Effect of head position on the success rate of blind intubation using intubating supraglottic airway devices

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Abstract

Background:

To evaluate the effect of head position on the performance of intubating supraglottic airway devices, we compared the success rate of blind intubation in the head-elevated and the pillowless head positions with the LMA Fastrach and the air-Q, and the change of glottic visualization through the air-Q.

Methods:

We assigned 193 patients to two groups according to the device used and subgrouped by head position used for intubation: Fastrach/pillowless, Fastrach/head-elevated, air-Q/pillowless, and air-Q/head-elevated. Blind intubation through the Fastrach or the air-Q was attempted up to twice after induction of general anesthesia. Before the attempt at blind intubation with the air-Q, the percentage of glottic opening (POGO) score was also fiberscopically evaluated at the outlet of the device in both head positions in a cross-over fashion.

Results:

The Fastrach significantly facilitated blind intubation compared with the air-Q in both the pillowless and head-elevated positions: 87.2% in Fastrach/pillowless vs 65.9% in air-Q/pillowless (P = .048), 90% in Fastrach/head-elevated vs 53.7% in air-Q/head-elevated (P < .001). The head-elevated position did not significantly affect the success rate of blind intubation for either device (P = .97 in Fastrach, P = .37 in air-Q). Although the head-elevated position significantly improved the POGO score from the median (10–90 percentile) 60% (0–100%) in the pillowless position to 80% (0–100%) (P = .008), it did not contribute to successful blind intubation with the air-Q.

Conclusion:

Although the head-elevated position improved glottic visualization in the air-Q, the head position had minimal influence on the success rate of blind intubation with either the Fastrach or the air-Q.

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