Svendsen Christine N, Rosenstock Charlotte V, Glargaard Gine L, Strøm Camilla, Lange Kai H W, Lundstrøm Lars H
Department of Anaesthesiology and Intensive Care, Nordsjaellands Hospital, Hillerød, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2022 May;66(5):589-597. doi: 10.1111/aas.14042. Epub 2022 Feb 14.
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.
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.
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).
We found no difference in total time for airway management between using the i-gel™ and using the AuraGain™.
