Airway Management in Morbidly Obese Patients: A Comparison of Intubating Laryngeal Mask Airway-Fastrack™ and Air-Q™ Intubating Laryngeal Airway as A Conduit for Bronchoscopic Tracheal Intubation

Background: It can be difficult for anesthesiologists to manage the airway of morbidly obese patients. Devices like the intubating laryngeal mask airway (ILMA) -FastTrach™) and Air-Q™ were specially designed to make tracheal intubation easier while ensuring ventilation and oxygenation. This study compared the efficiency of these two supraglottic airway devices (SAD) for fiberoptic intubation in adult morbidly obese patients.
Methods: Eighty morbidly obese (BMI>40 kg/m²) patients planned for elective surgery requiring tracheal intubation and general anesthesia participated in the study. Patients were allocated to the ILMA group or the Air-Q group. A fiberoptic bronchoscope was used to intubate the trachea through the SAD. The primary endpoint was the time to intubate the trachea. The time to insert the SAD, the insertion success rate of the SAD and tracheal tube, the laryngeal view, and any adverse events related to the procedure, were the secondary outcomes.
Results: The mean tracheal intubation time was shorter through the Air-Q™ compared to the  ILMA-Fastrach™ (41.4 ±6.1 s vs 76.22 ±10.2 s, P< 0.001). The mean insertion time of the Air-Q^TM was significantly shorter than that of the ILMA-Fastrach^TM (18.9 ±0.7 s vs 25.1 ±1.3 s, P < 0.001), The Air-Q had a significantly better success rate for tracheal tube insertion on the first attempt, but the overall intubation success rate was comparable for both devices. Conclusion: Air-Q™ was associated with a shorter time of device insertion and fiberoptic intubation, and a higher first-attempt insertion success rate of the tracheal tube than ILMA-Fastrach^TM.