A comparison of supraglottic devices in pediatric patients.

BACKGROUND

When managing patients with a difficult airway, supraglottic airways (SGAs) have been used as rescue devices or to serve as a conduit for endotracheal intubation. The current study compares various clinical outcomes, including the bronchoscopic view of the glottis when using 2 SGAs, the Air-Q laryngeal mask airway (LMA) and the i-gel SGA, in pediatric patients.

METHODS

Patients ≤18 years of age were prospectively randomized to receive either the Air-Q LMA or the i-gel SGA. Following SGA placement, a flexible fiberoptic bronchoscope was inserted through the SGA to visualize the glottis. Time taken to obtain the bronchoscopic view and place the SGA, and the ability to seal the airway at 20 cmHO were compared. The bronchoscopic view obtained was graded as follows: 1) glottic aperture seen completely; 2) glottic aperture seen partially with visual obstruction <50%; 3) glottic aperture seen, but visual obstruction >50%; and 4) glottic aperture not seen.

RESULTS

Fifty patients were enrolled and 48 (22/26 male/female) were included in the analysis. Median age was 13 years (IQR: 7, 16) and median weight was 49 kg (IQR: 25, 70). The Air-Q LMA and i-gel SGA groups did not differ in device placement time (median of 19 vs 21 seconds; 95% CI of difference in medians: - 2 to 7; =0.331), the time to achieve fiberoptic view of the glottis (median of 25 vs 21 seconds; 95% CI of difference: - 9 to 8; =0.489) or the grade of the bronchoscopic view of the airway. Eight Air-Q and 6 i-gel supraglottic devices sealed the airway at 20 cmHO.

DISCUSSION

The time required for successful placement of the SGA, the time required for bronchoscopic view, and the quality of bronchoscopic view through the Air-Q LMA and the i-gel SGA did not differ.