Comparison Between Fekry and Air-Q Intubating Airways as Conduit for Fibreoptic Endotracheal Intubation in Adult Patients

Study Overview
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Brief Summary
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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
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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.

Official Title
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Comparison Between Fekry and Air-Q Intubating Airways as Conduit for Fibreoptic Endotracheal Intubation in Adult Patients

Conditions
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Fekry VS the Air-Q Intubating Airways

Intervention / Treatment
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* Device: Patients will be intubated using Air-Q airway


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged ≥18 years old. Of both sexes. With American Society of Anaesthesiologists (ASA) physical status class I-ll. Scheduled for elective surgery under general anesthesia requiring ETT placement. Exclusion Criteria: Patient refusal. Patient that has any documented or suspected difficult airway or neck or upper respiratory tract abnormalities, facial deformities that invalidate Ganzouri airway score. Patient that has any active cardiac or chest problem and risk of aspiration.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Comparison between the two airways regarding: Time to Glottic view. Grade of bronchoscopic view. Success of intubation from 1st trial.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: GA (n =22)<br>Patients will be intubated using Air-Q airway | Device: Patients will be intubated using Air-Q airway<br>* 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)<br>|
| Active Comparator: GF (n =22)<br>Patients will be intubated using Fekry airway | Device: Patients will be intubated using Air-Q airway<br>* 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)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Endoscopy insertion time | Time from introducing the tip of scope through the proximal end of the airway device or mouth until the visualization of carina (multiple attempts will be added to compute this time | Withen 15 seconds from induction og Generel Anesthesia | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ITHIN Intubation time | Timing of complete intubation | Withen 15 seconds from induction og Generel Anesthesia | 
| Grade of endoscopic view | Endoscopic view grading | Withen 15 seconds from induction og Generel Anesthesia | 
| Success rate of intubation from 1st trial | 1st trial Success | Withen 15 seconds from induction og Generel Anesthesia | 
| Score of success of endotracheal intubation | Endotracheal intubation Score of success | Withen 15 seconds from induction og Generel Anesthesia till Study Completion | 
| Number of intubation and device insertion attempts | Attempts Number of intubation and device insertion | Withen 15 seconds from induction og Generel Anesthesia | 
| Complications | Coughing, laryngospasm, stridor, hoarseness, bronchospasm, arterial desaturation (SpO2<92), aspiration, bleeding or swelling to the lips, tongue, teeth, or blood staining the airway. | Withen 15 seconds from induction og Generel Anesthesia |