Anesthesia Management: Free-Hand vs. air-Q–Guided Fiber-Optic Intubation in Young Children

Authors: Sohn LE et al., Anaesthesia 2014 May 2;

Using the air-Q laryngeal mask airway did not confer advantage in this randomized trial.

Fiber-optic tracheal intubation can be particularly challenging in infants. To evaluate the possible benefits of using a supraglottic airway as a conduit for fiber-optic intubation, researchers recruited 80 healthy children between 1 and 24 months of age, with American Society of Anesthesiologists class 1–3, who were undergoing general anesthesia for elective surgery. Patients were randomized to insertion of a fiber-optic bronchoscope either by the conventional (free-hand) method or through a previously placed air-Q laryngeal mask airway, and by either an experienced (attending physician) or inexperienced (trainee) operator.

There were no significant differences in median time to successful tracheal intubation between the free-hand and air-Q groups (52 and 60 seconds) or between insertions by experienced and inexperienced operators (51 and 66 seconds). The air-Q required fewer maneuvers (e.g., jaw thrust, tongue displacement) to obtain an adequate laryngeal view (median, 0 vs. 1 maneuver). Complication rates with the two techniques were low and similar.

Comment

Using a laryngeal mask airway to facilitate fiber-optic intubation in young children does not appear to confer any advantage, and is a matter of operator preference.