A Prospective Randomized Comparative Study on i-gel versus Laryngeal Mask Airway Fastrach as a Conduit for Blind Tracheal Intubation Using Conventional PVC Endotracheal Tubes in Reverse Orientation

Introduction: Laryngeal mask airway (LMA) Fastrach was specially designed as a conduit for blind tracheal intubation in anticipated difficult airway and where we do not require neck extension. i-gel is a disposable, cheap supraglottic device with wide bore stem which facilitates direct passage of a conventional polyvinylchloride (PVC) endotracheal tube. Materials and Methods: A total of 80 adult patients of the American Society of Anaesthesiologist Physical status 1 and 2 of either sex undergoing elective surgical procedures under general anesthesia were randomly allocated into two groups, Group F: LMA Fastrach (n = 40) and Group G: i-gel (n = 40). Primary outcome measures: Ease of tracheal intubation through the supraglottic device assessed by the first attempt and overall success rate of intubation. The secondary outcome measures: Time required for the successful intubation in the first attempt, ease of supraglottic device placement and hemodynamic changes with intubation. Results: The overall success rate, as well as the first attempt success rate for blind endotracheal intubation, was high with LMA Fastrach and were 95% and 87.5%, respectively. The mean time for successful first-attempt tracheal intubation was equal in both the groups. Overall success rate for supraglottic device placement and hemodynamic changes were comparable in both groups. The failure rate for blind endotracheal intubation through the supraglottic airway device was significantly high in i-gel (27.5%) with the high incidence of esophageal intubation when compared to LMA Fastrach (P < 0.05). Conclusion: Ease of placement of i-gel masskes it a good supraglottic device. Insertion of conventional PVC endotracheal tubes in reverse orientation does not increase the success rate of tracheal intubation in i-gel. LMA Fastrach has the higher first attempt and overall success rate for blind tracheal intubation when compared to i-gel. We would suggest that when our goal is intubation in reverse orientation with conventional PVC tubes; we should go for LMA Fastrach rather than i-gel.