Efficiency of laryngeal mask airway ProtectorTM and i-gel® as a conduit in Aintree catheter-guided fibreoptic tracheal intubation: a randomised clinical trial

Background
Fibreoptic intubation through a supraglottic airway device (SAD) is recom­mended in difficult airway management algorithms. The Difficult Airway Society published a guideline describing the details of this technique in 2011. This study was designed to compare the efficiency of two different 2nd generation SADs as a conduit for Aintree catheter-guided fibreoptic tracheal intubation.

Methods
80 adult patients with an ASA score of 1–3 undergoing elective surgical procedures were included in the study. The patients were intubated after randomization to two groups: the i-gel group and the laryngeal mask airway (LMA) Protector group. SAD insertion time and tracheal intubation time were recorded separately. Demographic data, changes in haemodynamic parameters during the procedure, and complications were noted.

Results
In the LMA Protector and i-gel groups, the number of attempts (1.14 ± 0.35 vs. 1.24 ± 0.49 times, P = 0.394), device insertion time (14.89 ± 8.11 vs. 17.84 ± 16.59 seconds, P = 0.896), and the need for an optimization manoeuvre (43.2% vs. 37.8%, P = 0.813) were similar (P > 0.05). The fibreoptic laryngeal appearance scale and haemodynamic parameters were similar (P > 0.05). However, the airway complication rate was significantly higher in the LMA Protector group than in the i-gel group (21.6% vs. 2.7%, P = 0.013). The most common complications were bronchospasm and bloody secretion on SAD.

Conclusions
With the stable haemodynamic parameters, acceptable insertion time and lower complication rate, we concluded that the i-gel may be preferable in fibre­optic tracheal intubation. The rigid structure of the LMA Protector compared to the i-gel might contribute to this result.