title: Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study.
abstract: BACKGROUND
  Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation.
  
  
  METHODS
  After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes.
  
  
  RESULTS
  All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (p<0.05).
  
  
  CONCLUSIONS
  So the FLMA may be a better technique for management of patients with difficult airways.
authors.affiliation: Assistant Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Radhey
authors.initials: R
authors.lastname: Shyam
authors.affiliation: Additional Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Chaudhary
authors.affiliation: Assistant Professor, Department of Physiology, Career Institute of Medical Sciences & Hospital , Lucknow, Uttar Pradesh, India .
authors.forename: Pushplata
authors.initials: P
authors.lastname: Sachan
authors.affiliation: Scholar, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Prithvi Kumar
authors.initials: PK
authors.lastname: Singh
authors.affiliation: Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Gyan Prakash
authors.initials: GP
authors.lastname: Singh
authors.affiliation: Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Vinod Kumar
authors.initials: VK
authors.lastname: Bhatia
authors.affiliation: Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Girish
authors.initials: G
authors.lastname: Chandra
authors.affiliation: Professor, Department of Anaesthesiology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Dinesh
authors.initials: D
authors.lastname: Singh
keywords: Haemodynamic; Intubation; Ventilation