Use of intubation introducers through a supraglottic airway to facilitate tracheal intubation: a brief review Utilisation d’introducteurs d’intubation au travers d’un dispositif supraglottique pour faciliter l’intubation trachéale: article de synthèse court

Purpose This article is a narrative review regarding the usage and effectiveness of introducers or catheters to facilitate tracheal intubation through a supraglottic airway (SGA) as an alternative intubation technique in normal and difficult airway management. Sources Relevant articles were obtained through Medline (1948-July 2011). The articles were subsequently cross-referenced for additional literature, and only articles published in English were included. Principal findings In this review, we consider 32 reports using the LMA Classic, LMA Unique, LMA ProSeal, LMA Supreme, AuraOnce, and i-gel as SGA conduits for intubation. In 13 articles, the use of an Aintree Intubation Catheter was described as an intubation introducer and resulted in high success rates in both elective and emergent situations. Eight studies used a guidewire exchange catheter technique. Although blind intubation using a guidewire resulted in a high failure rate, these studies found that using a bronchoscope improved successful intubation. Ten studies showed that insertion of a gum elastic bougie with a bronchoscope as an intubation introducer has high success rates compared with blind bougie insertion. One article described the use of a small endotracheal tube as an intermediary for tracheal intubation. Conclusions In failed intubation scenarios, supraglottic airways, such as the LMA Classic or LMA ProSeal can serve as a conduit for tracheal intubation. A number of techniques using introducers or catheters can facilitate the insertion of an adequately sized endotracheal tube, particularly guided by a bronchoscope. Usage of introducers or catheters through a supraglottic airway may be a useful alternative intubation technique in difficult airway management. Résumé Objectif : Cet article est une analyse descriptive de l’utilisation et de l’efficacité des introducteurs ou cathéters pour faciliter l’intubation trachéale via un dispositif supraglottique (DSG) comme solution de rechange dans les cas de prise en charge de l’intubation trachéale normale ou difficile. Sources Les articles pertinents ont été tirés de la base de données MEDLINE de 1948 à juillet 2011. Les articles ont ensuite fait l’objet d’un référencement croisé afin d’obtenir plus de sources et seuls les articles en anglais ont été inclus. Constatations principales Dans cette analyse, nous considérons 32 comptes rendus où le LMA Classic, LMA Unique, LMA ProSeal, LMA Supreme, AuraOnce, et i-gel ont été utilisés comme conduits supraglottiques pour l’intubation. Dans 13 articles, Author contributions David T. Wong was responsible for the conception of the review and writing the manuscript. Jaisy J. Yang, Hannah Y. Mak, and Narasimhan Jagannathan contributed to the analysis of the articles and writing the manuscript. D. T. Wong, MD (&) H. Y. Mak, MSc Department of Anesthesia, Toronto Western Hospital, University of Toronto, MC2-405, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada e-mail: [email protected] J. J. Yang, BHSc Faculty of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada N. Jagannathan, MD Department of Anesthesiology, Northwestern University School of Medicine, Chicago, IL, USA 123 Can J Anesth/J Can Anesth (2012) 59:704–715 DOI 10.1007/s12630-012-9714-8