Introduction

Supraglottic airway devices (SADs) can serve as conduits for tracheal intubation (TI) during difficult airway management.

Aim

This study aims to assess three different SADs used for TI in patients undergoing elective surgery under general anaesthesia, comparing one first-generation SAD with two second-generation SADs.

Material and methods

This prospective, randomised clinical study included 193 adult patients (ASA I-II) who were randomly assigned to three groups. The first group underwent blind TI using the intubating LMA (Fastrach™), the second group via the I-gel®, and the third group through the LMA Protector™, with the latter two procedures guided by a flexible bronchoscope. The primary outcome measured was the time to successful tracheal intubation following placement of the SAD. Secondary outcomes included time from SAD introduction to ventilation, first pass success rates for both SAD and intubation, total procedure time and the oropharyngeal leak pressure.

Results

I-gel® had a longer time to TI than Fastrach™ (p < 0.001) and Protector™ (p = 0.03), and Protector™ was slower than Fastrach™ (p < 0.001). The time from SAD introduction to ventilation was longer with Fastrach™ and Protector™ compared to I-gel® (p < 0.001). Total procedure time was extended in the Protector™ group compared to both Fastrach™ and I-gel® (p < 0.001 for both), and in I-gel® compared to Fastrach™ (p < 0.001). TI success rates were comparable for I-gel® (95.4%) and Protector™ (96.9%), but lower for Fastrach™ (92.2%). Notably, oropharyngeal leak pressure was significantly higher with the Protector™ compared to the I-gel® (p < 0.001).

Conclusions

I-gel® and ProtectorTM produced similar outcomes as conduits for assisted intubation, both achieving high TI success rates. Fastrach™, however, was associated with a statistically significant reduction in unassisted intubation time. These results suggest that additional research in this area may be warranted.