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      Comparison of success rate of intubation through Air-Q with ILMA using two different endotracheal tubes

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          Abstract

          Background and Aims:

          Air-Q™ is a newly introduced airway device, which can be used to facilitate endotracheal intubation. The primary aim of this study was to assess whether use of two different endotracheal tubes (ETTs) (standard polyvinyl chloride [PVC] and reinforced PVC) increases the success rate of blind intubation through Air-Q™ (Group Q) when compared with intubating laryngeal mask airway (ILMA- Fastrach™) keeping ILMA as control (Group I).

          Methods:

          One hundred and twenty patients aged between 18 and 60 years with American Society of Anesthesiologists physical status I-II, undergoing elective surgery under general anaesthesia, were enrolled into this prospective, randomised, case–control study to compare the success rate of tracheal intubation between ILMA (Fastrach™) and Air-Q™ intubating laryngeal airway. Those patients with anticipated difficult airway were excluded from the study. All the recruited patients completed the study. Reinforced PVC ETT was used in both airway devices to secure intubation. Since standard PVC tube is recommended for use in Air-Q, when first intubation attempt failed, second or third attempt was made with standard PVC ETT. Total of three attempts were made for each procedure: Whereas in ILMA group, only reinforced tube was used in all three attempts.

          Results:

          The overall success rate after three attempts was more with Air-Q (96.6%) in our study compared with ILMA (91.6%) but no significant difference was seen between the groups ( P = 0.43).

          Conclusion:

          The present study shows that when intubation with reinforced tube fails, the success rate with use of conventional PVC tube is more with Air-Q when compared with ILMA.

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          Most cited references13

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          Difficult Airway Society guidelines for management of the unanticipated difficult intubation.

          M Popat, , I Latto (2004)
          Problems with tracheal intubation are infrequent but are the most common cause of anaesthetic death or brain damage. The clinical situation is not always managed well. The Difficult Airway Society (DAS) has developed guidelines for management of the unanticipated difficult tracheal intubation in the non-obstetric adult patient without upper airway obstruction. These guidelines have been developed by consensus and are based on evidence and experience. We have produced flow-charts for three scenarios: routine induction; rapid sequence induction; and failed intubation, increasing hypoxaemia and difficult ventilation in the paralysed, anaesthetised patient. The flow-charts are simple, clear and definitive. They can be fully implemented only when the necessary equipment and training are available. The guidelines received overwhelming support from the membership of the DAS. It is not intended that these guidelines should constitute a minimum standard of practice, nor are they to be regarded as a substitute for good clinical judgement.
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            Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways.

            The laryngeal mask airway (LMA; LMA North America, Inc., San Diego, CA) has a well-established role in the emergency and elective treatment of patients with difficult-to-manage airways (DA). In this study, the authors report their clinical experience with the intubating LMA (LMA-Fastrach; LMA North America, Inc., San Diego, CA) in 254 patients with different types of DA. The authors reviewed the anesthetic and medical records of patients with DA in whom the LMA-Fastrach was used electively or emergently at four institutions from October 1997 through October 2000. In each case, the number of insertion and intubation attempts was recorded. Success rates for blind and fiber optically guided intubation through the LMA-Fastrach were calculated, up to a maximum of five attempts per patient. The LMA-Fastrach was used in 257 procedures performed in 254 patients with DA, including patients with Cormack-Lehane grade 4 views; patients with immobilized cervical spines; patients with airways distorted by tumors, surgery, or radiation therapy; and patients wearing stereotactic frames. Insertion of the LMA-Fastrach was accomplished in three attempts or fewer in all patients. The overall success rates for blind and fiber optically guided intubations through the LMA-Fastrach were 96.5% and 100.0%, respectively. The LMA-Fastrach was used successfully in a high percentage of patients who presented with a variety of DA. The clinical experience presented herein indicates that this device may be particularly useful in the emergency and elective treatment of patients in whom intubation with a rigid laryngoscope has failed and in the treatment of patients with immobilized cervical spines.
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              • Abstract: not found
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              Laryngeal mask airway and the ASA difficult airway algorithm.

              J Benumof (1996)
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                Author and article information

                Journal
                Indian J Anaesth
                Indian J Anaesth
                IJA
                Indian Journal of Anaesthesia
                Medknow Publications & Media Pvt Ltd (India )
                0019-5049
                0976-2817
                April 2016
                : 60
                : 4
                : 242-247
                Affiliations
                [1]Department of Anaesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                Author notes
                Address for correspondence: Dr. KV Bharath, Department of Anaesthesia, Kasturba Medical College, Manipal - 576 104, Udupi, Karnataka, India. E-mail: drbharathkv@ 123456gmail.com
                Article
                IJA-60-242
                10.4103/0019-5049.179448
                4840803
                27141106
                8935681e-a91c-49a9-be0a-49e9d0f3fa84
                Copyright: © Indian Journal of Anaesthesia

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Anesthesiology & Pain management
                air-q intubating laryngeal airway,intubating laryngeal mask airway,endotracheal intubation,laryngeal mask airway,fastrach™,supraglottic airway devices

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