Comparison of Air-QⓇ insertion techniques in pediatric patients with fiber-optic bronchoscopic assessment: a prospective randomized control trial / 대한마취과학회지

BACKGROUND: Air-QⓇ laryngeal mask airway (LMA) is a second-generation supraglottic airway device (SAD) providing adequate airway control despite the unfavorable airway anatomy in children. Several studies have assessed it as a conduit for tracheal intubation and compared its efficacy with that of other SADs, but there are no studies comparing the laryngeal view with midline and rotational insertion techniques of Air-Q. Therefore, this study compared the fiber-optic bronchoscopic (FOB) assessment of the Air-Q position using these two insertion techniques.METHODS: This randomized controlled trial included 80 patients of the American Society of Anesthesiologists physical status I/II of either sex (age group 5–12 years, weight 10–30 kg), who were scheduled for elective surgery in the supine position under general anesthesia. The patients were randomly subjected to rotational and midline technique groups (n = 40, each), and appropriate sized Air-Q, based on the weight of the patient, was inserted using the technique allocated to each patient. Time taken and number of attempts for successful insertion of the devices and any complications after removal of device were studied.RESULTS: FOB grade 1 (ideal position) was seen in 29/40 (72.5%) and 19/40 (47.5%) children subjected to the rotational and classic midline techniques, respectively (P = 0.045). The time taken to successfully insert the Air-Q was significantly lesser in the rotational technique group (7.2 ± 1.5 s) than in the classic midline technique group (10.2 ± 2.1 s) (P < 0.001), whereas complications were similar in both groups.CONCLUSIONS: The rotational technique was associated with better FOB view, and was faster than the classic midline technique of Air-Q insertion in pediatric patients.

Sniffing Position Improves the Laryngeal View Regardless of Body Mass Index / 대한마취과학회지

BACKGROUND: Most anesthesiologists universally recommend the sniffing position and consider it to be essential for improving the performance of orotracheal intubation. However, a recent investigation reported that the sniffing position does not aid the laryngoscope except under specific circumstances (i.e., obesity). Therefore, this study examined the impact of the BMI (body mass index) on the effectiveness of the sniffing position in improving the laryngeal view. METHODS: A video laryngoscopy imaging system and POGO (the percentage of glottic opening) scoring system were used to assess the laryngeal view in 79 adult patients undergoing a laryngoscopy. In each patient, the laryngeal view was videotaped continuously from simple head extension to the sniffing position by inflating a pressure bag as a pillow to obtain approximately 15o of flexion of the lower cervical spine on the chest. The variables assessed included the BMI, the POGO score in each position and the change in the POGO score. RESULTS: The POGO scores improved with the sniffing position (18.1 +/- 14.3%). However, the sniffing position did not improve the POGO score in 16/79 (20.3%) patients. The sniffing position did not worsen the POGO score in any patient. No significant correlation was found between the BMI and the change in the POGO score in the sniffing position (Pearson's correlation coefficient r = 0.075). CONCLUSIONS: The sniffing position has the potential to improve the laryngeal view in all intubations without needing to consider the BMI. Therefore, the sniffing position appears to be advantageous for orotracheal intubation compared with a simple head extension.