Tips and tricks to increase the success rate of blind tracheal intubation through the Air-Q (TM) versus the intubating laryngeal mask airway Fastrach (TM)

Background: The Air-Q intubating laryngeal airway is a new supraglottic airway device which overcomes some of the limitations inherent to the intubating laryngeal mask airway (ILMA Fastrach (TM)) for tracheal intubation. Previous studies showed lower success rate of the Air-Q (TM) versus ILMA Fastrach (TM). This study was conducted to illustrate new maneuvers for increasing the success rate of Air-Q (TM) versus ILMA Fastrach (TM) and compare between both devices. Methods: One-hundred and seventy adult patients, ASA I or II, aged > 16 years old undergoing elective surgery under general anesthesia were divided randomly into 2 equal groups (85 each). Group A: using Air-Q ILA size 3.5 or size 4.5 Group B: using ILMA size 4 or size 5 according to the manufacturer's recommendations for body weight in both groups. The time and the total success rate of blind intubation through them in 2 attempts only were recorded. In Group A, extension of the head with cricoid pressure was applied. The hemodynamic response to devices insertion and the complications related to both devices were compared. Results: In Group A, the total success rate in 2 attempts was 94.12%, while in Group B, it was 96.47%. However, this difference was not statistically significant. The first attempt success rate was 81.18% in Group A, while it was 82.35% in Group B. The total time to intubate the hemodynamic response to device insertion and the incidence of complications (sore throat, trauma and hoarseness of voice) showed no statistically significant difference between both groups. Conclusion: This study showed that extension of the head with cricoid pressure greatly increases the success rate of blind intubation through the Air-Q to 94.12% versus the ILMA Fastrach 96.47% with no statistically significant difference between both devices. (C) 2013 Production and hosting by Elsevier B.V.