Tracheal intubation using intubating laryngeal tube iLTS-D™ and LMA Fastrach™ in 99 adult patients: A prospective multicentric randomised non-inferiority study.

STUDY OBJECTIVE: This study aimed to investigate the overall success of tracheal intubation using the intubating Laryngeal Tube Suction-Disposable (iLTS-D™, VBM, Sulz a. N., Germany) compared to the Laryngeal Mask Airway (LMA) Fastrach™ (Teleflex, Athlone, Ireland). We hypothesised that the iLTS-D™ would be non-inferior to the LMA Fastrach™ for tracheal intubation and ventilation. DESIGN: Multicentric, non-inferiority, randomised controlled study. SETTING: Operating rooms from two tertiary and one secondary centre in Switzerland from January 2017 to July 2019. The investigators were trained anaesthetists with extensive experience with laryngeal masks but limited to laryngeal tubes. The study was discontinued after the planned interim analysis. PATIENTS: Ninety-nine adult patients were included after randomisation. The inclusion criteria were American Society of Anesthesiologists physical status 1 to 3 in patients scheduled for elective surgery requiring tracheal intubation. Patients with a history of difficult intubation were excluded. INTERVENTION(S): After anaesthesia induction and once neuromuscular blockade was obtained, ventilation was initiated, and tracheal intubation was performed through the randomised device with the flexible endoscope tip placed proximally to the tip of the tracheal tube (visualised blind intubation). MEASUREMENTS: The primary outcome was the intubation success rate after two attempts. The secondary outcomes were time to intubation, successful ventilation rate, time to achieve ventilation, and gastric access success rate. MAIN RESULTS: The overall intubation success rate was significantly higher in the Fastrach™ group than in the iLTS-D™ group (91.8% vs 70.0%, p = 0.006). No difference was found in the ventilation success rate (94% for iLTS-D™ and 100% for LMA Fastrach™ [p = 0.829]). The time to achieve ventilation and intubation were similar between the groups. No major airway complications were noted. CONCLUSIONS: Although both supraglottic devices provided the same effective ventilation rate, the LMA Fastrach™ was superior to the iLTS-D™ as a conduit for intubation in 99 adult patients without a known difficult intubation. These preliminary results need to be confirmed in studies that include a larger population. TRIAL REGISTRATION: Clinicaltrials.gov, 21.09.2016, Identification Number NCT02922595.

Comparison of the single-use Ambu(®) aScope™ 2 vs the conventional fibrescope for tracheal intubation in patients with cervical spine immobilisation by a semirigid collar*.

Fibreoptic intubation remains a key technique for the management of difficult intubation. We randomly compared the second generation single-use Ambu(®) aScope™ 2 videoscope with a standard re-usable flexible intubating fibrescope in 50 tracheal intubations in patients with a difficult airway simulated by a semirigid collar. All patients' tracheas were intubated successfully with the aScope 2 or the re-usable fibrescope. The median (IQR [range]) time to intubate was significantly longer with the aScope 2 70 (55-97 [41?-226]) s vs 50 (40-59 [27-175]) s, p = 0.0003) due to an increased time to see the carina. Quality of vision was significantly lower with the aScope 2 (excellent 24 (48%) vs 49 (98%), p = 0.0001; good 22 (44%) vs 1 (2%), p = 0.0001; poor 4 (8%) vs 0, p = 0.12) but with no difference in the subjective ease to intubate (easy score of 31 (62%) vs 38 (76%), p = 0.19; intermediate 12 (24%) vs 7 (14%), p = 0.31; difficult 7 (14%) vs 5 (5%), p = 0.76). The longer times to intubate and the poorer scores for quality of vision do not support the use of the single-use aScope 2 videoscope as an alternative to the re-usable fibrescope.

[Eosinophilic gastritis after helicobacter pylori eradication]. / Eosinophile Gastritis nach Helicobacter-pylori-Eradikation.

The development of eosinophilic gastritis immediately after Helicobacter pylori eradication has not previously been described: A 62-year-old woman developed eosinophilic gastritis immediately after a triple therapy for Helicobacter pylori eradication, consisting of pantoprazole, amoxicillin and clarithromycin. She suffered from burning epigastric pain and loss of appetite. Blood eosinophilia, gastritis and eosinophilic infiltration of the gastric corpus wall were detected. The treatment with low-dose prednisolone led to remission of the blood eosinophilia, complaints, gastritis and eosinophilic infiltration. The remission persisted after the prednisolone treatment had been finished. Eosinophilic gastritis can be diagnosed only by pathohistological examination. This need for biopsy should be stressed, because the usual gastritis treatment with proton pump inhibitors fails in cases of eosinophilic gastritis. Helicobacter pylori does not seem to play a significant role in the aetiopathology of this disorder. In our case, we suggest that the eradication drug therapy actually caused the disease.