Fekry VS the Air-Q Intubating Airways
Conditions
Brief summary
The fibreoptic bronchoscope remains one of the most important methods of intubating patients particularly when there is difficulty with intubation. Facilitating fiberoptic oropharyngeal intubation procedure, specific airways have been devised to push the tongue anteriorly to clear a passage for the fibrescope into the trachea. Of these airways the Air-Q Intubating Laryngeal Airway (Air-Q) (Cookgas, St. Louis, MO, USA) and Fekry Oral Intubating Airway (Ameco Technology, Cairo, Egypt).
Detailed description
The Air-Q Intubating Laryngeal Airway (Air-Q): The Air-Q™ Intubating Laryngeal Airway (Air-Q) (Cookgas, St. Louis, MO, USA) is a SAD that was designed primarily to act as a conduit for the passage of a cuffed tracheal tube during tracheal intubation (1), Compared with the LMA, the Air-Q has a shorter silicon airway tube that allows an easy visualization of vocal cords and intubation and removal of the device after tracheal tube insertion. The device has a removable color coded connector, allows intubation through the airway tube. The device is also wider, C-curved and has an integrated bite block which makes it easier to place reinforces the tube and diminishes the need for a separate bite block, with an elevation ramp that facilitates intubation and directs the tube toward the laryngeal inlet. It also has a built-up mask for improved seal. All of these features facilitate the passage of the tracheal tube through the device and into the trachea. Fekry airway (Oral Intubating Airway; Egyptian Patent 28118): Several modifications of oropharyngeal airways aiming to allow facilitation of intubation and easy removal of the airway after placement of ETT. In Fekry airway, modification of the Williams airway facilitates the airway removal after ETT insertion without need to remove the international part of the ETT (this reduce risk of ETT dislodgement during airway removal). The modification made to the Williams airway is that the roof of the proximal cylindrical tunnel is opened from its upper part to allow one step insertion of the tube. There is no need for removal of the tube connector after tube insertion. It allows passage of the suction catheter and may allow oxygen insufflations through a catheter. As mastering airway management in difficult cases is an essential job to anesthesiologist, we think it is important to find an easy adjunct to this hard job. investigators hypothesized that Fekry airway could offer a better conduit to flexible fiberoptic intubation rather than the air-Q device, because it needs less experience in how to use, less intubation time.
Interventions
DEVICEPatients will be intubated using Air-Q airway
Both groups: Grade 1: Split airway provides an unobstructed path for bronchoscope from mouth to glottis. Grade 2: Tongue rests against posterior pharyngeal wall causing partial obstruction to bronchoscope. Grade 3: Epiglottis rests against posterior pharyngeal wall causing partial obstruction to bronchoscope. Grade 4: Tongue and epiglottis rest against posterior pharyngeal wall, both causing partial obstruction to bronchoscope. Grade 5: Tongue rests against posterior pharyngeal wall causing total obstruction to bronchoscope (failure). Grade 6: Epiglottis rests against posterior pharyngeal wall causing total obstruction to bronchoscope (failure)
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
DOUBLE (Subject, Investigator)
Masking description
Randomization will be done using computer generated number and concealed using sequentially numbered, sealed opaque envelope.
Intervention model description
Comparison between the two airways regarding: 1. Time to Glottic view. 2. Grade of bronchoscopic view. 3. Success of intubation from 1st trial.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Patients aged ≥18 years old. * Of both sexes. * With American Society of Anaesthesiologists (ASA) physical status class I-ll. * Scheduled for elective surgery under general anesthesia requiring ETT placement.
Exclusion criteria
* Patient refusal. * Patient that has any documented or suspected difficult airway or neck or upper respiratory tract abnormalities, facial deformities that invalidate Ganzouri airway score. * Patient that has any active cardiac or chest problem and risk of aspiration.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Endoscopy insertion time | Withen 15 seconds from induction og Generel Anesthesia | Time from introducing the tip of scope through the proximal end of the airway device or mouth until the visualization of carina (multiple attempts will be added to compute this time |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Grade of endoscopic view | Withen 15 seconds from induction og Generel Anesthesia | Endoscopic view grading |
| ITHIN Intubation time | Withen 15 seconds from induction og Generel Anesthesia | Timing of complete intubation |
| Success rate of intubation from 1st trial | Withen 15 seconds from induction og Generel Anesthesia | 1st trial Success |
| Number of intubation and device insertion attempts | Withen 15 seconds from induction og Generel Anesthesia | Attempts Number of intubation and device insertion |
| Complications | Withen 15 seconds from induction og Generel Anesthesia | Coughing, laryngospasm, stridor, hoarseness, bronchospasm, arterial desaturation (SpO2\<92), aspiration, bleeding or swelling to the lips, tongue, teeth, or blood staining the airway. |
| Score of success of endotracheal intubation | Withen 15 seconds from induction og Generel Anesthesia till Study Completion | Endotracheal intubation Score of success |
Countries
Egypt
Outcome results
None listed