I-gel Versus Classic-Laryngeal Mask Airway (C-LMA) as a Conduit for Tracheal Intubation Using Ventilating Bougie

Medical College Baroda58 enrolled

Overview

Supraglottic Airway devices(SGAs) like I-Gel and C-LMA ( classic laryngeal mask airway ) have been used as a conduit for tracheal intubation using ventilating bougie. General Anaesthesia with tracheal intubation is one of the technique for giving anaesthesia. Tracheal intubation may become difficult sometimes and endangers patients life. Using SGAs as a conduit for tracheal intubation helps in securing airway. This will be further facilitated by using ventilating bougie, as it maintains oxygenation.

SGAs have been used as a conduit for tracheal intubation using ventilating bougie. Patients were anaesthetised with intravenous induction agent, non-depolarising muscle relaxant and then SGAs were inserted. Two groups were compared. In group I : I-gel was inserted, its position was confirmed and then ventilating bougie was inserted through it. It's position was confirmed, then I-gel was removed , Endotracheal tube was railroaded over ventilating bougie and it's position was confirmed. In group C : C-LMA was inserted, its position was confirmed and then ventilating bougie was inserted through it. It's position was confirmed, then C-LMA was removed , Endotracheal tube was railroaded over ventilating bougie and it's position was confirmed.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Intubation; Difficult

Interventions

Tracheal Intubation using I-gel and ventilating bougieDEVICE

Following general anaesthesia I-gel was inserted. After proper placement . ventilating bougie was inserted. Once it's placement is confirmed I-gel was removed keeping the ventilating bougie in situ. Then appropriate sized endotracheal tube was railroaded over ventilating bougie then it (v.bouggie) was removed . Proper placement of endotracheal tube was confirmed by bilateral equal chest excursion and air entry on auscultation, absence of gastric insuffflation sound over epigastrium and 'sine' wave on capnography. Maximum 3 attempts were allowed for I-gel, ventilating bougie and endotracheal tube.

Tracheal Intubation using C-LMA and ventilating bougieDEVICE

Following general anaesthesia C-LMA was inserted. After proper placement of C-LMA, ventilating bougie was inserted. It's placement was confirmed and C-LMA was removed after deflation of cuff keeping the ventilating bougie in situ. Then appropriate sized endotracheal tube was railroaded over ventilating bougie. It's placement was confirmed by bilateral equal air entry and chest excursion, absence of gastric insufflation sound over epigastrium and 'sine' wave on capnography. Maximum 3 attempts were allowed for C-LMA , ventilating bougie and endotracheal tube.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * age 18 to 60 years * Gender : either sex * American society of Anaesthesiologist's Physical Status (ASAPS) I and II * Patients posted for surgery requiring general anaesthesia and endotracheal intubation. Exclusion Criteria: * age \<18 years and \> 60 years * ASAPS III or IV * Obesity body mass index \>25 * Patients with mouth opening \<2cms * Patients with Malampatti grade III and IV * Patients having history of gastro-esophageal reflux disease * Patients with history of inadequate fasting * Patients with known or anticipated difficult tracheal intubation or face-mask ventilation.

Outcomes

Primary Outcomes

Number of Attempts for I-gel or Classic-LMA Insertions

Time frame: 60 seconds

Number of Attempts for Ventilating Bougie Insertions Through I-gel or C-LMA

Time frame: 45 seconds

Number of Attempts for Railroading of Endotracheal Tube Over Ventilating Bougie

Time frame: 30 seconds

Time of Insertion

Time frame: 5 minutes

Total Intubation Time

Time frame: 5 minutes

Secondary Outcomes

Heart Rate

Heart rate to observe at the following time intervals. 1. Base line 2. After induction 3. After dexmedetomidine injection 4. Supraglottic airway insertion 5. Ventilating bougie insertion 6. ETT insertion 7. 3minute after ETT insertion 8. 5 minute after ETT insertion 9. 7 minute after ETT insertion 10. 10 minute after ETT insertion 11. 15 minute after ETT insertion Study period is upto 15 minutes, thereafter the study ends here.

Time frame: 25 minutes

Systolic Blood Pressure

Systolic blood pressure measured at following time intervals. 1. Base line 2. After Dexmedetomidine injection 3. After induction of anaesthesia 4. Supraglottic airway insertion 5. Ventilating bougie insertion 6. ETT insertion 7. 3 minute after ETT insertion 8. 5 minute after ETT insertion 9. 7 minute after ETT insertion 10. 10 minute after ETT insertion 11. 15 minute after ETT insertion. The study period was upto 15 minutes and thereafter the study ends.

Time frame: 25 minutes

Diastolic Blood Pressure

Diastolic blood pressure measured at following time intervals. 1. Base line 2. After Dexmedetomidine injection 3. After Induction 4. Supraglottic airway insertion 5. Ventilating bougie insertion 6. ETT insertion 7. 3 minute after ETT insertion 8. 5 minute after ETT insertion 9. 7 minute after ETT insertion 10. 10 minutes after ETT insertion 11. 15 minute after ETT insertion The study period was upto 15 minutes. thereafter study ends.

Data from ClinicalTrials.gov

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