Airway Management Clinical Trial
Official title:
Fibre-optic Guided Tracheal Intubation Through Supraglottic Airway Devices - a Randomised Comparison Between I-gel and the LMA ProtectorTM
The study aims to establish which of the two second generation Supraglottic Airway Devices, the I-gel or the the laryngeal ask airway (LMA) Protector, is best suited to be used as a conduit to fibreoptic bronchoscope assisted tracheal intubation. The primary outcome of this will be the time to complete the tracheal intubation.
Tracheal intubation through a supraglottic airway device (SAD) is a well-established
technique in the management of patients with a difficult airway. The technique can be used in
patients in whom difficult intubation is expected, or in situations when tracheal intubation
using another method was not possible. It is now recommended that tracheal intubation through
the SAD should be performed using a fibreoptic scope (a camera device) to minimise the risk
of trauma to the airway, and that second generation SADs are used to minimise the risk of
aspiration of gastric contents.
There are two second generation SADs currently available which allow tracheal intubation: the
I-gel and the LMA protector.
The I-gel is a second generation supraglottic airway device widely used in anaesthesia and
resuscitation. Fibreoptic intubation through the I-gel has been evaluated in a recent
prospective study (1), with the first attempt success rate of 91.4%. In another study (2) of
patients with predicted difficult airway, the success rate of the procedure at first attempt
was 96%.
LMA Protector is a recently introduced, improved version the LMA supreme - another second
generation SAD. LMA supreme has been used in clinical practice for more than 10 years,
however, tracheal intubation through the device was extremely difficult because of the small
size of the breathing channel. The LMA Protector, has a larger breathing channel allowing the
passage of an endotracheal tube. Compared to the I-gel, is has also got a larger gastric
drainage tube. This allows easy suction in the event of regurgitation. Therefore, it appears
to be superior to the I-gel in preventing the aspiration. But there are no studies comparing
the ease of intubation through I-gel and LMA Protector
The aim of this study is to compare the ease of performing the fibreoptic guided tracheal
intubation through these two devices. Our hypothesis is that intubation through the I-gel is
easier and quicker.
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