Air-Q as an intubating LMA: Insights from a case series

• Author Details:   
• Shruti Hiteshkumar Patel ^*
• Shaji Shara Manuel Azikakath
• Vishal Babubhai Shrimali
• Deep Pareshkumar Unadkat
• Anup shrichand Chandnani

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Background and Aims: The Air-Q intubating laryngeal airway (ILA) is a second-generation supraglottic device designed for use as a bridging conduit in both conventional and fiberoptic intubation, particularly in difficult airway scenarios. This case series evaluates the performance of the Air-Q ILA in terms of ease of intubation, success rates, airway morbidity, and hemodynamic responses. While the device offers advantages like reduced hemodynamic stress and minimal airway trauma, limitations such as risks of regurgitation, aspiration, air leaks, and displacement remain considerations. This case series aimed to assess the efficacy of the Air-Q ILA as a conduit for endotracheal intubation, focusing on key performance metrics, including ease of use, success rates, airway morbidity, and hemodynamic responses.

Methodology: This case series included 15 patients of ASA I and II status, weighing 50–70 kg, scheduled for elective surgeries under general anesthesia requiring endotracheal intubation. After achieving adequate muscle relaxation, an Air-Q ILA size 3.5 was introduced. Device placement was confirmed by ensuring adequate ventilation and performing fiberoptic visualization using the Brimacombe and Berry scoring system.

A cuffed Portex endotracheal tube was inserted through the Air-Q device, and intubation was confirmed via capnography. The time taken for device placement (Air-Q insertion to ventilation confirmation) and tube insertion (intubation confirmation via capnography) was recorded. Ease of intubation and the number of attempts required were also noted. Standard ASA monitoring protocols were maintained throughout the procedure.

Results: Brimacombe and Berry score as per fiberoptic view was 4 in 9 patients and 3 in 2 patients and 1 in 4 patients.  Mean Air-Q placement time was 18.04 + 1.39 seconds and tube placement time was 21 + 1.61 seconds. Successful intubation was achieved in 11 of 15 patients (73%), with 9 intubated on the first attempt and 2 on the second attempt.

Conclusion: The Air-Q ILA is an effective supraglottic device that provides both ventilation and a reliable conduit for blind intubation using standard endotracheal tubes. It facilitates shorter intubation times and minimizes hemodynamic stress, making it a valuable tool in airway management.                                                                                             

Keywords: Air-Q, Intubating laryngeal airway, Endotracheal intubation, Fiberoptic view, Hemodynamic response.