To assess a new technique for intubation via the laryngeal mask airway (LMA) in which a lighted stylet is used to optimise the position of the LMA before intubation. Methods: In 114 patients, following LMA insertion, the lighted stylet (Trachlight Wand TM)with mounted tracheal tube el-I-) was advanced 1.5 cm beyond the mask aperture bars and the anterior neck observed for a distinct central point of light at the cricothyroid membrane (CTM). If this was not seen, the LMA was repositioned in the pharynx, depending on the location of the light, by manually advancing, withdrawing or rotating the device, manipulating the head/neck or trying an alternative size. Tracheal intubation was attempted only when transillumination was correct. The TT with lighted st/let was advanced until the supra-stemal notch was transilluminated. Results: In 89 patients (78%) the CTM was transilluminated without repositioning, in 12 (10%) a single positional adjustment was required, and in I 0 (9%) a change of LMA size was required. In three patients (3%) transillumination of the CTM was impossible. In the 97% of patients in whom transillumination was correct, tracheal intubation was successful in all at the first attempt without the need for further repositioning or size change. Conclusion: The lighted stylet is useful in facilitating intubation via the LMA in anaesthetised adult patients when used as a guide to optimal LMA position.Objectif: t~valuer une nouvelle technique d'intubation au moyen du masque laryng~ (M L) dans lequel un stylet lumineux est utilis~ pour maximiser la position du ML avant rintubation. M&hodes : Chez II 4 patients, apr& I'insertion du ML, le styler lumineux (Trachlight Wand 9 sur lequel est mont~ un tube endotrach~al (TE) a ~t~ pouss~ de 1,5 cm au-del~ des barres d'ouverture du masque et la partie ant&ieure du cou a ~t~ examin& pour d~terminer un point central pr&is de lumi&e au niveau de la membrane crico-thyroidienne (MCT). Si ce point central n'&ait pas visible, le ML &air replac~ darts le pharynx, selon la Iocalisation de la lumi&e, par pouss& manuelle, en retirant ou en toumant I'appareil, en manipulant la t&e ou le cou ou en essayant un masque de taille diff&ente. I'intubation endotrach~ale ~tait tent~e seulement quand la transillumination &ait jug& adequate. Le TE avec le stylet lumineux a ~t~ introduit jusqu'~ ce que le creux de la fourchette stemale soit transillumin~. R~sultats : Chez 89 patients (78 96) la MCT &ait transillumin~e sans remise en place, chez 12 patients ( I 0 %) un seul ajustement a 6t~ n&essaire et chez I 0 patients (9 %) un changement de taille du ML a ~t~ requis. Chez trois patients (3 %) la transillumination de la MCT a ~t~ impossible. Parmi les 97 % de patients chez qui la transillumination &ait adequate, I'intubation trach~ale a ~t~ un succ~s pour tous d& le premier essai sans avoir recours une remise en place ult&ieure ou ~ un changement de taille du ML. Conclusion : Le stylet lumineux est utile pour faciliter I'intubation au moyen du ML chez les patients adultes sous an...

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“…Various ways of achieving this have been suggested. Many techniques include the use of two connected ETTs joined either by wedging the two together, taping them together, or with an adapted female-to-female connector [19][20][21] . Another possibility is the use of the overlength Croup tube made by Portex 22 .…”

Section: • Training In These Techniques Is Essentialmentioning

confidence: 99%

Fiberoptic Bronchoscopy Versus Video Laryngoscopy in Pediatric Airway Management

Karišik

Janjević

Sorbello

2016

ACC

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SUMMARY -The primary goal of pediatric airway management is to ensure oxygenation and ventilation. Routine airway management in healthy pediatric patients is normally easy in experienced hands. Really difficult pediatric airway is rare and usually is associated with anatomically and physiologically important findings such as congenital abnormalities and syndromes, trauma, infection, swelling and burns. Using predictors of difficult intubation should be mandatory preoperative assessment in pediatric patients. Difficult airway algorithm for pediatric patients has to consist of three parts: oxygenation (A), tracheal intubation (B), and rescue (C). According to this new algorithm, if conventional direct laryngoscopy fails, we have to use alternative glottic visualization device. Do we really need video laryngoscopy? If we look at numbers, we might estimate that conventional laryngoscopy is successful and effective in around 98.5% of cases. Do we need to replace Macintosh laryngoscope with video laryngoscope completely in our routine practice? Should video laryngoscope be available to replace fiberoptic intubation in pediatric airway management? According to the algorithm, fiberoptic-assisted tracheal intubation combined with extraglottic airway devices is the standard of care. Establishment of protocols for equipping and maintaining airway trolleys and regular training in their use must be provided to avoid tissue hypoxia in children with compromised airway.

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The 3.5/4.5 Modification for Fiberscope-Guided Tracheal Intubation Using the Laryngeal Mask Airway

Cited by 28 publications

References 0 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

Use of a lighted stylet for intubation via the laryngeal mask airway

Fiberoptic Bronchoscopy Versus Video Laryngoscopy in Pediatric Airway Management

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