Comparison of fibreoptic guided tracheal intubation through LMA protector and i-gel in adult paralysed patients

Providing a safe airway is the prime responsibility of an anaesthesiologist. Supra glottic airway devices (SAD) are being widely used for airway management in the anaesthetic field, critical care and emergency situations. Since the introduction of the first generation classic laryngeal mask airway (cLMA), the evolution in supraglottic airway designs has been a continuous process. Second generation SADs incorporate a second drainage tube to enhance the safety of supraglottic airway devices. In current scenario they are not only used as a ventilating device but also act as conduit for planned blind as well as fiberoptic guided intubation in anticipated or unanticipated difficult laryngoscopies.i-gel (Intersurgical, Berkshire, UK) is a promising second-generation SAD which has gained popularity over last decade because of its anatomical shape and gel filled cuff. The airway channel of i-gel is shorter and wider compared to that of the other SADs, allowing the adult size endotracheal tube to easily pass through it. Its large bowl, better alignment with glottis along with the absence of aperture bars makes i-gel a favorable conduit for fibreoptic-guided tracheal intubation. The LMA Protector (Teleflex Medical Europe Ltd., Athlone, Ireland) is a recently introduced, second-generation SAD with design features that minimizes the risk of gastric aspiration. In comparison to the i-gel, there are two gastric drainage tubes on either side of the ventilation channel and an enlarged air inflatable cuff.In addition,the airway lumen of the LMA Protector is wide enough to pass an adequately sized tracheal tube. Hence, LMA Protector can be used as a conduit for fibreoptic-guided tracheal  intubation.As there is no previous randomized trial primarily comparing fibreoptic-guided tracheal intubation via the LMA Protector with i-gel using polyvinyl chloride ( PVC ) endotracheal tube. So, we planned the current study to compare fibreoptic-guided tracheal intubation through the i-gel with the LMA Protector using PVC ETT.