Comparison of Tracheal Intubation Using the Air-Q ILA and LMA Blockbuster Among Adults Undergoing Elective Surgery: A Randomized Controlled Trial

Kavitha Girish; Thilaka Muthiah; Dalim Kumar Baidya; Renu Sinha; Vimi Rewari; Souvik Maitra; Manpreet Kaur; Rajeshwari Subramaniam

doi:10.4274/TJAR.2024.241624

Comparison of Tracheal Intubation Using the Air-Q ILA and LMA Blockbuster Among Adults Undergoing Elective Surgery: A Randomized Controlled Trial

Turk J Anaesthesiol Reanim. 2024 Sep 17;52(4):147-153. doi: 10.4274/TJAR.2024.241624.

Authors

Kavitha Girish¹, Thilaka Muthiah², Dalim Kumar Baidya³, Renu Sinha⁴, Vimi Rewari⁴, Souvik Maitra⁴, Manpreet Kaur⁵, Rajeshwari Subramaniam⁴

Affiliations

¹ Baby Memorial Hospital, Clinic of Anaesthesiology, Kozhikode, India.
² Apollo Simulation Centre, Apollo Hospitals, Chennai, India.
³ All India Institute of Medical Sciences, Department of Anaesthesiology, Critical Care and Pain Medicine, Guwahati, India.
⁴ All India Institute of Medical Sciences, Department of Anaesthesiology, Pain Medicine and Critical Care, New Delhi, India.
⁵ Penn State Hershey Medical Center and Penn State College of Medicine, Department of Anaesthesia and Perioperative Medicine, Hershey, Pennsylvania.

PMID: 39287194
DOI: 10.4274/TJAR.2024.241624

Abstract

Objective: Air-Q intubating laryngeal airway (ILA) is associated with a 58-77% success rate in blind intubation. The newer laryngeal mask airway (LMA) blockbuster is specially designed to facilitate easier endotracheal intubation and may have a higher success rate. The current study aimed to compare the success rate of endotracheal intubation using the Air-Q ILA and LMA blockbuster.

Methods: After ethics committee approval and informed written consent, 140 adult patients with normal airways who were scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were recruited for this randomized controlled trial. Blind endotracheal intubation was performed using the Air-Q ILA in group A and the LMA blockbuster in group B with special maneuvers and/or tubes in the second attempt. Fibreoptic bronchoscope (FOB) guidance was used in the third attempt if required. The primary outcome was the success rate of intubation without FOB assistance. The number of attempts for supraglottic airway (SGA) insertion, the time taken for SGA insertion, and the overall intubation time was also noted.

Results: The success rate of intubation without FOB guidance was significantly higher in group B than in group A [91.4% vs 55.7%; relative risk (RR) 1.68; (95% confidence interval (CI) 1.34, 2.11); p<0.0001]. The number of attempts for SGA insertion was similar in groups A and group B [87% vs 90%; RR 1.03; (95% CI-0.92, 1.16); p=0.60]. The times for successful SGA insertion and endotracheal intubation were also similar between the groups.

Conclusion: The LMA blockbuster offers a significantly higher success rate for endotracheal intubation without FOB guidance than the Air-Q ILA in adult patients with normal airways. However, an increased success rate was achieved with the use of a specially designed flexible endotracheal tube and maneuvers.

Keywords: Airway management; bronchoscopy; endotracheal intubation; glottis; laryngeal mask airway.