Department of Anesthesiology, Children's Memorial Hospital, Northwestern University's Feinberg School of Medicine, 2300 Children's Plaza, Chicago, IL 60614, USA.
Anesth Analg. 2011 Jan;112(1):176-82. doi: 10.1213/ANE.0b013e3181fe0408. Epub 2010 Nov 16.
The air-Q Intubating Laryngeal Airway (ILA) (Cookgas LLC, Mercury Medical, Clearwater, FL) is a supraglottic airway device available in pediatric sizes, with design features to facilitate passage of cuffed tracheal tubes when used to guide tracheal intubation. We designed this prospective observational study of the ILA to assess the ease of its placement in paralyzed pediatric patients, determine its position and alignment to the larynx using a fiberoptic bronchoscope, gauge its efficacy as a conduit for fiberoptic intubation with cuffed tracheal tubes, and evaluate the ability to remove the ILA without dislodgement of the tracheal tube after successful tracheal intubation.
One hundred healthy children, aged 6 months to 8 years, ASA physical status I to II, and scheduled for elective surgery requiring general endotracheal anesthesia were enrolled in this prospective study. Based on the manufacturer's guidelines, each patient received either a size 1.5 or 2.0 ILA according to their weight. The number of attempts for successful insertion, leak pressures, fiberoptic grade of view, number of attempts and time for tracheal intubation, time for ILA removal, and complications were recorded.
ILA placement, fiberoptic tracheal intubation, and ILA removal were successful in all patients. The size 1.5 ILA cohort had significantly higher rates of epiglottic downfolding compared with the size 2.0 ILA cohort (P < 0.001), despite adequate ventilation variables. When comparing fiberoptic grade of view to weight, a moderate negative correlation was found (r = -0.41, P < 0.001), indicating that larger patients tended to have better fiberoptic grades of view. The size 1.5 ILA cohort had a significantly longer time to intubation (P = 0.04) compared with the size 2.0 ILA cohort. However, this difference may not be clinically significant because there was a large overlap of confidence bounds in the average times of the size 1.5 ILA (27.0 ± 13.0 seconds) and size 2.0 ILA cohorts (22.7 ± 6.9 seconds). When comparing weight to time to tracheal intubation, a weak correlation that was not statistically significant was found (r = -0.17, P = 0.09), showing that time to intubation did not differ significantly according to weight, despite higher fiberoptic grades in smaller patients.
The ILA was easy to place and provided an effective conduit for tracheal intubation with cuffed tracheal tubes in children with normal airways. Additionally, removal of the ILA after successful intubation could be achieved quickly and without dislodgement of the tracheal tube. Because of the higher incidence of epiglottic downfolding in smaller patients, the use of fiberoptic bronchoscopy is recommended to assist with tracheal intubation through this device.
空气-Q 插管型喉罩气道（ILA）（Cookgas LLC，Mercury Medical，Clearwater，FL）是一种可用于小儿的声门上气道装置，其设计特点可便于在引导气管插管时插入带套囊的气管导管。我们设计了这项前瞻性观察性研究，旨在评估 ILA 在全身麻醉下接受气管插管的麻痹小儿中的放置简易性，通过纤维支气管镜确定其在喉中的位置和对齐方式，评估其作为带套囊气管导管纤维支气管镜插管的导管的效果，并评估在成功气管插管后移除 ILA 而不使气管导管移位的能力。
100 名健康儿童，年龄 6 个月至 8 岁，ASA 身体状况 I 至 II 级，计划接受全身麻醉下的择期手术，纳入本前瞻性研究。根据制造商的指南，根据体重为每个患者选择 1.5 或 2.0 号的 ILA。记录成功插入的尝试次数、泄漏压力、纤维支气管镜检查的视野等级、气管插管的尝试次数和时间、ILA 移除时间和并发症。
所有患者均成功进行了 ILA 放置、纤维支气管镜气管插管和 ILA 移除。尽管通气变量充足，但 1.5 号 ILA 组的会厌折叠发生率明显高于 2.0 号 ILA 组（P < 0.001）。当比较纤维支气管镜检查的视野与体重时，发现存在中度负相关（r = -0.41，P < 0.001），表明较大的患者往往具有更好的纤维支气管镜检查视野等级。1.5 号 ILA 组的插管时间明显长于 2.0 号 ILA 组（P = 0.04）。然而，由于置信区间在 1.5 号 ILA（27.0 ± 13.0 秒）和 2.0 号 ILA 队列（22.7 ± 6.9 秒）的平均值之间有较大重叠，因此这种差异可能没有临床意义。当比较体重与气管插管时间时，发现相关性较弱且无统计学意义（r = -0.17，P = 0.09），表明尽管较小的患者纤维支气管镜检查等级较高，但插管时间并未因体重而有显著差异。
ILA 易于放置，可为气道正常的儿童提供带套囊气管导管的有效插管通道。此外，在成功插管后，ILA 可以快速且无气管导管移位地移除。由于较小患者会厌折叠的发生率较高，建议使用纤维支气管镜协助通过该设备进行气管插管。
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