Learning curve of fiberoptic-guided tracheal intubation through supraglottic airway device for pediatric airway management: a manikin study

Background: Although fiberoptic-guided endotracheal intubation using a supraglottic airway device is a good alternative for the management of difficult airways, its learning curve for residents has not been evaluated in pediatric patients. We aimed to train residents using a pediatric manikin and obtain learning curves for the procedure to evaluate the efficiency of the training. Methods: We conducted a single-armed prospective study with anesthesiology residents. Plain endotracheal tube intubation guided by a fiberoptic bronchoscope through Ambu ® AuraGain TM was demonstrated in a pediatric manikin to the participants before training. The procedure was divided into four steps: supraglottic airway device insertion, vocal cord identification, carina identification, and endotracheal tube insertion into the trachea. The results and elapsed procedure times of each trial were recorded. The learning curves for the participants were constructed and analyzed using the cumulative sum method. Results: All of the 30 participants acquired proficiency at the end of the practice between eight and 25 trials. The overall success rate for the procedure was 92.8%, and above 80% for all participants. Mean (±SD) procedure time was 71.3 (±50.7) s. The 4 th step accounted for 86.2% of total failures and 48.0% of the total procedure time. The procedure time rapidly decreased in the 2 nd trial, and a modest decline was observed thereafter. Conclusions: Anesthesiology residents obtained proficiency within 25 times of practice for fiberoptic-guided intubation in a pediatric manikin through an AuraGain supraglottic airway device with acceptable success rate and procedure time. The procedure time markedly decreased following the first experience.