Study reveals Airway Challenges and Optimization of Intubation with Second-Generation supraglottic airway devices

Second-generation supraglottic airway devices (SADs) serve as both a ventilation tool and a pathway for certain types of intubation in challenging laryngoscopy situations. However, relying on blind intubation through SADs is not recommended due to challenges like requiring multiple attempts, low success rates, prolonged duration, potential for esophageal intubation, and risk of airway injury. Recent research study compared the use of LMA Protector and i-gel as conduits for fiber-optic guided tracheal intubation in adult paralyzed patients using PVC endotracheal tubes (ETT). The study aimed to assess the time to tracheal intubation via the two supraglottic airway devices (SADs) as the primary outcome, with insertion and intubation characteristics as secondary outcomes. A total of 66 patients within the age range of 18-70 years and with ASA physical status I/II were randomly allocated to groups for the comparison.

Results and Comparison of Airway Devices

The results indicated that there were no significant differences between LMA Protector and i-gel in terms of time to view the carina, tracheal intubation time, insertion characteristics, or adverse effects. Both devices showed comparable performance as conduits for fiber-optic guided tracheal intubation. The study findings suggested that grade 1 and grade 2 glottic views were achieved effectively with both devices, in line with previous literature supporting good glottic views with appropriately placed SADs.

Evaluation of Insertion and Intubation Parameters

The study also evaluated parameters like ease of insertion, intubation attempts, tracheal tube impingement, and oropharyngeal leak pressure, all of which were found to be statistically non-significant between LMA Protector and i-gel. While the i-gel exhibited more instances of tracheal tube impingement, the differences were not significant. Adverse effects such as blood stains on the device, oropharyngeal trauma, and postoperative complications like sore throat were similar in both groups, demonstrating comparable safety profiles for both SADs. The study acknowledged certain limitations, including the exclusion of patients with anticipated difficult airways or BMI > 35 kg/m2, which might impact the generalizability of the findings to broader patient populations. However, the research concluded that LMA Protector and i-gel are technologically equivalent when used as conduits for fiber-optic guided tracheal intubation with PVC ETT in adult paralyzed patients. The study emphasized the importance of these findings in enhancing airway management practices in clinical settings.

Key Points

- The study compared the LMA Protector and i-gel as conduits for fiber-optic guided tracheal intubation in adult paralyzed patients using PVC endotracheal tubes.

- Primary outcome was the time to tracheal intubation, with insertion and intubation characteristics as secondary outcomes.

- 66 patients aged 18-70 with ASA physical status I/II were randomly allocated to groups. - Results showed no significant differences between LMA Protector and i-gel in terms of intubation time, insertion characteristics, or adverse effects, indicating comparable performance.

- Evaluation of parameters like ease of insertion, intubation attempts, tracheal tube impingement, and oropharyngeal leak pressure showed non-significant differences between the two devices.

- Adverse effects such as blood stains, oropharyngeal trauma, and postoperative complications were similar in both groups, indicating comparable safety profiles for LMA Protector and i-gel.

Reference –

M. Bhardwaj et al. (2024). Comparison Of Fibreoptic-Guided Tracheal Intubation Through LMA Protector And I-Gel In Adult Paralysed Patients – A Randomised Comparative Study. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_656_24.