Bougie assisted endotracheal intubation using the Air-Q™ Intubating Laryngeal Airway: A prospective randomized clinical study

Background
Air-Q™ Intubating Laryngeal Airway is an extraglottic airway device used as a primary airway tool or as an adjunct to tracheal intubation. The bougie is a simple flexible device that might increase the success rate of endotracheal intubation either blindly or through a supraglottic device. We hypothesized that using bougie guided intubation through air-Q™ can improve the success rate with minimal complications.
Methods
One hundred and forty patients of either sex, >18 years old, ASA I-II scheduled for elective surgical procedures under general anesthesia with intubation were randomly allocated to one of two groups of 70 patients each. Blind tracheal intubation was performed through air-Q™ with bougie assistance (Group B) or without (Group Q). In both groups, 3 attempts were allowed for successful device insertion. After obtaining normal capnographic wave, 3 more attempts were tried for intubation with or without bougie guidance. Lung ventilation through air-Q™ was permitted between intubation attempts. If tracheal intubation through air-Q™ was unsuccessful, it was performed by direct laryngoscopy.
Results
Air-Q™ time, ease, attempts number of insertion and ventilation grade were comparable between both groups. Total intubation time was significantly longer in group-B (P = 0.001) while overall success rate for intubation was comparable (64.3%). Group-B showed significant (P = 0.001) higher incidence of complications (trauma (P = 0.023), sore throat (P = 0.001), dysphonia (P = 0.023) and dysphagia (P = 0.001)) as compared with group-Q. In spite of significant decrease in both heart rate and mean arterial pressure in both groups after air-Q™ insertion, yet there was significant increase in both parameters after intubation compared to baseline values (P < 0.05) which was more prominent in group-B than in group-Q. Significant increase in HR and MAP was elicited after bougie placement in group-B (P < 0.01).
Conclusion
Bougie guided tracheal intubation through air-Q™ didn’t improve overall success rate with significant longer time, hemodynamic derangement and traumatic sequelae.