Comparison Between Fekry and Air-Q Intubating Airways as Conduit for Fibreoptic Endotracheal Intubation in Adult Patients
Condition: Fekry VS the Air-Q Intubating Airways
Study type: Interventional

Summary: 
      The fibreoptic bronchoscope remains one of the most important methods of intubating patients
      particularly when there is difficulty with intubation.

      Facilitating fiberoptic oropharyngeal intubation procedure, specific airways have been
      devised to push the tongue anteriorly to clear a passage for the fibrescope into the trachea.

      Of these airways the Air-Q Intubating Laryngeal Airway (Air-Q) (Cookgas, St. Louis, MO, USA)
      and Fekry Oral Intubating Airway (Ameco Technology, Cairo, Egypt).
    

Detailed description: 
      The Air-Q Intubating Laryngeal Airway (Air-Q):

      The Air-Q™ Intubating Laryngeal Airway (Air-Q) (Cookgas, St. Louis, MO, USA) is a SAD that
      was designed primarily to act as a conduit for the passage of a cuffed tracheal tube during
      tracheal intubation (1), Compared with the LMA, the Air-Q has a shorter silicon airway tube
      that allows an easy visualization of vocal cords and intubation and removal of the device
      after tracheal tube insertion. The device has a removable color coded connector, allows
      intubation through the airway tube. The device is also wider, C-curved and has an integrated
      bite block which makes it easier to place reinforces the tube and diminishes the need for a
      separate bite block, with an elevation ramp that facilitates intubation and directs the tube
      toward the laryngeal inlet. It also has a built-up mask for improved seal. All of these
      features facilitate the passage of the tracheal tube through the device and into the trachea.

      Fekry airway (Oral Intubating Airway; Egyptian Patent 28118):

      Several modifications of oropharyngeal airways aiming to allow facilitation of intubation and
      easy removal of the airway after placement of ETT.

      In Fekry airway, modification of the Williams airway facilitates the airway removal after ETT
      insertion without need to remove the international part of the ETT (this reduce risk of ETT
      dislodgement during airway removal).

      The modification made to the Williams airway is that the roof of the proximal cylindrical
      tunnel is opened from its upper part to allow one step insertion of the tube. There is no
      need for removal of the tube connector after tube insertion. It allows passage of the suction
      catheter and may allow oxygen insufflations through a catheter.

      As mastering airway management in difficult cases is an essential job to anesthesiologist, we
      think it is important to find an easy adjunct to this hard job.

      investigators hypothesized that Fekry airway could offer a better conduit to flexible
      fiberoptic intubation rather than the air-Q device, because it needs less experience in how
      to use, less intubation time.
    

Intervention name(s): Patients will be intubated using Air-Q airway
Intervention type(s): Device
Intervention description(s): Both groups:
Grade 1: Split airway provides an unobstructed path for bronchoscope from mouth to glottis.
Grade 2: Tongue rests against posterior pharyngeal wall causing partial obstruction to bronchoscope.
Grade 3: Epiglottis rests against posterior pharyngeal wall causing partial obstruction to bronchoscope.
Grade 4: Tongue and epiglottis rest against posterior pharyngeal wall, both causing partial obstruction to bronchoscope.
Grade 5: Tongue rests against posterior pharyngeal wall causing total obstruction to bronchoscope (failure).
Grade 6: Epiglottis rests against posterior pharyngeal wall causing total obstruction to bronchoscope (failure)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Comparison between the two airways regarding:
Time to Glottic view.
Grade of bronchoscopic view.
Success of intubation from 1st trial.
Masking: Double (Participant, Investigator)
Primary purpose: Diagnostic