Comparison of a Novel Technique for Fibreoptic-guided Intubation through an I-gel® with the Aintree Technique: A Randomised Crossover Manikin Study

Background and Aims: In an unanticipated difficult airway, a second-generation supraglottic airway device is often inserted as a rescue measure, which then needs to be exchanged for an endotracheal tube (ETT). The technique described by the Difficult Airway Society-UK requires a specialised Aintree catheter and paediatric fibreoptic bronchoscope (FOB), which are not always available. This study aimed at evaluating a Novel technique using an adult FOB and a bougie through an I-gel ® to perform this exchange. Methods: In this prospective randomised crossover manikin study, twenty anaesthesiologists were recruited to perform three attempts of the Aintree and Novel technique on two adult airway manikins over 3 days. Hence, a total of 120 attempts were performed, 60 in each technique. Results: Both the Aintree and Novel techniques had a 100% first pass success rate. The Novel technique required a significantly lesser overall time for intubation, 68.70 (19.19) seconds, compared to the Aintree technique, 84.62 (30.65) seconds, P < 0.001. The participants noted a significant ease of performing the Novel technique, Numerical Rating Scale (NRS) 2 (1.56), compared to the Aintree technique, NRS 3.65 (2.09), P < 0.001. 50% participants noted an intraoral kink of the Aintree catheter while threading the ETT over it. Conclusion: In this manikin study, we found that a Novel technique for fibreoptic-guided tracheal intubation through an I-gel ® using a bougie outperforms the Aintree catheter technique in terms of time and ease of intubation. Furthermore, widespread availability of the adult fibreoptic and bougie may make this technique more practical.