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Awake tracheal intubation in anticipated difficult airways: LMA Fastrach vs flexible bronchoscope: A pilot study.
J Clin Anesth. 2017 Feb; 37:31-37.JC

Abstract

STUDY OBJECTIVE

To compare the use of LMA Fastrach intubating laryngeal mask airway (ILMA) to flexible bronchoscopy (FB) for awake intubation in patients with difficult airways.

DESIGN

Randomized prospective study.

SETTING

Large academic medical center.

PATIENTS

Forty adult patients, American Society of Anesthesiologists I-IV, meeting the criteria for awake intubation based on history and physical examination.

INTERVENTIONS

After sedation and airway topicalization, patients were randomized to either FB group, n=19, or ILMA group, n=21. All intubations were performed by or under the supervision of an attending anesthesiologists, with variable participation of residents or certified registered nurse anesthetists. A maximum of three attempts were permitted with the assigned technique, to be followed by the alternative method in case of failure.

MEASUREMENTS

Times to carbon dioxide (end-tidal carbon dioxide) detection, endotracheal tube placement, number of attempts, training level of operator, and adverse events were recorded. Blood pressure, oxygen saturation, and heart rate were measured. Patients were interviewed the following day regarding their experience and satisfaction.

MAIN RESULTS

Overall intubation success rate within three attempts was 95% for both groups. However, successful intubation on the first attempt occurred at a significantly higher rate with ILMA vs FB (95% vs 58%; P=.0028). Total mean time to endotracheal tube placement was also significantly shorter in the ILMA group vs FB (92 vs 246 seconds; P=.0001). There were no adverse events in either group, and patient satisfaction was not significantly different.

CONCLUSION

Awake intubation can be performed successfully and expeditiously with the use of LMA Fastrach in patients with a difficult airway and no contraindication to a blind technique. It compared favorably to the use of the fiberoptic bronchoscope in the patient cohort presented in this study.

Authors+Show Affiliations

Department of Anesthesiology, Loyola University Medical Center/Stritch School of Medicine, Maywood, IL 60153, USA. Electronic address: sherinehanna@hotmail.com.Department of Anesthesiology, Loyola University Medical Center/Stritch School of Medicine, Maywood, IL 60153, USA.Department of Anesthesiology, Loyola University Medical Center/Stritch School of Medicine, Maywood, IL 60153, USA.Department of Anesthesiology, VA Hines Medical Center, Hines, IL 60141, USA.Department of Anesthesiology, Loyola University Medical Center/Stritch School of Medicine, Maywood, IL 60153, USA.American University of Antigua Medical School, New York, NY 10004, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28235524

Citation

Hanna, Sherine F., et al. "Awake Tracheal Intubation in Anticipated Difficult Airways: LMA Fastrach Vs Flexible Bronchoscope: a Pilot Study." Journal of Clinical Anesthesia, vol. 37, 2017, pp. 31-37.
Hanna SF, Mikat-Stevens M, Loo J, et al. Awake tracheal intubation in anticipated difficult airways: LMA Fastrach vs flexible bronchoscope: A pilot study. J Clin Anesth. 2017;37:31-37.
Hanna, S. F., Mikat-Stevens, M., Loo, J., Uppal, R., Jellish, W. S., & Adams, M. (2017). Awake tracheal intubation in anticipated difficult airways: LMA Fastrach vs flexible bronchoscope: A pilot study. Journal of Clinical Anesthesia, 37, 31-37. https://doi.org/10.1016/j.jclinane.2016.10.040
Hanna SF, et al. Awake Tracheal Intubation in Anticipated Difficult Airways: LMA Fastrach Vs Flexible Bronchoscope: a Pilot Study. J Clin Anesth. 2017;37:31-37. PubMed PMID: 28235524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Awake tracheal intubation in anticipated difficult airways: LMA Fastrach vs flexible bronchoscope: A pilot study. AU - Hanna,Sherine F, AU - Mikat-Stevens,Marianne, AU - Loo,James, AU - Uppal,Raj, AU - Jellish,W Scott, AU - Adams,Matthew, Y1 - 2016/12/22/ PY - 2013/12/20/received PY - 2016/10/24/revised PY - 2016/10/28/accepted PY - 2017/2/26/entrez PY - 2017/2/27/pubmed PY - 2017/9/15/medline KW - Airway management KW - Anticipated difficult airway KW - Awake Intubation KW - Awake fastrach intubation KW - Awake intubation KW - Difficult airway management KW - Fastrach intubation in comparison with fiberoptic bronchoscope KW - Intubation techniques SP - 31 EP - 37 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 37 N2 - STUDY OBJECTIVE: To compare the use of LMA Fastrach intubating laryngeal mask airway (ILMA) to flexible bronchoscopy (FB) for awake intubation in patients with difficult airways. DESIGN: Randomized prospective study. SETTING: Large academic medical center. PATIENTS: Forty adult patients, American Society of Anesthesiologists I-IV, meeting the criteria for awake intubation based on history and physical examination. INTERVENTIONS: After sedation and airway topicalization, patients were randomized to either FB group, n=19, or ILMA group, n=21. All intubations were performed by or under the supervision of an attending anesthesiologists, with variable participation of residents or certified registered nurse anesthetists. A maximum of three attempts were permitted with the assigned technique, to be followed by the alternative method in case of failure. MEASUREMENTS: Times to carbon dioxide (end-tidal carbon dioxide) detection, endotracheal tube placement, number of attempts, training level of operator, and adverse events were recorded. Blood pressure, oxygen saturation, and heart rate were measured. Patients were interviewed the following day regarding their experience and satisfaction. MAIN RESULTS: Overall intubation success rate within three attempts was 95% for both groups. However, successful intubation on the first attempt occurred at a significantly higher rate with ILMA vs FB (95% vs 58%; P=.0028). Total mean time to endotracheal tube placement was also significantly shorter in the ILMA group vs FB (92 vs 246 seconds; P=.0001). There were no adverse events in either group, and patient satisfaction was not significantly different. CONCLUSION: Awake intubation can be performed successfully and expeditiously with the use of LMA Fastrach in patients with a difficult airway and no contraindication to a blind technique. It compared favorably to the use of the fiberoptic bronchoscope in the patient cohort presented in this study. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/28235524/Awake_tracheal_intubation_in_anticipated_difficult_airways:_LMA_Fastrach_vs_flexible_bronchoscope:_A_pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(16)30969-2 DB - PRIME DP - Unbound Medicine ER -