Evaluation of three adjusting manoeuvres and type of endotracheal tube in the success of air-Q^™ aided tracheal intubation

Background: The present study observed whether the use of three different adjusting manoeuvres and use of an armoured tracheal tube would increase the success rate of tracheal intubation, aided by the air-Q^™ intubating laryngeal airway (air-Q^™ ILA). Method: Fifty American Society of Anesthesiologists (ASA) I and II patients undergoing elective surgical procedures were randomly assigned to two groups. In the endotracheal tube (ETT) group, standard ETT was used, while in the armoured ETT (AETT) group, tracheal intubation was performed using AETT. After a uniform premedication, induction and relaxation technique, an appropriate sized air-Q^™ ILA with ETT in-situ, was placed. After good ventilation, a flexible fibrescope was passed down the ETT, and the percentage of glottic opening (POGO) was documented. Subsequently, three adjusting manoeuvres were applied in sequence. These included firstly, backward pressure over the larynx; secondly, head extension; and lastly, neck fexion. After noting the POGO score with each adjusting manoeuvre, the incidence of successful intubation was noted, with and without manoeuvres. Results: The best POGO score (84%) was observed with the application of backward pressure. Successful tracheal intubation was achieved in 56-60% of patients without the use of any manoeuvres, using either type of tracheal tube. For the rest, tracheal intubation was achieved using backward pressure, except in one patient from the ETT group. The incidence of successful tracheal intubation was nearly identical with either type of ETT. Conclusion: Successful tracheal intubation can be achieved in 96% of cases using adjusting manoeuvres. The nature of the tracheal tubes did not influence the success rate.