Jagannathan Narasimhan, Sohn Lisa, Ramsey Melissa, Huang Andrea, Sawardekar Amod, Sequera-Ramos Luis, Kromrey Loryn, De Oliveira Gildasio S
Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA,
Can J Anaesth. 2015 Jun;62(6):587-94. doi: 10.1007/s12630-014-0304-9. Epub 2014 Dec 24.
Supraglottic airways are commonly used as conduits for fibreoptic bronchoscopy (FOB)-guided intubation in pediatric patients. We hypothesized that anesthesiology trainees with limited prior experience with FOB-guided intubation through a supraglottic airway in children would intubate the trachea faster through the air-Q™ supraglottic airway than through the i-gel™.
Ninety-six children aged one month to six years were randomized to receive either the i-gel or air-Q for FOB-guided tracheal intubation by anesthesiology trainees. Time for successful tracheal intubation was the primary endpoint. Secondary endpoints included: time for device insertion, number of attempts for successful device insertion, airway leak pressures, FOB grade of laryngeal view, total number of attempts for tracheal intubation, time for removal of the device after tracheal intubation, and associated complications.
The median (interquartile range [IQR]) times to successful tracheal intubation for the air-Q (62.5 [47.9-77] sec) and the i-gel (55.9 [48.5-81.8] sec) were not significantly different (median difference 6.6 sec; 95% confidence interval [CI] -13.3 to 8.7; P = 0.53). The median (IQR) time to insertion for the air-Q (16.7 [14.4-20.0] sec) was shorter than for the i-gel (19.6 [16.7-23.0] sec) (median difference 2.9 sec; 95% CI 0.8 to 4.7; P = 0.005). There were no differences between devices with respect to airway leak pressures, success rates, and time to removal. Compared with the air-Q, the i-gel was associated with more problems during device removal after tracheal intubation, including breakage of the tracheal tube pilot balloon (n = 0 vs n = 13, respectively; P < 0.001), inadvertent extubation (n = 1 vs n = 5, respectively; P < 0.001), and difficulty controlling the tracheal tube (n = 0 vs n = 21, respectively; P < 0.001).
Contrary to our hypothesis, both the air-Q and i-gel supraglottic airways served as effective conduits for FOB-guided tracheal intubation in children when performed by trainees with limited prior experience. The i-gel, however, was associated with more problems during device removal following tracheal intubation. This study was registered at http://clinicaltrials.gov/show/NCT02189590 .
声门上气道常用于小儿患者纤维支气管镜（FOB）引导下插管。我们假设，既往在小儿声门上气道FOB引导下插管经验有限的麻醉科住院医师，通过Air-Q™声门上气道气管插管比通过i-gel™更快。
96例1个月至6岁儿童随机分为两组，分别接受i-gel或Air-Q，由麻醉科住院医师进行FOB引导下气管插管。成功气管插管时间为主要终点。次要终点包括：设备插入时间、成功插入设备的尝试次数、气道漏气压力、喉镜视野FOB分级、气管插管总尝试次数、气管插管后设备移除时间及相关并发症。
Air-Q组（62.5[47.9 - 77]秒）和i-gel组（55.9[48.5 - 81.8]秒）成功气管插管的中位（四分位间距[IQR]）时间无显著差异（中位差异6.6秒；95%置信区间[CI] - 13.3至8.7；P = 0.53）。Air-Q组的中位（IQR）插入时间（16.7[14.4 - 20.0]秒）短于i-gel组（19.6[16.7 - 23.0]秒）（中位差异2.9秒；95%CI 0.8至4.7；P = 0.005）。在气道漏气压力、成功率及移除时间方面，两种设备无差异。与Air-Q相比，i-gel在气管插管后设备移除过程中出现更多问题，包括气管导管导气囊破裂（分别为n = 0和n = 13；P < 0.001）、意外拔管（分别为n = 1和n = 5；P < 0.001）以及控制气管导管困难（分别为n = 0和n = 21；P < 0.001）。
与我们的假设相反，对于既往经验有限的住院医师而言，Air-Q和声门上气道i-gel均是小儿FOB引导下气管插管的有效通道。然而，i-gel在气管插管后设备移除过程中出现的问题更多。本研究已在http://clinicaltrials.gov/show/NCT02189590注册。
