Randomized Clinical Trial Comparing the Success Rate of Blockbuster Intubating Laryngeal Mask Airway Versus Fastrach Intubating Laryngeal Mask Airway During Blind Endotracheal Intubation.

Background A new piece of equipment, the Blockbuster (BB) Intubating Laryngeal Mask Airway (ILMA; Tuoren Medical India, Gurugram, India), was created in 2012. Dr. Chandy created the Fastrach (F) ILMA in 1997, which is another supraglottic airway equipment. The primary purpose of this study was to compare the success rate of intubation with BB-ILMA and F-ILMA. Methods In the chosen age category of >20 to <70 years, undergoing general anesthesia for intubation with ILMAs, 55 patients were in the BB-ILMA (group B), and 55 patients were in the F-ILMA (group F). These ILMAs were put in after the induction and checked to see if adequate ventilation was accomplished with either of these devices. Once ventilation had been attained, we proceeded with fiberoptic scope to visualize the glottis, followed by blind intubation. The primary objective was to compare the first pass successful intubation of BB-ILMA and F-ILMA. The secondary objectives were ease of LMA insertion, time taken for intubation, hemodynamic changes, glottis fiberoptic view, and complications. Results The first pass successful intubation of the BB-ILMA and F-ILMA are 94.5% and 87.3%, respectively, whereas the time taken for intubation in BB-ILMA and F-ILMA are 25.02 seconds (s) and 42.77 s with a p-value of 0.0001, indicating a statistically significant relationship. Conclusion When compared to the F-ILMA (group F), the BB-ILMA (group B) has a higher success rate for blind tracheal intubation, with lesser time taken for intubation and fewer complications.

THE HENNEPIN DOUBLE-TUBE TECHNIQUE: A MORE EFFICIENT METHOD OF TRACHEAL INTUBATION THROUGH THE LMA FASTRACH.

BACKGROUND: The LMA Fastrach (LMA North America, Inc; hereafter termed the intubating laryngeal mask airway [ILMA]) is an extraglottic device designed to facilitate endotracheal intubation. After the endotracheal tube is placed through the lumen of the ILMA into the trachea, the ILMA is removed, using a proprietary stabilizer rod to hold the tube in place. DISCUSSION: The traditional method of ILMA removal is not optimized for the critically ill patient. It requires the use of unfamiliar equipment, exposes the patient to a significant period without ventilation, and risks tube dislodgement. We designed a simple technique with a double-endotracheal tube setup that addresses these problems using common equipment, allowing for continuous ventilation, and minimizing the risk of tube dislodgement. CONCLUSIONS: The traditional method of ILMA removal around an endotracheal tube is not designed for critically ill patients or the physicians taking care of them. This novel technique is designed to improve the usability of the ILMA for physicians and improve airway outcomes for patients.

Rapid Sequence Airway with the Intubating Laryngeal Mask in the Emergency Department.

BACKGROUND: The administration of sedation and neuromuscular blockade to facilitate extraglottic device (EGD) placement is known as rapid sequence airway (RSA). In the emergency department (ED), EGDs are used largely as rescue devices. In select patients, there may be significant advantages to using EGDs over laryngoscopy as the primary airway device in the ED. OBJECTIVE: Our study sought to describe the practice of RSA in the ED, including rates of successful oxygenation, ventilation, and complications from EGD use. METHODS: We identified patients in the ED between 2007 and 2017 who underwent RSA with the LMA® Fastrach™ (hereafter termed ILMA; Teleflex Medical Europe Ltd., Athlone, Ireland) placed as the first definitive airway management device. A trained abstractor performed chart and video review of the cases to determine patient characteristics, physician use of the ILMA, indication for ILMA placement, success of oxygenation and ventilation, success of intubation, and complications related to the device. RESULTS: During the study period, 94 patients underwent RSA with the ILMA. Of those, 93 (99%) were successfully oxygenated and ventilated, and when intubation was attempted, 89% were able to be intubated through the ILMA. The incidence of vomiting and aspiration was 1% and 3%, respectively. There were 30 different attending physicians who supervised RSA and the median number was 2 per physician in the 10-year study period. CONCLUSION: The practice of RSA with the ILMA in the ED is associated with a high rate of successful oxygenation, ventilation, and intubation with infrequent complications, even when performed by physicians with few experiences in the approach.

