Comparison of CTrach, Intubating Laryngeal Mask Airway (ILMA) and I-gel for Tracheal Intubation

NCT ID: NCT00983229

Last Updated: 2010-11-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-08-31

Study Completion Date

2010-09-30

Brief Summary

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Various supraglottic airways may be used as a dedicated airway for insertion of intubating fibrescope and tracheal intubation in the patients with difficult to manage airways (Difficult Airway Society Guidelines).

The investigators aim to compare three different types of supraglottic device as a conduit for tracheal intubation - CTrach optical laryngeal mask, Intubating laryngeal mask airway and I-gel supraglottic airway. Null hypothesis for this study is that all three devices will perform without statistical difference in the means of success rate and time needed for their insertion and tracheal intubation.

Detailed Description

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Supraglottic airway devices such as I-LMa, Igel and LMA Ctrach are designed to create a "dedicated" airway which safely allows both spontaneous and controlled ventilation. The use of supraglottic airways can allow planned fibreoptic intubations in expected difficult cases and can provide an emergency airway in cases of unexpected difficult airway.

The ILMA (Intavent Orthofix Ltd.,Wokingham, UK) has been designed for either blind or fibrescope-guided tracheal intubation, in patients with expected and unexpected difficult airway. Since its development in 1997, it has been used for both blind and fibrescope-guided tracheal intubations in the patients with difficult airway. The ILMA is currently a 'gold standard' in supraglottic airways used for tracheal intubation.

The I-gel (Intersurgical Ltd., Wokingham, UK) is a newer dedicated airway device, which with its wide bore allows direct passage of a tracheal tube.

The CTrach (The Laryngeal Mask Company,Singapore) is a newer device for airway management. It has special optical fibres built-in inside its bowl and a liquid crystal display which allows views of the larynx while the endotracheal tube is being placed.

With reference to these supraglottic airway devices, only a small number of case reports detail tracheal intubation through an I-gel in patients with difficult airways. There have been manikin studies comparing ILMA and CTrach, and some descriptive studies on the use of CTrach in patients with predicted difficult airways- but no studies comparing the performance of these devices in clinical practice.

Conditions

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Intubation

Keywords

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difficult airway fibreoptic intubation supraglottic airways laryngeal mask airway

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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CTrach

1. Induction to GA with 1mcg/kg fentanyl, and 1-3 mg/kg of propofol to loss of verbal contact and neuromuscular relaxation with 0.5 mg/kg of atracurium.
2. Direct laryngoscopy, evaluation of laryngeal view grade according to Cormack-Lehane classification.
3. Insertion of CTrach (sizes 3,4 or 5), establishment of ventilation.
4. Direct evaluation of laryngeal view through CTrach
5. Tracheal intubation through CTrach LMA
6. Maintenance of anaesthesia with 02, air and sevoflurane 1-2 MAC and positive pressure ventilation
7. At the end of surgery patient will be awoken as normal. Any sign of trauma to the oral cavity and airways and gastric fluid in trachea will be noted.

Group Type ACTIVE_COMPARATOR

Tracheal intubation

Intervention Type PROCEDURE

Insertion of a plastic tube under direct vision (built-in camera, intubating fibrescope) into trachea.

Intubating Laryngeal Mask Airway (ILMA)

1. Induction to GA with 1mcg/kg fentanyl, and 1-3 mg/kg of propofol to loss of verbal contact and neuromuscular relaxation with 0.5 mg/kg of atracurium.
2. Direct laryngoscopy, evaluation of laryngeal view grade according to Cormack-Lehane classification.
3. Insertion of ILMA (sizes 3,4 or 5), establishment of ventilation.
4. Evaluation of laryngeal view through ILMA using fibrescope
5. Tracheal intubation through ILMA using fibrescope.
6. Maintenance of anaesthesia with 02, air and sevoflurane 1-2 MAC and positive pressure ventilation
7. At the end of surgery patient will be awoken as normal. Any sign of trauma to the oral cavity and airways and gastric fluid in trachea will be noted.

Group Type ACTIVE_COMPARATOR

Tracheal intubation

Intervention Type PROCEDURE

Insertion of a plastic tube under direct vision (built-in camera, intubating fibrescope) into trachea.

I-gel

1. Induction to GA with 1mcg/kg fentanyl, and 1-3 mg/kg of propofol to loss of verbal contact and neuromuscular relaxation with 0.5 mg/kg of atracurium.
2. Direct laryngoscopy, evaluation of laryngeal view grade according to Cormack-Lehane classification.
3. Insertion of I-gel (sizes 3,4 or 5), establishment of ventilation.
4. Evaluation of laryngeal view through I-gel using fibrescope
5. Tracheal intubation through I-gel using fibrescope
6. Maintenance of anaesthesia with 02, air and sevoflurane 1-2 MAC and positive pressure ventilation
7. At the end of surgery patient will be awoken as normal. Any sign of trauma to the oral cavity and airways and gastric fluid in trachea will be noted.

Group Type ACTIVE_COMPARATOR

Tracheal intubation

Intervention Type PROCEDURE

Insertion of a plastic tube under direct vision (built-in camera, intubating fibrescope) into trachea.

Interventions

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Tracheal intubation

Insertion of a plastic tube under direct vision (built-in camera, intubating fibrescope) into trachea.

Intervention Type PROCEDURE

Other Intervention Names

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intubation insertion of tracheal tube

Eligibility Criteria

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Inclusion Criteria

* ASA I-III patients
* Age 18-89 years, males and females
* Elective surgical patients needing tracheal intubation

Exclusion Criteria

* ASA IV or V patients
* Emergency surgical procedures
* Patients at increased risk of aspiration
Minimum Eligible Age

18 Years

Maximum Eligible Age

89 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Northern Health and Social Care Trust

OTHER_GOV

Sponsor Role lead

Responsible Party

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Northern Health and Social Care Trust, Antrim Area Hospital

Principal Investigators

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Pavel Michalek, MD,PhD,DESA

Role: PRINCIPAL_INVESTIGATOR

Northern HSC Trust

Locations

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Antrim Area Hospital

Antrim, Antrim, United Kingdom

Site Status

Countries

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United Kingdom

References

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Campbell J, Michalek P, Deighan M. I-gel supraglottic airway for rescue airway management and as a conduit for tracheal intubation in a patient with acute respiratory failure. Resuscitation. 2009 Aug;80(8):963. doi: 10.1016/j.resuscitation.2009.04.037. Epub 2009 Jun 10. No abstract available.

Reference Type BACKGROUND
PMID: 19520483 (View on PubMed)

Michalek P, Hodgkinson P, Donaldson W. Fiberoptic intubation through an I-gel supraglottic airway in two patients with predicted difficult airway and intellectual disability. Anesth Analg. 2008 May;106(5):1501-4, table of contents. doi: 10.1213/ane.0b013e31816f22f6.

Reference Type BACKGROUND
PMID: 18420867 (View on PubMed)

Sreevathsa S, Nathan PL, John B, Danha RF, Mendonca C. Comparison of fibreoptic-guided intubation through ILMA versus intubation through LMA-CTrach. Anaesthesia. 2008 Jul;63(7):734-7. doi: 10.1111/j.1365-2044.2008.05481.x.

Reference Type BACKGROUND
PMID: 18582259 (View on PubMed)

Ferson DZ, Rosenblatt WH, Johansen MJ, Osborn I, Ovassapian A. Use of the intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology. 2001 Nov;95(5):1175-81. doi: 10.1097/00000542-200111000-00022.

Reference Type BACKGROUND
PMID: 11684987 (View on PubMed)

Charters P, O'Sullivan E. The 'dedicated airway': a review of the concept and an update of current practice. Anaesthesia. 1999 Aug;54(8):778-86. doi: 10.1046/j.1365-2044.1999.00888.x.

Reference Type BACKGROUND
PMID: 10460531 (View on PubMed)

Pandit JJ, MacLachlan K, Dravid RM, Popat MT. Comparison of times to achieve tracheal intubation with three techniques using the laryngeal or intubating laryngeal mask airway. Anaesthesia. 2002 Feb;57(2):128-32. doi: 10.1046/j.0003-2409.2001.02401.x.

Reference Type BACKGROUND
PMID: 11871949 (View on PubMed)

Joo HS, Kapoor S, Rose DK, Naik VN. The intubating laryngeal mask airway after induction of general anesthesia versus awake fiberoptic intubation in patients with difficult airways. Anesth Analg. 2001 May;92(5):1342-6. doi: 10.1097/00000539-200105000-00050.

Reference Type BACKGROUND
PMID: 11323374 (View on PubMed)

Ng BS, Goy RW, Bain JA, Chen FG, Liu EH. The impact of manual in-line stabilisation on ventilation and visualisation of the glottis with the LMA CTrach: a randomised crossover trial. Anaesthesia. 2009 Aug;64(8):894-8. doi: 10.1111/j.1365-2044.2009.05935.x.

Reference Type BACKGROUND
PMID: 19604194 (View on PubMed)

Liu EH, Goy RW, Lim Y, Chen FG. Success of tracheal intubation with intubating laryngeal mask airways: a randomized trial of the LMA Fastrach and LMA CTrach. Anesthesiology. 2008 Apr;108(4):621-6. doi: 10.1097/ALN.0b013e318167af61.

Reference Type BACKGROUND
PMID: 18362593 (View on PubMed)

Liu EH, Goy RW, Chen FG. An evaluation of poor LMA CTrach views with a fibreoptic laryngoscope and the effectiveness of corrective measures. Br J Anaesth. 2006 Dec;97(6):878-82. doi: 10.1093/bja/ael252. Epub 2006 Sep 19.

Reference Type BACKGROUND
PMID: 16984953 (View on PubMed)

Other Identifiers

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09/NIR03/44

Identifier Type: -

Identifier Source: org_study_id