AI Article Synopsis
- The study investigates whether neck extension improves the success rate of blind tracheal intubation using the Ambu® AuraGain™ laryngeal mask compared to a neutral neck position.
- In a trial with 121 patients, the results showed a higher success rate for the extension group in both first-attempt intubation (68% vs. 47%) and overall attempts (71% vs. 50%).
- While neck extension enhances success rates for this technique, it is recommended as an alternative rather than the primary method of intubation due to a notable failure rate.
Article Abstract
Purpose: Although the use of fibreoptic guidance is recommended for tracheal intubation through supraglottic airway devices, it can also be performed in a blind manner. Based on the previous finding that a fibreoptic view of the vocal cords was better in the extended neck position than in the neutral position, we hypothesized that neck extension can better facilitate blind intubation through the Ambu® AuraGain™ laryngeal mask than the neutral position.
Methods: Patients undergoing general anesthesia were randomly assigned to the extension group or the neutral group. After induction of anesthesia, the AuraGain™ was placed in the oropharynx, followed by blind intubation through the AuraGain™ in the assigned neck position within a maximum of two attempts. The primary outcome was successful blind intubation through the AuraGain™ in the first attempt.
Results: Of 168 adult patients screened, 124 patients were enrolled and 121 patients were included in the final analysis (extension group, n = 59; neutral group, n = 62). The incidence of successful blind intubation on the first attempt was significantly higher in the extension group than in the neutral group (68% vs. 47%, respectively; relative risk [RR], 1.45; 95% confidence interval [CI], 1.05 to 1.99; P = 0.02). The overall incidence of successful blind intubation was also significantly higher in the extension group than in the neutral group (71% vs 50%, respectively; RR, 1.42; 95% CI, 1.06 to 1.92; P = 0.02). The time required for successful blind intubation and the incidence of hoarseness, cough, or sore throat at 24 hr after extubation did not differ between groups.
Conclusion: Neck extension can be used to facilitate blind intubation through the Ambu® AuraGain™ laryngeal mask. Considering the relatively high failure rate, blind intubation via the AuraGain™ should be used as an alternative, not as a first-line choice.
Trial Registration: www.ClinicalTrials.gov (NCT03408431); registered 24 January 2018.
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| http://dx.doi.org/10.1007/s12630-019-01353-4 | DOI Listing |
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