A comparative study of haemodynamic effects of single-blinded orotracheal intubations with intubating laryngeal mask airway, Macintosh and McGrath video laryngoscopes.

INTRODUCTION: The efficacy of an intubation technique is crucial to the success of ventilation therapies. Intubating laryngeal mask airway (ILMA), Macintosh and McGrath techniques are yet to be evaluated thoroughly. Orotracheal intubations with ILMA, McGrath, and Macintosh laryngoscopes are compared based on haemodynamic changes, time taken for intubations, and success rate. MATERIAL AND METHODS: This is a prospective, single-blinded, randomised controlled trial. Primary outcome: identification of the most efficient intubation technique. Secondary outcomes: haemodynamic parameters, time taken for intubation and the rate of success of intubation. Patients enrolled: 90. Groups: 3. Each participant is randomly assigned to a group. Inclusion criteria: both sexes, age: 18-55 years, ASA: I or II, Mallampati < III, Mouth opening > 2 fingers, BMI < 40 kg m-2, any elective surgery, general anaesthesia requiring endotracheal intubation. The haemodynamic changes, time taken for intubations, and success rate during ILMA, Macintosh and McGrath intubations were recorded and statistically analysed. RESULTS: Macintosh and ILMA raised the heart rate (min-1) more than McGrath at the second minute (95% CI: 76.50 ± 1.34 [McGrath] < 81.73 ± 1.46 [Macintosh] < 90.42 ± 1.24 [ILMA]). ILMA required the longest intubation time (s) (95% CI: 71.64 ± 2.14 [ILMA] > 40.26 ± 1.36 [McGrath] > 30.63 ± 1.53 [Macintosh]). Macintosh and McGrath intubations were all successful, whereas ILMA recorded two failures. However, the observed failures were statistically insignificant (95% CI: 93.33 ± 4.35%). CONCLUSIONS: McGrath intubation is the most efficient technique based on its haemodynamics. ILMA required the longest intubation time and statistically, rates of success of the techniques are alike.

Comparison of Fiberoptic-Guided Tracheal Intubation Through Intubating Laryngeal Mask Airway (ILMA) FastrachTM and Ambu® Aura-i™: A Randomized Clinical Study.

Background and aim The primary aim of the study was to compare the intubation characteristics and effectiveness of intubating laryngeal mask airway (ILMA) and Ambu® Aura-i™ as a conduit for facilitating fiberoptic-guided intubation. Methods Eighty patients were enrolled in the randomized-controlled hospital-based study. After inducing general anesthesia, an appropriately sized ILMA (group 1)/Ambu Aura-I (group 2) was placed. Fiberoptic assessment of the glottic view was done followed by fiberoptic-guided tracheal intubation. The time taken for the insertion of ILMA/Ambu Aura-i, glottic view grading, time taken for fiberoptic-guided intubation, ease of intubation, time taken for the removal of ILMA/Ambu Aura-i were recorded. Data analysis was done using the two-tailed independent t-test, paired t-test, and Fisher's exact probability test. Result Anthropometric and airway parameters were similar in both groups. The success rate of the insertion of both devices was 100%. In group 1, the mean time taken for the insertion was 20.53±1.91, and it was 13.98±2.4 in group 2 (P<0.001S). Fiberoptic assessment of the glottic view in group 1 (ILMA group) was grade 1 in 80% of the patients, whereas it was 92% in group 2 (Ambu Aura-i) (P=0.54). The mean time taken for fiberoptic-guided intubation was 14.95±1.85 in group 1 and 14.15±1.37 in group 2 (P>0.001). No significant difference was observed according to the number of attempts in intubating through ILMA/Ambu Aura-i. Seventy-five percent (75%) in group 1 and 87.5% in group 2 were successfully inserted on the first attempt (𝑝 = 0.33). The time taken for the removal of the device was 11.87 +1.265 seconds in group 1 and 11.25±1.58 seconds in group 2 (P=0.054). Conclusion The Ambu Aura-i scores superiorly over ILMA in requiring less time for successful insertion on the basis of statistical analysis and hence appears to be a better independent ventilatory device.

[Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial]. / Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado.

BACKGROUND: Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. METHODS: Eighty patients with ASA physical status I-III, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. RESULTS: There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9±22.1s vs. 50.7±21.2s; p<0.001). A significant difference was found when the times of total intubation were compared (29.9±22.1s vs. 97.4±42.7s; p<0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p<0.05). CONCLUSIONS: Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

Comparison of channelled videolaryngoscope and intubating laryngeal mask airway for tracheal intubation in obese patients: a randomised clinical trial / Comparação de videolaringoscópio com canal e máscara laríngea na intubação traqueal de pacientes obesos: estudo clínico randomizado

Abstract Background: Obesity causes various difficulties in intubation and ventilation, which are confronted due to increased fat tissue in the upper airway and diminished compliance in the chest wall. Videolaryngoscopes and Intubating Laryngeal Mask Airway (ILMA) are good options as recommended by the American Society of Anesthesologists (ASA) difficult airway guidelines. We aimed to compare ILMA and Airtraq (a channeled videolaryngoscope) in obese patients. Methods: Eighty patients with ASA physical status 1-3, aged between 18 and 65 years and with a body mass index greater than 35 kg.m-2, who were undergoing elective surgery requiring orotracheal intubation, were included in the study. Patients were intubated with one of the devices cited. Results: There was no difference between the number of intubation attempts, insertion times and need for optimisation manoeuvres of Airtraq and ILMA. The intubation with Airtraq was accomplished in a shorter period of time than in that in the ILMA group (29.9 ± 22.1s vs. 50.7 ± 21.2s; p < 0.001). A significant difference was found when the times of total intubation were compared (29.9 ± 22.1s vs. 97.4 ± 42.7s; p < 0.001). The mean arterial pressure statistically increased after device insertion in the ILMA group (p < 0.05). Conclusions: Airtraq appears to be superior to ILMA in obese patients, with a total of time intubation of less than 60 seconds and with low mean arterial pressure changes. However, ILMA is still a useful tool that provides both ventilation and intubation throughout the whole intubation process.

Resumo Justificativa: A obesidade dificulta a ventilação manual e intubação traqueal devido ao acúmulo de tecido adiposo na via aérea superior e a complacência diminuída na caixa torácica. Os videolaringoscópios e as Máscaras Laríngeas para Intubação (MLI) são alternativas boas para o manuseio da via aérea difícil, de acordo com as diretrizes da Sociedade Americana de Anestesologia (ASA). O objetivo do estudo foi comparar o uso da MLI e do Airtraq, um videolaringoscópio com canal, em pacientes obesos. Método: Estudamos 80 pacientes com classificação ASA I-III, com idades entre 18 e 65 anos e índice de massa corporal acima de 35 kg.m-2, submetidos a cirurgia eletiva com indicação de intubação orotraqueal. Os pacientes foram intubados empregando-se um dos seguintes dispositivos: MLI ou Airtraq. Resultados: Não houve diferença entre o número de tentativas de intubação, tempo de inserção do dispositivo e necessidade de manobras de otimização para o Airtraq e MLI. A intubação com Airtraq foi realizada mais rapidamente do que no Grupo MLI (29,9 ± 22,1 s vs. 50,7 ± 21,2 s; p < 0,001). Houve diferença significante na comparação do tempo total para intubação (29,9 ± 22,1 s vs. 97,4 ± 42,7 s; p < 0,001). Houve aumento estatisticamente significante da pressão arterial média após a inserção do dispositivo no Grupo MLI (p < 0,05). Conclusões: Airtraq parece ser superior a MLI em pacientes obesos, apresentando tempo total de intubação abaixo de 60 segundos e com menor variação na pressão arterial média. Todavia, a MLI ainda é ferramenta útil que propicia tanto ventilação quanto intubação durante todo o processo de manejo da via aérea.

