title: [Comparison of Cookgas and Fastrach intubating laryngeal mask airway with fiberoptic bronchoscope in anticipated difficult airway management].
abstract: OBJECTIVE
  To compare the clinical effectiveness of fiberoptic bronchoscope (FOB)-guided intubation through the Cookgas intubating laryngeal airway(CILA)and the Fastrach intubating laryngeal mask airway (FT-LMA) in the management of anticipated difficult airways.
  
  
  METHODS
  Sixty patients with all three difficult intubation criterion (thyromental distance<60 mm, interincisor distance<35 mm, and Mallampati class 3 or 4) undergoing elective plastic surgery under general anesthesia were randomly allocated into CILA group (n=30) and FT-LMA group (n=30). After anesthesia being induced and CILA or FT-LMA being inserted, the patients were treated with FOB-guided intubation through CILA or FT-LMA. The success of the intubating laryngeal airway(ILA)insertion and FOB-guided intubation, the number of attempts, and the duration of the successful attempt were recorded.
  
  
  RESULTS
  The ILA was inserted successfully in 30 patients from CILA group and 27 patients from FT-LMA group. Three failed cases in FT-LMA group were inserted successfully with CILA. In CILA group, the first FOB-guided intubation attempt succeeded in 26 patients, and 4 cases were intubated at the second attempt. In 27 patients of FT-LMA group, 20 cases were intubated successfully at the first attempt, 4 cases at the second attempt, and 3 cases failed; of these three failed patients, two patients were intubated smoothly with FOB through CILA at the first attempt, one was intubated by FOB via CILA at the second attempt. The duration of FT-LMA insertion [(35.3±12.8)s] was significantly longer when compared with CILA [(23.9±17.5)s] (P<0.05). However, the duration of FOB-guided intubation through CILA and FT-LMA [(48.6±13.5)s vs.(53.2±14.2)s] and the time of ILA removal [(40.4±10.2)s vs. (38.5±11.3)s] were not significantly different between these two groups (P>0.05). The adverse events during and after intubtion were not significantly different between these two groups.
  
  
  CONCLUSIONS
  FOB-guided intubation through CILA and FT-LMA is safe and feasible for the management of anticipated difficult airways. However, in patients with severe scar contracture of face and neck and those with huge expander in neck, the CILA insertion and FOB-guided intubation via CILA is superior to FT-LMA.
authors.affiliation: Department of Anesthesiology, Plastic Surgery Hospital, CAMS and PUMC, Beijing 100114, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Yang
authors.forename: Xiao-ming
authors.initials: XM
authors.lastname: Deng
authors.forename: Shi-yi
authors.initials: SY
authors.lastname: Tong
authors.forename: Geng-zhi
authors.initials: GZ
authors.lastname: Tang
authors.forename: Yan-ming
authors.initials: YM
authors.lastname: Zhang
authors.forename: Ling-xin
authors.initials: LX
authors.lastname: Wei
authors.forename: Jing-hu
authors.initials: JH
authors.lastname: Sui
authors.forename: Yu-lei
authors.initials: YL
authors.lastname: Sun
authors.forename: Ju-hui
authors.initials: JH
authors.lastname: Liu
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Xiao-wen
authors.initials: XW
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D058109:Airway Management / Q000379:methods*; D000768:Anesthesia, General; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D055815:Young Adult