• Seokha Yoo, Sun-Kyung Park, Won Ho Kim, Min Hur, Bahk Jae-Hyon JH Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea., Young-Jin Lim, and Jin-Tae Kim.
• Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
• Can J Anaesth. 2019 Jun 1; 66 (6): 639-647.

PurposeAlthough 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.MethodsPatients 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.ResultsOf 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.ConclusionNeck 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 Registrationwww.ClinicalTrials.gov (NCT03408431); registered 24 January 2018.

23 keywords...

hide…