title: Fiberoptic-guided intubation after insertion of the i-gel airway device in spontaneously breathing patients with difficult airway predicted: a prospective observational study.
abstract: OBJECTIVE
  To assess the viability of performing fiberoptic-guided orotracheal intubation through the i-gel airway device previously inserted in spontaneously breathing patients with predicted difficult airway to achieve a patent airway.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Operating room in a tertiary care hospital.
  
  
  METHODS
  Eighty-five adult patients with at least 3 difficult airway predictors or difficult airway management history were included.
  
  
  METHODS
  The i-gel device was inserted in spontaneous ventilation under oropharyngeal local anesthesia and sedation. After checking the adequate ventilation through the i-gel with capnography curve, general anesthesia was induced to introduce the endotracheal tube guided by fiberoptic bronchoscope.
  
  
  METHODS
  We recorded the i-gel insertion time (tgel), intubation time (tint), and O2saturation in pulse oximetry in different moments: basal (t0), after 3 minutes of preoxygenation with a face mask at 100% fraction of inspired O2(t1), after i-gel mask insertion (t2), and after intubation (t3). Adverse events during the procedure were also recorded, and patient discomfort was questioned.
  
  
  RESULTS
  All patients were successfully intubated. O2saturation in pulse oximetry values were (mean±SD): 96.9±1.22 (t0), 99.0±0.85 (t1), 96.2±2.37 (t2), and 96.0±2.54 (t3). tgel and tint were 38.0±7.76 seconds and 36.5±5.55 seconds (mean±SD), respectively. No serious adverse events were recorded, and no patient suffered airway damage. Visual analogue scale for patient discomfort was 2 (interquartile range, 1-3).
  
  
  CONCLUSIONS
  i-gel insertion in spontaneously breathing patients avoids the "cannot ventilate" scenario. The subsequent fiberoptic-guided intubation through the i-gel is a safe and effective technique. More studies might be necessary to confirm the results presented, but we consider that the technique described is an adequate alternative to classic orotracheal intubation with fiberoptic bronchoscope in spontaneous ventilation for certain patients with predicted difficult airway.
authors.affiliation: Department of Anesthesiology, University Hospital Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain. Electronic address: jarevalo@fjd.es.
authors.forename: Julian
authors.initials: J
authors.lastname: Arévalo-Ludeña
authors.affiliation: Department of Anesthesiology, University Hospital Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain. Electronic address: jjarcas@fjd.es.
authors.forename: Jose Juan
authors.initials: JJ
authors.lastname: Arcas-Bellas
authors.affiliation: Department of Anesthesiology, University Hospital Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain. Electronic address: ralvarez@fjd.es.
authors.forename: Rafael
authors.initials: R
authors.lastname: Alvarez-Rementería
authors.affiliation: Department of Anesthesiology, University Hospital Fundacion Jimenez Diaz, Avenida Reyes Catolicos 2, 28040, Madrid, Spain. Electronic address: lemunoz@fjd.es.
authors.forename: Luis Enrique Muñoz
authors.initials: LE
authors.lastname: Alameda
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D020680:Bronchoscopes; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012119:Respiration
keywords: Airway management; Bronchoscope; Intratracheal intubation; Laryngeal masks