Comparison of Aintree and Fastrach techniques for low-skill fibreoptic intubation in patients at risk of secondary cervical injury: A randomised controlled trial

BACKGROUND We compared two methods of asleep fibreoptic intubation in patients at risk of secondary cervical injury: the Aintree Intubation Catheter via a classic laryngeal mask airway (cLMA) versus the Fastrach technique via the intubating laryngeal mask airway (iLMA). OBJECTIVE To test which system has the highest rate of successful intubations in the clinical setting. DESIGN A randomised controlled study. SETTING Single-centre, between 2007 and 2010. PATIENTS We randomly allocated 80 patients (30 women and 50 men) who underwent elective neurosurgery of the cervical spine to either group, placed in a neutral position and wearing a soft cervical collar. Entry criteria were ASA status 1 to 3, age 18 to 80 years and written informed consent. Exclusion criteria were patients with cervical instability, known or predicted difficult airway, BMI greater than 40 kgm2 and symptomatic gastro-oesophageal reflux. INTERVENTIONS Two anaesthetists who were experienced in both techniques performed all procedures within the study. There was a maximum of three attempts for each technique. MAIN OUTCOME MEASURES The primary outcome was the rate of successful fibreoptic intubation in a neutral position. We also investigated the timing sequence for both techniques, the Brimacombe and Berry Bronchoscopy Score, and differences in technical aspects. RESULTS All 40 patients in the Aintree group but only 31 patients in the Fastrach group were intubated successfully. Thus, fibreoptic intubation failed significantly less using the Aintree technique (P0.002). For secondary outcomes, the cLMA was faster (260 versus 289 s, P0.039) and easier to insert (P0.036) than the iLMA. The fibreoptic view of the glottis according to the Brimacombe and Berry Bronchoscopy Score was better (P0.016) and the tracheal tube was easier to insert (P0.010) in the Aintree group. CONCLUSION Fibreoptic intubation using the Aintree system was more successful than the Fastrach technique in our population of patients in a neutral position wearing a soft cervical collar. The differences in the time to successful intubation between the two groups are unlikely to be clinically relevant.