title: A randomized comparison between the i-gel™ and the air-Q™ supraglottic airways when used by anesthesiology trainees as conduits for tracheal intubation in children.
abstract: OBJECTIVE
  Supraglottic airways are commonly used as conduits for fibreoptic bronchoscopy (FOB)-guided intubation in pediatric patients. We hypothesized that anesthesiology trainees with limited prior experience with FOB-guided intubation through a supraglottic airway in children would intubate the trachea faster through the air-Q™ supraglottic airway than through the i-gel™.
  
  
  METHODS
  Ninety-six children aged one month to six years were randomized to receive either the i-gel or air-Q for FOB-guided tracheal intubation by anesthesiology trainees. Time for successful tracheal intubation was the primary endpoint. Secondary endpoints included: time for device insertion, number of attempts for successful device insertion, airway leak pressures, FOB grade of laryngeal view, total number of attempts for tracheal intubation, time for removal of the device after tracheal intubation, and associated complications.
  
  
  RESULTS
  The median (interquartile range [IQR]) times to successful tracheal intubation for the air-Q (62.5 [47.9-77] sec) and the i-gel (55.9 [48.5-81.8] sec) were not significantly different (median difference 6.6 sec; 95% confidence interval [CI] -13.3 to 8.7; P = 0.53). The median (IQR) time to insertion for the air-Q (16.7 [14.4-20.0] sec) was shorter than for the i-gel (19.6 [16.7-23.0] sec) (median difference 2.9 sec; 95% CI 0.8 to 4.7; P = 0.005). There were no differences between devices with respect to airway leak pressures, success rates, and time to removal. Compared with the air-Q, the i-gel was associated with more problems during device removal after tracheal intubation, including breakage of the tracheal tube pilot balloon (n = 0 vs n = 13, respectively; P < 0.001), inadvertent extubation (n = 1 vs n = 5, respectively; P < 0.001), and difficulty controlling the tracheal tube (n = 0 vs n = 21, respectively; P < 0.001).
  
  
  CONCLUSIONS
  Contrary to our hypothesis, both the air-Q and i-gel supraglottic airways served as effective conduits for FOB-guided tracheal intubation in children when performed by trainees with limited prior experience. The i-gel, however, was associated with more problems during device removal following tracheal intubation. This study was registered at http://clinicaltrials.gov/show/NCT02189590 .
authors.affiliation: Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, IL, USA, simjag2000@gmail.com.
authors.forename: Narasimhan
authors.initials: N
authors.lastname: Jagannathan
authors.forename: Lisa
authors.initials: L
authors.lastname: Sohn
authors.forename: Melissa
authors.initials: M
authors.lastname: Ramsey
authors.forename: Andrea
authors.initials: A
authors.lastname: Huang
authors.forename: Amod
authors.initials: A
authors.lastname: Sawardekar
authors.forename: Luis
authors.initials: L
authors.lastname: Sequera-Ramos
authors.forename: Loryn
authors.initials: L
authors.lastname: Kromrey
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: De Oliveira
mesh_terms: D000776:Anesthesiology / Q000193:education / Q000295:instrumentation / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D005336:Fiber Optic Technology; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors