Background and Goal of Study:Orotracheal intubation in patients with limited cervical spine mobility may be difficult if performed with direct laryngoscopy. These patients may benefit from techniques with less o no movement of the neck. Our aim was to compare the efficacy and safety of using the  Airtraq® videolaryngoscope and the I-gel® supraglottic device for orotracheal intubation in patients with simulated cervical fixation.

Materials and Methods:60 patients without difficult airway predictors in whom orotracheal intubation was necessary were recruited. After information and patients´ acceptance, they were randomly divided into 2 groups of 30. One group (A) was intubated using the Airtraq® laryngoscope and the other (G) was intubated using a fiberoptic bronchoscope through the I-gel®. After 3 minutes of preoxigenation with 100% O2, general anesthesia was induced. Patients´ pillow was then removed and simulated cervical stabilization by means of a strip tape was established thus fixating the patient's head to the surgical table in neutral position in order to prevent cervical movements. Group A patients were manually ventilated for two minutes with 100% O2, and then orotracheal intubation using the Airtraq® was carried out. In group (G) the I-gel® device was inserted during the two minutes of manual ventilation after the anesthetic induction at anesthesiologist discretion. After two minutes of manual ventilation and I-gel® insertion, orotracheal intubation was performed with the help of a flexible fiberoptic bronchoscope. Intubation success rate, time to intubation (Tti), number of intubation attempts and adverse events were recorded and compared between both groups.

Results and Discussion:All patients were successfully intubated. Tti was 28,5 ± 16,3 s for group A, and 25,2 ± 11,5 s for group G (p 0.543) showing no statistical differences between both techniques. In one patient of group A the Airtraq® could not be introduced into the patient´s mouth because it collided with the chest wall and he was intubated using the I-gel®. We also encountered difficulty in Airtraq introduction in other patients. No adverse events were recorded. 

Conclusion(s):Both Airtraq® intubation and fiberoptic guided intubation through the I-gel® are safe and effective techniques to achieve intubation in patients with cervical spine stabilization and reduction of neck mobility. Fiberoptic intubation through the I-gel® seems to be easier to perform than Airtraq intubation.

01 / Airtraq videolaryngoscope intubation vs. fiberscope intubation through the I-gel supraglottic device in simulated cervical in-line stabilization.