The Efficiency of Different Oropharyngeal Airways as a Conduit for Fiberoptic Intubation. Comparative Study
Condition: Fiberoptic Tracheal Intubation
Study type: Interventional

Summary: 
      60 Patients were randomly allocated into three equal groups, after induction of general
      anesthesia one of the three airways included in the study (Modified Williams, Modified
      Gudle's and LMA MADgic airway) was used as a conduit for endotracheal tube placement using
      fiberoptic bronchoscopy. Airway insertion time, ease of insertion, adaptation to oral cavity
      and intubation time was recorded.
    

Detailed description: 
      The study was conducted in Kasr Alainy hospital, faculty of medicine, Cairo University.

      After approval of ethical committee and informed written consent from each patient, 60
      patient aging above 18 years, ASA I-II , with Ganzouri airway score <4 and undergoing
      elective surgeries under general anesthesia were included in the study.

      Patients were randomly allocated into three equal groups:

      Group M (GM) (n=20 patients): patient was intubated using LMA MADgic airway. Group W (GW)
      (n=20 patients): patient was intubated using modified Williams airway.

      Group G (GG) (n=20 patients): patient was intubated using modified Guedel's airway.

      Randomization was performed by random computer allocation with numbered closed opaque
      envelopes.

      The study was performed by expert anesthesiologist in FOB intubation. In the preparation
      room, all patients was cannulated with a 20 gauge venous cannula and 0.02mg/kg Midazolam was
      given. Patient transferred to the operating room and was monitored with non-invasive blood
      pressure, pulse oximetry and ECG. After preoxygenation using a facemask for 5 min, induction
      of anesthesia was done with 2mg/kg propofol, 1 μg/kg of fentanyl and 0.6 mg/kg of atracurium.

      After loss of consciousness the selected airway according to group randomization was inserted
      into the mouth (size selection and technique of insertion according to manufacturer
      instruction). Time of insertion defined as the time, in seconds, from touching the patients'
      mouth with the airway until capnographic confirmation of ventilation by facemask. The ease of
      insertion was determined by number of attempts of airway insertion. Adaptation of the airway
      was determined by adequacy of ventilation, fitness to the oral cavity and appearance of
      successive ETco2 waves.

      Manual positive-pressure ventilation was then started with 100% oxygen and 1-1.5% isoflurane
      through the facemask for 3 min until complete muscle relaxation was confirmed (when
      train-of-four count becomes zero).

      Loaded FOB was inserted for intubation through the airway, laryngeal view grade was recorded
      (LVG) using Brimacomb and Berry scale; thereafter, the fiberscope was advanced into the
      trachea to a level just above the carina and the tracheal tube was railroaded over it.

      Tracheal intubation could be facilitated by tube rotation, jaw thrust, neck extension or
      flexion and adjustment of the airway was allawed and was recorded. The intubation time was
      recorded ; that is, the time from cessation of manual ventilation using a facemask until
      restarting of ventilation through the tracheal tube.

      The airway was removed except the LMA MADgic airway which was removed before ETT insertion.
      The ease of airway removal was evaluated by the anesthesiologist.
    

Intervention name(s): Modified Williams airway; Modified Guedle's airway; LMA MADgic airway
Intervention type(s): Device; Device; Device
Intervention description(s): This airway used as a conduit for fiberoptic bronchoscopic tracheal intubation in Group W; This airway used as a conduit for fiberoptic bronchoscopic tracheal intubation in Group G; This airway used as a conduit for fiberoptic bronchoscopic tracheal intubation in Group M
Other intervention name(s): Fikrey airway
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: prospective randomized trial
Masking: None (Open Label)
Primary purpose: Device Feasibility