An Unusual Cause of Intubating Laryngeal Mask Obstruction Preventing Successful Intubation in the Emergency Department.

BACKGROUND: The intubating laryngeal mask airway (ILMA) allows providers to blindly intubate through the device. We report a case of foreign material obstructing passage of an endotracheal tube (ET) through an ILMA. CASE REPORT: A 45-year-old man with unknown past medical history was found obtunded with an apparent intentional drug and alcohol overdose, and required tracheal intubation. We opted to use an ILMA to optimize preoxygenation prior to intubation. His upper dentures were removed and an ILMA was inserted without complication; ventilation was easily performed. Blind tracheal intubation was attempted; the ET was inserted through the ILMA and was unable to be advanced past 15 cm despite multiple attempts, including repositioning the ILMA and rotating the ET. The ILMA was removed to prepare for video laryngoscopy. He was subsequently successfully intubated using a standard geometry video laryngoscope, which showed no anatomical abnormalities. After the case, the ILMA was inspected and the bowl of the ILMA was found to be occluded with denture adhesive. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report demonstrates that it is possible that foreign material within the ILMA can make successful intubation impossible, despite successful placement and ventilation through the device. Maneuvers may be performed to attempt successful ET intubation, but when unsuccessful, removal of the ILMA and alternate airway management must be performed.

A new second-generation supraglottic airway device (Ambu® AuraGain•) versus intubating laryngeal mask airway as conduits for blind intubation - A prospective, randomised trial.

BACKGROUND AND AIMS: The Ambu® AuraGain• is a new single-use supraglottic airway device with gastric channel, designed to facilitate intubation. The study aimed to assess the success rates of proper placement and intubation using Ambu® AuraGain• compared with intubating laryngeal mask airway (ILMA). METHODS: One hundred and twenty patients (18-60 years) were enrolled into this prospective, randomised, comparative study. After inducing general anaesthesia, appropriate size ILMA (group I)/Ambu® AuraGain• (group A) was placed as per the manufacturer's recommendations and correct placement was confirmed. Appropriate size endotracheal tube was passed through the device. The success rate of insertion and intubation, number of attempts, Cormack-Lehane grading before insertion and haemodynamics were recorded. Data were analysed using Mantel-Haenszel Chi-square test, Student's t-test and Fisher's exact test. RESULTS: Demographic and airway parameters were uniformly distributed in both the groups. The success rate for insertion was 100% in both devices. The success rate for intubation was 96.6% (58/60) in group I and 36.6% in group A (P < 0.001). In group I, patients with mean thyromental distance >7.62 ± 0.75 cm had higher successful intubation compared with patients with mean thyromental distance <5.25 ± 0.35 cm (P = 0.014). Cormack-Lehane grading did not correlate with intubation attempts or success rate in group I (P = 0.45), whereas in group A the rate of successful blind intubation with Cormack-Lehane grade 1 was 50% (19/38). CONCLUSION: Both devices have 100% insertion success, though Ambu® AuraGain• has lower success rate for facilitating intubation compared with ILMA.

Comparison of blind intubation through the I-gel and ILMA Fastrach by nurses during cardiopulmonary resuscitation: a manikin study.

OBJECTIVES: To investigate whether nursing staff can successfully use the I-gel and the intubating laryngeal mask Fastrach (ILMA) during cardiopulmonary resuscitation. BACKGROUND: Although tracheal intubation is considered to be the optimal method for securing the airway during cardiopulmonary resuscitation, laryngoscopy requires a high level of skill. METHODS: Forty five nurses inserted the I-gel and the ILMA in a manikin, with continuous and without chest compressions. RESULTS: Mean intubation times for the ILMA and I-gel without chest compressions were 20.60 ± 3.27 and 18.40 ± 3.26 s, respectively (p < 0.0005). ILMA proved more successful than the I-gel regardless of compressions. Continuation of compressions caused a prolongation in intubation times for both the I-gel (p < 0.0005) and the ILMA (p < 0.0005). CONCLUSION: In this mannequin study, nursing staff can successfully intubate using the I-gel and the ILMA as conduits with comparable success rates, regardless of whether chest compressions are interrupted or not.