The present study entitled “Comparative evaluation of BlockBuster and Fastrach Laryngeal Mask Airway for endotracheal intubation.”, was a prospective, randomised and controlled study done to evaluate and compare the performance of Blockbuster and LMA Fastrach for tracheal intubation in 100 adult patients of ASA physical status 1/2 of either sex, in the age group of 18-60 years undergoing elective surgeries under general anaesthesia. After approval of protocol by Hospital Ethics Committee, Clinical Trial Registry-India (CTRI/2018/02/011947); and written informed consent, patients were randomly allocated into following groups of 50 each:

Group 1 (Blockbuster) (n=50) in which Blockbuster was used

Group 2 (FT-LMA) (n=50) in which LMA Fastrach was used

A standard monitoring and anaesthetic technique was used for all the patients. All patients were pre-medicated with inj. Glycopyrrolate 0.2 mg, inj. Midazolam 0.04 mg/kg intravenously, 5 min before induction. After pre-oxygenation for three minutes, anaesthesia was induced using morphine 0.1 mg/kg, propofol 2.0 to 2.5 mg/kg. After checking for ability to achieve adequate mask ventilation, vecuronium 0.1 mg/kg was used to facilitate muscle relaxation. After opening the sealed envelope, the allocated Blockbuster or FT-LMA was inserted. The cuff was inflated with intracuff pressure of 60 cm H₂O; optimal positioning and ventilation were observed without an audible leak. The oropharyngeal leak pressure and fibreoptic view of the larynx were determined. A well lubricated cuffed ETT of appropriate size was inserted blindly to accomplish intubation. If resistance was felt during blind attempt, the FOB guided intubation was performed. At confirmation of correct placement of the tracheal tube, SAD was removed using stabilizing rod to keep tracheal tube in place.

The SAD insertion parameters including number of attempts, ease of insertion; time taken for Blockbuster or FT-LMA insertion; OLP; fibreoptic grading of laryngeal view; number of attempt and time taken for tracheal intubation; time taken for SAD removal and blood stained on SAD were noted. Hemodynamic parameters were obtained at the following time points: baseline; after induction of anaesthesia; after device insertion, after 1 min, 2 min, 3 min, 4 min, 5 min and 10 min of tracheal intubation after SAD removal. Postoperative sore throat, hoarseness of voice, dysphagia in the first post-operative hour was recorded. The observations were analysed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, version 22.0 for Windows) and the following conclusions were drawn:

1.       Both the groups were comparable in relation to the demographic profile of the patients (age, gender, ASA grade, weight, height, Body mass index).

2.       The number of attempts, time taken and ease of insertion of Blockbuster and FT-LMA was similar in both the groups.

3.       Mean OLP 28.30±1.89 cm H₂O versus 24.46±1.75 cm H₂O in Blockbuster and FT-LMA group respectively.

4.       Fibreoptic view of the vocal cords (grades 4: only vocal cord seen and 3: vocal cord score plus posterior epiglottis visible) was comparable in both the groups.

5.       The success of first attempt blind endotracheal intubation was significantly higher in the Blockbuster (100%) group than the FT-LMA (94%) group.

6.       No patients in Blockbuster group while 3 (6%) patients in FT-LMA group required second attempt using FOB.

7.       Time taken for endotracheal intubation was lesser with Blockbuster group (14.14±2.49 sec) as compared with FT-LMA group (18.34±2.86 sec)

8.       The hemodynamic parameters (HR, SBP, DBP and MAP) at different point of time were comparable in both the groups. Hemodynamic parameters increased after one min of intubation in both the groups with lesser increase in group 1(statistically significant)

9.       The presence of macroscopic blood stain was comparable in both groups.