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

Clinical Assessment of the Ambu® Aura-i™ as an Independent Ventilatory Device and Conduit for Fiberoptic-Guided Endotracheal Intubation in Adults

Background and aim A novel supraglottic airway device of the second generation is the Ambu® Aura-i™. It is designed to accommodate standard cuffed tracheal tubes and is phthalate-free and compatible with MRI. The primary objectives of the research were to examine the properties and efficiency of Ambu® Aura-i™ as a means of enabling fiberoptic-guided intubation, the view of the glottis during fiber optic examination, the duration of intubation in fiber optic bronchoscopy, the ease of intubation, the success rate of intubation, and the duration for device removal from the tracheal tube. Methodology A hospital-based descriptive observational study was conducted with 80 patients. An adequately sized Ambu® Aura-i™ was placed after general anesthesia was induced. Following a fiberoptic examination of the view of the glottis through the Ambu® Aura-i™, the trachea was intubated under fiberoptic guidance. The Ambu® Aura-i™ insertion time, glottic view grading, ease of intubation, and time required for fiberoptic-guided intubation were recorded. Also, the time taken to remove the Ambu® Aura-i™ was documented. Results Similar levels of ease were experienced by both groups after inserting the Ambu® Aura-i™, being easy in both group 1 (37/40) and in group 2 (38/40). In group 1, the average time taken to insert the Ambu® Aura-i™ was 13.53±1.91 seconds, while in group 2, it was 13.98±2.4 seconds. The average time required for fiberoptic-guided intubation was found to be 14.95±1.85 seconds in group 1 and 14.15±1.37 seconds in group 2, indicating a statistically negligible variation. Conclusion The low cost of Ambu® Aura-i™, size suitability and availability for almost all age groups, compatibility with MRI machines, and availability in phthalate-free versions contribute to it being a more appealing and useful ventilatory device, as well as an intubation tool for both normal and emergency airway management.

Preliminary evaluation of SaCoVLM video laryngeal mask-guided intubation in airway management for anesthetized children

BACKGROUNDS

To preliminary evaluate the application of novel SaCoVLM video laryngeal mask -guided intubation for anesthetized children.

METHODS

One hundred twenty-four children with microtia (ages 5-15 years,) who required general intubation anaesthesia, were enrolled in the study. After induction of general anesthesia,guided tracheal intubation under direct vision of the SaCoVLM was performed. Our primary outcome was first-pass success rate of guided tracheal tube placement. Secondary outcome included glottic visualization grades, the first-attempt success rate of LMA placement, the time for LMA placement and time to endotracheal intubation as well as the time for LMA removal after successful intubation, the fiberoptic grade of laryngeal view, the baseline and postinduction hemodynamic parameters were also recorded,and the incidence 24 h complications after operation.

RESULTS

The first-pass success rate of guided tracheal tube placement was 91.1% (95%CI = 1.04-1.14), the status of glottic visualization was classified: grade 1 in 27cases, grade 2 in 36 cases, grade 3 in 41 cases and grade 4 in 20 cases. The first success rate of LMA placement was 92.7% (95%CI = 1.03-1.13), the time for LMA insertion was 15.7 (±9.1) s, intubation time was 30.9 (±17.6) s and withdrawl time was 24.9 (±9.3) s. The incidence of postoperative sore throat at 2 h was 29%, and 16.1% at 24 h, without dysphagia and hypoxia.

CONCLUSION

The SaCoVLM video laryngeal mask-guided intubation is feasible in children, with a high success rate, could be a new promising device to guide intubation in airway management.

TRIAL REGISTRATION

This study was approved by the University's Institutional Review Board and written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at clinicaltrials.gov (ChiCTR2200061481, http://www.chictr.org.cn . Principal investigator: Juan Zhi; Date of registration: 26/06/2022.

Intubation using video laryngeal mask airway SaCoVLM and laryngeal mask airway Ambu® Aura-i in anesthetized children with microtia: a randomized controlled study

The Ambu Aura-i laryngeal mask is considered to be a device for blind intubation as well as for fiberoptic guided intubation. The novel video laryngeal airway mask SaCoVLM is a supraglottic airway device that allows intubation under direct vision. We hypothesized that success rates for device placement and tracheal intubation with the SaCoVLM would be comparable with the Ambu Aura-i mask. A prospective, randomized clinical trial was conducted from March 2021 to December 2021. One hundred and twenty patients were enrolled and randomized in the study. Direct intubation was performed with the SaCoVLM, and fiberoptic guided intubation was performed with the Ambu Aura-i mask. The primary outcome measure was the first success rate of LMA placement. Secondary outcome measures were the time from device placement and time from endotracheal intubation (as well as the time for LMA removal after successful intubation), differences in airway leak pressure, fiberoptic grade of the laryngeal view, and incidence of blood staining. The first success rate of LMA placement was similar for the two devices. There was no difference in the time for successful endotracheal intubation between the Ambu Aura-i and SaCoVLM groups (24.1 s ± 6.3 versus 25.7 s ± 2.1; p > 0.05). The time for removal was slower in the SaCoVLM group than in the Ambu Aura-i group (20.8 s ± 0.8 versus 14.7 s ± 6.1; p < 0.01). The airway leak pressure was higher in the SaCoVLM group than in the Ambu Aura-i group (27.0 s ± 1.0 versus 22.3 s ± 3.6; p < 0.01), and the incidence of blood staining was higher in the SaCoVLM group (16.7%). The SaCoVLM has an overall comparable performance to the Ambu Aura-i mask. However, the SaCoVLM is better relative to direct intubation without the assistance of a flexible intubation scope, which reduces the device's demand.

AuraGain™ versus i-gel™ for bronchoscopic intubation under continuous oxygenation: A randomised controlled trial

INTRODUCTION

After failed mask ventilation and tracheal intubation, guidelines issued by the Difficult Airway Society recommend placing a second generation supraglottic airway device to secure oxygenation. Ultimately, a secure airway can be obtained by tracheal intubation through the supraglottic airway device using a bronchoscope. In this randomised trial, we compared the AuraGain™ with the i-gel™ as conduit for bronchoscopic intubation under continuous oxygenation performed by a group of anaesthesiologists with variable experience in a general population of patients.

METHOD

We randomised one hundred patients who were equally allocated to flexible bronchoscopic intubation through the i-gel™ or the AuraGain™. In a random order, 25 anaesthesiologists each performed four intubations, two using the i-gel™ and two using the AuraGain™. Our primary outcome was 'total time for airway management'; i.e. total time from manually reaching the SAD to successful FBI confirmed at the end of the first inspiratory downstroke on the capnography curve.

RESULTS

In total, 87% (95% CI, 79%-92%) of the patients were successfully intubated through the allocated supraglottic airway device. There was no difference in total time for airway management between the i-gel™ and the AuraGain™ (199 vs. 227 s, p = .076). However, there was a difference in time for placement of the i-gel™, compared to the AuraGain™, (37 vs. 54 s, p < .001). There were nine failed intubations in the AuraGain™ group compared to four in the i-gel™ group (p = .147).

CONCLUSION

We found no difference in total time for airway management between using the i-gel™ and using the AuraGain™.