Ease of intubation using oral Microcuff RAE (Ring-Adair-Elwyn) tube with and without premounted Frova intubating introducer in children undergoing cleft lip and palate surgeries - A randomised controlled study.

Abstract

Background and aims: Ring-Adair-Elwyn (RAE) tracheal tube is morphologically different from the routine endotracheal tubes. Unlike conventional endotracheal tubes, the passage of the RAE tube through the laryngopharynx and vocal cords might be challenging. We hypothesised that an oral RAE endotracheal tube railroaded over the Frova intubating introducer would reduce intubation time.

Methods: Eighty children with cleft lip and palate anomalies without additional difficult airway predictors were enroled. They were randomly assigned to two groups: Group Frova (n = 40), which received preloaded oral RAE tracheal tubes with a Frova intubating introducer, and Group Non-Frova (n = 40), which received oral RAE tracheal tubes without the Frova introducer. The primary outcome was the tracheal intubation time. Secondary outcomes were the first-attempt intubation success rate, the need for external laryngeal manoeuvres (ELMs), ease of intubation and airway complications.

Results: The mean age (months) was 21 [standard deviation (SD): 14.2] in Group Frova and 20.7 (SD: 13.5) in Group Non-Frova. The mean intubation time (sec) was not different between Group Frova and Group Non-Frova [39.15 (SD: 15.39) (95% confidence interval {CI}: 31.3, 47.0) vs. 35.76 (SD: 15.29) (95% CI: 27.9, 43.6); mean difference = 3.39 (95% CI: -3.6, 10.41); P = 0.338]. Furthermore, the first-attempt success rate was comparable between groups (34 vs. 29, P = 0.308). There was no difference in the requirement of ELMs (13 vs. 17, P = 0.261), and the ease of intubation was also comparable.

Conclusion: Frova introducer-guided endotracheal intubation with an oral RAE tube does not decrease intubation time in children undergoing cleft lip and palate surgery.