Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu<sup>®</sup> AuraGain™ laryngeal mask vs the i‐gel™ airway

Moser, Berthold; Keller, Christian; Audigé, Laurent; Dave, Mital H.; Bruppacher, Heinz R.

doi:10.1111/aas.13242

Cited by 27 publications

(29 citation statements)

References 37 publications

(41 reference statements)

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“…Our SAGFBI times are comparable to others using Auragain ™ with duration ranging from 40 to 127 s.[ 7 ] Safe apnoea time of 247 s was reported in obese patients. [ 16 ] In anticipated difficult airways, SAGFBI confers additional advantages: SAD placement helps maintain a patent airway, allowing oxygenation; and rescue ventilation can be provided in between intubation attempts.…”

Section: Discussionsupporting

confidence: 84%

“…[ 14 ] In a recent study in obese patients, first attempt and second attempt success rates in SAGFBI were 91% and 100%, respectively. [ 7 ] This reinforces the DAS's recommendation that if rescue SAD ventilation is successful, then SAGFBI to secure the airway should be considered.…”

Section: Discussionmentioning

confidence: 55%

“…Flexible bronchoscopic intubation via the SAD (supraglottic airway guided flexible bronchoscopic intubation, SAGFBI) has high success rates in difficult airways (96–100%),[ 6 ] and obese patients (100%). [ 7 ] However, we are unaware of studies evaluating the effect of positioning (supine versus ramped) on bronschoscopic glottic view in obese patients. This would help determine whether to maintain the ramped position or to change into the supine position.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study

2020

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Background and Aims: Airway management in obese patients is associated with increased risk of difficult airway and intubation. After failed intubation, supraglottic airway-guided flexible bronchoscopic intubation (SAGFBI) may be required. It is uncertain whether SAGFBI is best performed in the ramped versus conventional supine “sniffing air” position. We conducted a feasibility study to evaluate the logistics of positioning, compared glottic views, and evaluated SAGFBI success rates. Methods: We conducted a prospective, pilot study in patients with a body mass index (BMI) 30–40 kg/m 2 undergoing elective operations requiring tracheal intubation. All patients were placed in a ramped position. After induction, a supraglottic airway device (SAD) was inserted. A flexible bronchoscope was inserted into the SAD and a photograph of the glottic view taken. The patient was repositioned to the supine position. A second photograph was taken. SAGFBI was performed. Images were randomised and assessed by two independent anesthetists. Results: Of 17 patients recruited, 15 patients were repositioned successfully. There were no differences in glottic views observed in the two positions. SAGFBI was successful in 92.9% of patients (median time 91.5 s). Haemodynamic changes were noted in 42.7% of patients which resolved spontaneously. Conclusion: Our pilot study was completed within 5 months, achieved low dropout rate and protocol feasibility was established. SAGFBI was successfully and safely performed in obese patients, with a median time of 91.5 s. The time taken for SAGFBI was similar to awake intubation using FBI and videolaryngoscopy. Our study provided preliminary data supporting future, larger-scale studies to evaluate glottic views in the ramped versus supine positions.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

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Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study

2020

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“…The greater these measurements, the shorter the tracheal intubation time (see also Supporting Information, Table S1). Paradoxically perhaps, obesity could improve ventilation through the Totaltrack, something also observed with other supraglotic airways . One explanation for this could be that deposits of adipose tissue in the pharyngeal walls allow the supraglottic airway to adapt to the airway and achieve a better seal .…”

Section: Discussionmentioning

confidence: 94%

The Totaltrack^TM video laryngeal mask: an evaluation in 300 patients

et al. 2019

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The Totaltrack TM is a new video laryngeal mask, which combines a supraglottic airway with a videolaryngoscope. We evaluated the performance of this device in an observational study in 300 adult patients. The Totaltrack was inserted at the first attempt and the glottis seen in all cases. In 249 patients (83%; 95%CI 78.7-87.3%) the glottis was seen at the first attempt. Adequate ventilation and tracheal intubation were achieved in all patients. The median time to visualisation of vocal cords, to confirmation of ventilation and to successful tracheal intubation was 5 s, 13 s and 24 s, respectively. Nineteen patients (6.3%; 95%CI 3.55-9.05%) suffered minor complications, such as mucosal lesion or blood staining. The Totaltrack appears effective for airway management.

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“…recent papers suggest the use of an oxygenated intubation technique through Sad combining use of catheter mount and eTT cuff inflation inside SAD during intubation maneuver. 34 placement of endotracHeal tube tHrougH a sad main steps for placement of an endotracheal tube through a Sad are (Figure 2): 35,36 • choose the size of the Sad on the patient's weight according to the manufacturer's recommendations. check for both lubrication of the airway channel and correct deflation of the cuff (the i-gel cuff is a soft gel-like non-inflatable cuff);…”

Section: Intubation Through Sads Using the Aintree Intubation Cathetermentioning

confidence: 99%

Competences in bronchoscopy for Intensive Care Unit, anesthesiology, thoracic surgery and lung transplantation

Solidoro¹,

Corbetta²,

Patrucco³

et al. 2019

Panminerva Med

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Over the last decades, the use of flexible bronchoscopy has greatly increased in intensive care, anesthesia and thoracic surgery for diagnostic purpose, management of critical patients and to facilitate airway management for tracheal intubation, one lung ventilation and lung transplant management. The huge availability of endoscopic instruments and devices for airway management has amplified indications and possibilities for bronchoscopic procedures performed by intensive care physicians, anesthesiologist, endoscopists, and surgeons too. These practices need adequate technical skills that can be acquired only through defined learning pathways. This manuscript summarizes the indications and the competencies needed to perform bronchoscopic procedures in intensive care, anesthesia and thoracic surgery settings.

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Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu^® AuraGain™ laryngeal mask vs the i‐gel™ airway

Abstract: Time for intubation through both supraglottic airway devices was similar. Attributed to fast possibility of securing the airway with both supraglottic airway devices, we believe that both, AuraGain™ and i-gel™, can be a good alternative in the airway management in obese patients.

Cited by 27 publications

References 37 publications

Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study

Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study

The Totaltrack^TM video laryngeal mask: an evaluation in 300 patients

Competences in bronchoscopy for Intensive Care Unit, anesthesiology, thoracic surgery and lung transplantation

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Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu® AuraGain™ laryngeal mask vs the i‐gel™ airway

Abstract: Time for intubation through both supraglottic airway devices was similar. Attributed to fast possibility of securing the airway with both supraglottic airway devices, we believe that both, AuraGain™ and i-gel™, can be a good alternative in the airway management in obese patients.

Cited by 27 publications

References 37 publications

Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study

Comparison of glottic visualisation through supraglottic airway device (SAD) using bronchoscope in the ramped versus supine 'sniffing air' position: A pilot feasibility study

The TotaltrackTM video laryngeal mask: an evaluation in 300 patients

Competences in bronchoscopy for Intensive Care Unit, anesthesiology, thoracic surgery and lung transplantation

Contact Info

Product

Resources

About

Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu^® AuraGain™ laryngeal mask vs the i‐gel™ airway

The Totaltrack^TM video laryngeal mask: an evaluation in 300 patients