title: Comparison of Aintree and Fastrach techniques for low-skill fibreoptic intubation in patients at risk of secondary cervical injury: a randomised controlled trial.
abstract: BACKGROUND
  We compared two methods of asleep fibreoptic intubation in patients at risk of secondary cervical injury: the Aintree Intubation Catheter via a classic laryngeal mask airway (cLMA) versus the Fastrach technique via the intubating laryngeal mask airway (iLMA).
  
  
  OBJECTIVE
  To test which system has the highest rate of successful intubations in the clinical setting.
  
  
  METHODS
  A randomised controlled study.
  
  
  METHODS
  Single-centre, between 2007 and 2010.
  
  
  METHODS
  We randomly allocated 80 patients (30 women and 50 men) who underwent elective neurosurgery of the cervical spine to either group, placed in a neutral position and wearing a soft cervical collar. Entry criteria were ASA status 1 to 3, age 18 to 80 years and written informed consent. Exclusion criteria were patients with cervical instability, known or predicted difficult airway, BMI greater than 40  kg  m⁻² and symptomatic gastro-oesophageal reflux.
  
  
  METHODS
  Two anaesthetists who were experienced in both techniques performed all anaesthesia procedures within the study. There was a maximum of three attempts for performing each technique.
  
  
  METHODS
  The primary outcome was the rate of successful fibreoptic intubation in a neutral position. We also investigated the timing sequence for both techniques, the Brimacombe and Berry Bronchoscopy Score, and differences in technical aspects.
  
  
  RESULTS
  All 40 patients in the Aintree group but only 31 patients in the Fastrach group were intubated successfully. Thus, fibreoptic intubation failed significantly less using the Aintree technique (P = 0.002). For secondary outcomes, the cLMA was faster (260 versus 289  s, P = 0.039) and easier (P = 0.036) to insert than the iLMA. The fibreoptic view of the glottis according to the Brimacombe and Berry Bronchoscopy Score was better (P = 0.016) and the tracheal tube was easier to insert (P = 0.010) in the Aintree group.
  
  
  CONCLUSIONS
  Fibreoptic intubation using the Aintree system was more successful than the Fastrach technique in our population of patients in a neutral position wearing a soft cervical collar. The differences in the time to successful intubation between the two groups are unlikely to be clinically relevant.
authors.affiliation: From the Department of Anaesthesiology, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany (MJM, KR, VW, AS), Department of Anaesthesia, St. George's Hospital, London, UK (RZ), Department of Neurosurgery, Klinikum St. Georg gGmbH, Leipzig, Germany (OS) and Department of Anaesthesia I, University Witten, Herdecke, Germany (GS) *Both Michael J. Malcharek and Kai Rockmann have contributed equally, each as first author of this work and in preparing the original research article.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Malcharek
authors.forename: Kai
authors.initials: K
authors.lastname: Rockmann
authors.forename: Ralph
authors.initials: R
authors.lastname: Zumpe
authors.forename: Oliver
authors.initials: O
authors.lastname: Sorge
authors.forename: Viktor
authors.initials: V
authors.lastname: Winter
authors.forename: Armin
authors.initials: A
authors.lastname: Sablotzki
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D002574:Cervical Vertebrae / Q000293:injuries; D002983:Clinical Competence; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013997:Time Factors