Randomized trial comparing the i-gel™ and Magill tracheal tube with the single-use ILMA™ and ILMA™ tracheal tube for fibreoptic-guided intubation in anaesthetized patients with a predicted difficult airway

Background. The i-gel (TM) is a single-use supraglottic airway device (SAD) that allows fibreoptic-guided tracheal intubation through the device. Until now, no prospective data for this procedure are available. Therefore, in a prospective randomized controlled trial, we evaluated fibreoptic-guided tracheal intubation with a standard Rusch (TM) PVC tracheal tube (TT) through the i-gel (TM) compared with the single-use ILMA (TM) (sILMA (TM)) TT through the sILMA (TM) in patients with a predicted difficult airway. Methods. With ethics committee approval and written informed consent, 160 patients were randomly assigned to either SAD. After placement of the SAD, a fibreoptic bronchoscope was introduced into the trachea as a railroad for the TT. Primary outcome variable was the first-attempt fibreoptic-guided intubation success rate. Secondary variables included time for insertion and intubation, airway leak pressures, fibreoptic view, and adverse events. Data are presented as mean (SD) or percentages. A P-value of <0.05 was considered statistically significant. Results. Fibreoptic-guided intubation was successful at the first attempt in 76 patients (96%) using the i-gel (TM) and in 71 patients (90%) using the sILMA (TM) (P=0.21). Most of the failed intubations were rescued by conventional laryngoscopy. Airway leak pressure was higher for the sILMA (TM). There were no problems during removal of either type of SAD. Conclusions. Fibreopic-guided tracheal intubation through the i-gel (TM) using a standard Rusch (TM) Magill TT is successful and an alternative to the sILMA (TM) with the sILMA (TM) TT.