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Background <p>Awake tracheal intubation is advised for patients with known difficult airways. While flexible bronchoscopy is the conventional technique, video laryngoscopy offers faster intubation. Recent studies reveal that supraglottic airway devices can also be effectively used for awake intubation; however, few investigations compare their effectiveness with that of flexible bronchoscopy and video laryngoscopy. This study&#xa0;aims to compare the effectiveness of these three. methods: flexible bronchoscopy, video laryngoscopy, and awake tracheal intubation using supraglottic airway devices.</p> Methods <p>Patients were divided into three groups: fiberoptic bronchoscopy, video laryngoscopy, and supraglottic airway groups. All patients received <i>S</i>edation with remifentanil and midazolam, <i>T</i>opical anesthesia with inhaled and sprayed lidocaine, <i>O</i>xygenation with high-flow oxygen therapy, and intubation <i>P</i>erformed by the same operator, known as the ‘<i>STOP’</i> protocol. The primary outcomes encompassed first-attempt success rate, alternative method success rate, and overall success rates. Secondary outcomes included intubation times and procedural complications.</p> Results <p>Success and complication rates were similar across groups. The supraglottic airway group had a mean vocal cord imaging time of 74.93 ± 55&#xa0;s, longer than video laryngoscopy but shorter than fiberoptic bronchoscopy. Intubation times were longer for the supraglottic airway group (210.0 ± 120&#xa0;s) than for video laryngoscopy but shorter than fiberoptic bronchoscopy.</p> Conclusion <p>The awake supraglottic airway technique offers advantages over traditional awake intubation methods, including the ability to monitor tidal volume and maintain continuous oxygenation throughout the procedure. This technique achieves comparable success rates, intubation times, and complication rates to video laryngoscopy and fiberoptic bronchoscopy, making it a reliable alternative for difficult airways.</p> Trial registration <p><a href="https://clinicaltrials.gov">https://clinicaltrials.gov</a> (NCT06279416, registered on 19.02.2024).</p>

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Supraglottic airway devices in awake tracheal intubation: a viable alternative to fiberoptic and video laryngoscopy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月7日

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  • Mehmet Yilmaz,
  • Ahmet Yuksek,
  • Ayse Zeynep Turan Civraz,
  • Merve Yazici Kara,
  • Sema Candan,
  • Kemal Tolga Saracoglu,
  • Ayten Saracoglu

摘要

Background

Awake tracheal intubation is advised for patients with known difficult airways. While flexible bronchoscopy is the conventional technique, video laryngoscopy offers faster intubation. Recent studies reveal that supraglottic airway devices can also be effectively used for awake intubation; however, few investigations compare their effectiveness with that of flexible bronchoscopy and video laryngoscopy. This study aims to compare the effectiveness of these three. methods: flexible bronchoscopy, video laryngoscopy, and awake tracheal intubation using supraglottic airway devices.

Methods

Patients were divided into three groups: fiberoptic bronchoscopy, video laryngoscopy, and supraglottic airway groups. All patients received Sedation with remifentanil and midazolam, Topical anesthesia with inhaled and sprayed lidocaine, Oxygenation with high-flow oxygen therapy, and intubation Performed by the same operator, known as the ‘STOP’ protocol. The primary outcomes encompassed first-attempt success rate, alternative method success rate, and overall success rates. Secondary outcomes included intubation times and procedural complications.

Results

Success and complication rates were similar across groups. The supraglottic airway group had a mean vocal cord imaging time of 74.93 ± 55 s, longer than video laryngoscopy but shorter than fiberoptic bronchoscopy. Intubation times were longer for the supraglottic airway group (210.0 ± 120 s) than for video laryngoscopy but shorter than fiberoptic bronchoscopy.

Conclusion

The awake supraglottic airway technique offers advantages over traditional awake intubation methods, including the ability to monitor tidal volume and maintain continuous oxygenation throughout the procedure. This technique achieves comparable success rates, intubation times, and complication rates to video laryngoscopy and fiberoptic bronchoscopy, making it a reliable alternative for difficult airways.

Trial registration

https://clinicaltrials.gov (NCT06279416, registered on 19.02.2024).