Age-related differences in the performance of the self-pressurising air-Q intubating laryngeal airway: a prospective...

The clinical performance of supraglottic airway devices (SADs) may be affected by anatomical and physiological changes of the oropharyngeal structure that occur with aging. We aimed to evaluate the performance of self-pressurized air-Q intubating laryngeal airway (air-Q SP) in young, middle-aged, and elderly patient groups undergoing elective surgery under general anesthesia with the use of an air-Q SP.

A total of 153 patients, aged 18-85 years, with American Society of Anesthesiologists physical status I-III who underwent urological surgery were included in this prospective, comparative study. Patients were equally allocated into groups according to parient age, Group Young: 18-40 years; Group Middle-aged: 41-64 years and Group Elderly: 65-85 years. The primary outcome was oropharyngeal leak pressure (OLP); SAD insertion time, first-attempt success rate, ease of insertion, maneuvers required for successful ventilation, fiberoptic grading of the glottic view, peak inspiratory pressure (PIP) and postoperative complications were also assessed. Analysis of variance was used for comparisons between patient groups, and adjusted p values were reported in the post hoc tests. Multivariate regression analyses were performed to evaluate factors associated with OLP values.

The median [IQR] OLP values were 29 [26-35] cm H₂O, 24 [14-39] cm H₂O and 26 [21-29] cm H₂O in Groups Young, Middle-aged and Elderly respectively. The OLP values in Group Young were significantly higher than those in Group Middle-aged and Group Elderly (p = 0.001, and p = 0.014 respectively). Air-Q SP insertion in Group Young was significantly faster and easier, required fewer maneuvers, provided better fiberoptic views, lower PIP and higher postoperative first hour dysphagia and dysphonia rate. Multivariate analysis revaled that BMI was associated with OLP (OR 0.335, 95%CI) (R² = 0.111, F = 4.639, p = 0.001). A negative correlation was found between patients' age and OLP values (r = -0.239, p = 0.003).

Compared with the middle-aged and elderly groups, the young group had superior sealing and insertion characteristics with use of air-Q SP but transient early postoperative dysphagia and dysphonia. The air-Q SP was sufficient for adequate ventilation in all groups.