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      Comparison of success rate of BlockBuster ® versus Fastrach ® LMA as conduit for blind endotracheal intubation: A prospective randomised trial

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          Abstract

          Background and Aims:

          BlockBuster ® Laryngeal Mask Airway, a newer supraglottic airway device, is claimed to be an efficient conduit for endotracheal intubation. Intubating laryngeal mask airway (LMA) is an established device for the same. This randomised study was undertaken to evaluate the success rate of blind intubation using either of these LMAs.

          Methods:

          Sixty patients of age group 20-60 years undergoing general anaesthesia were randomised in 2 groups, of 30 patients each, for tracheal intubation using either BlockBuster ® LMA (Group B) or the Intubating LMA Fastrach ® (Group F). After induction of anaesthesia, LMAs were inserted and on achieving adequate ventilation with the device, fibreoptic scopy was performed to assess the glottis visualisation score. Blind intubation was attempted through the supraglottic airway devices (SAD). The primary objective was first pass successful intubation and secondary outcomes were ease, time for LMA insertion, oropharyngeal seal pressure (OSP), LMA removal time, fibreoptic scoring and complications. Data was analysed using SPSS V22 software.

          Results:

          The first-attempt success rate of tracheal intubation was 90% in Group B and 66.6% in Group F ( P = 0.028), while the overall success rate of intubation was 96.6% in Group B and 89.9% in Group F ( P = 0.3). The OSP in Group B was 33.7 ± 1.8 and 22.7 ± 1.5 cm H 2O in Group F ( P = 0.001). Complications such as sore throat and blood stain were reduced with BlockBuster ® LMA.

          Conclusion:

          BlockBuster ® LMA provides higher first pass success rate of blind tracheal intubation with less complications like sore throat and blood staining.

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          Most cited references20

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          All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

          The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre-oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway device (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes ‘complete ventilation failure’, and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a ‘difficult airway alert form’ must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart.
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            A proposed fiber-optic scoring system to standardize the assessment of laryngeal mask airway position.

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              Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways.

              The laryngeal mask airway (LMA; LMA North America, Inc., San Diego, CA) has a well-established role in the emergency and elective treatment of patients with difficult-to-manage airways (DA). In this study, the authors report their clinical experience with the intubating LMA (LMA-Fastrach; LMA North America, Inc., San Diego, CA) in 254 patients with different types of DA. The authors reviewed the anesthetic and medical records of patients with DA in whom the LMA-Fastrach was used electively or emergently at four institutions from October 1997 through October 2000. In each case, the number of insertion and intubation attempts was recorded. Success rates for blind and fiber optically guided intubation through the LMA-Fastrach were calculated, up to a maximum of five attempts per patient. The LMA-Fastrach was used in 257 procedures performed in 254 patients with DA, including patients with Cormack-Lehane grade 4 views; patients with immobilized cervical spines; patients with airways distorted by tumors, surgery, or radiation therapy; and patients wearing stereotactic frames. Insertion of the LMA-Fastrach was accomplished in three attempts or fewer in all patients. The overall success rates for blind and fiber optically guided intubations through the LMA-Fastrach were 96.5% and 100.0%, respectively. The LMA-Fastrach was used successfully in a high percentage of patients who presented with a variety of DA. The clinical experience presented herein indicates that this device may be particularly useful in the emergency and elective treatment of patients in whom intubation with a rigid laryngoscope has failed and in the treatment of patients with immobilized cervical spines.
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                Author and article information

                Journal
                Indian J Anaesth
                Indian J Anaesth
                IJA
                Indian Journal of Anaesthesia
                Wolters Kluwer - Medknow (India )
                0019-5049
                0976-2817
                December 2019
                11 December 2019
                : 63
                : 12
                : 988-994
                Affiliations
                [1]Department of Anaesthesiology, S. N. Medical College and HSK Hospital, Bagalkote, Karnataka, India
                Author notes
                Address for correspondence: Dr. Anilkumar Ganeshnavar, Department of Anaesthesiology, S. N. Medical College and HSK Hospital, Bagalkote - 587 102, Karnataka, India. E-mail: anilganesh22@ 123456gmail.com
                Article
                IJA-63-988
                10.4103/ija.IJA_396_19
                6921324
                31879422
                4eddc6e4-5a4d-4b80-b6c1-0c4cea666c72
                Copyright: © 2019 Indian Journal of Anaesthesia

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 03 June 2019
                : 23 August 2019
                : 17 November 2019
                Categories
                Original Article

                Anesthesiology & Pain management
                blockbuster®,fastrach®,laryngeal mask airway,tracheal intubation

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