Comparison of Fiber-Optic Assessment in Midline Versus Rotational Insertion Technique of AIr-Q in Pediatric Surgeries: A Randomised Double Blind Interventional Study in Department of Anaeshesiology, S.M.S. Medical College and Hospital Jaipur

Background: Effective airway management in pediatric anesthesia is challenging due to anatomical differences. The Air-Q supraglottic airway device (SAD) is widely used, but optimal insertion techniques remain understudied. This study compares the midline and rotational techniques for Air-Q insertion in pediatric patients, focusing on fiber-optic bronchoscopic (FOB) assessment of laryngeal view. In this randomized, Methods: double-blind study, 120 children (ASA I-II, aged 5-12 years) undergoing elective surgeries under general anesthesia at S.M.S. Medical College, Jaipur (2022-2023), were equally divided into two groups: Group A (midline insertion, n=60) and Group B (rotational insertion, n=60). Primary outcomes included FOB laryngeal view (Brimacombe score), insertion time, and first-attempt success rate. Secondary outcomes were oropharyngeal leak pressure (OLP), ease of insertion, hemodynamic stability, and complications (cough, sore throat, laryngospasm, blood on device). No significant difference was found in FOB laryngeal view (p=0.310), with 48.3% (Group A) and Results: 36.7% (Group B) achieving Grade 4. Insertion time was shorter with the rotational technique (11.32 ± 1.08 vs. 12.28 ± 1.09 seconds, p<0.001). First-attempt success rates (93.3% vs. 96.7%, p=0.675) and ease of insertion (93.3% vs. 96.7% easy) were comparable. OLP (22.05 ± 2.5 vs. 22.4 ± 1.8 cmH2O, p=0.381) and complications (cough: 5% vs. 1.7%; blood on device: 8.3% vs. 6.7%) showed no significant differences. Hemodynamic parameters were similar, except for higher mean arterial pressure in the midline group at certain time points. The rotational Conclusion: technique for Air-Q insertion is faster but offers no significant advantage over the midline technique in FOB laryngeal view, ease of insertion, success rate, OLP, or complications. Both techniques are safe and effective for pediatric airway management under controlled ventilation.