Fiber-Optic intubation through a Modified Laryngeal Mask

Maroof, M.; Khan, Rosina; Siddique, Msk; Bhatti, T. H.; Hussain, Ayyaz

doi:10.1097/00000542-199209001-00510

Cited by 5 publications

(1 citation statement)

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“…A number of studies have reported use of the laryngeal mask and fibreoptic laryngoscope for tracheal intubations [7][8][9][10]. Individual case reports have also described a variety of techniques [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: Laryngeal Mask Airwaymentioning

confidence: 99%

The ‘dedicated airway’: a review of the concept and an update of current practice

Charters

O’Sullivan

1999

Anaesthesia

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SummaryThe term 'dedicated airway' was ifrst used in connection with nasal fibreoptic intubations using the cuffed nasopharyngeal airway. Since that time, the concept has developed and the term has been extended to include fibreoptic intubation techniques involving both the laryngeal mask airway and cuffed oropharyngeal airway. 'Dedicated airway' can now be defined as: 'An upper airway device dedicated to the maintenance of airway patency while other major airway interventions are anticipated or are in progress. The device should be compatible with spontaneous and controlled ventilation. 'Dedicated airway techniques allow planned fibreoptic intubations in difficult cases and provide an emergency airway option in an unexpected difficult intubation when the alternative may be to wake the patient. As well as promoting safe conditions for training fibreoptic intubation in general, there is the particular advantage of being able to train using these techniques in patients known to be difficult to intubate. The authors' evolved clinical experiences in promoting the concept and the rlevant literature are reviewed.

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Section: Laryngeal Mask Airwaymentioning

confidence: 99%

The ‘dedicated airway’: a review of the concept and an update of current practice

Charters

O’Sullivan

1999

Anaesthesia

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A new solution to fibreoptic intubation in the presence of blood and secretions

et al. 1995

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We report the case of a 43-yr-old lady who was admitted to the Day Surgery Unit for release of her carpal tunnel retinaculum. During the preoperative visit, she reported no intercurrent illnesses, drug therapy or allergies. She did say, however, that she was frightened of general anaesthesia, since she had experienced terrifying dreams during surgery under general anaesthesia on three occasions during the previous ten years. On further questioning, she admitted that she had used lysergic acid diethylamide (LSD) during the late 1960's, the last occasion being 1968 when she had experienced characteristic hallucinations. She had not experienced hallucinations in the ensuing years, except on the surgical occasions mentioned.One of the three previous operations had been performed at our hospital and the anaesthetic record was checked. On that occasion she had received papaveretum and hyscine as a premedication, and anaesthesia had been induced with thiopentone, and maintained with oxygen, nitrous oxide and halothane. The patient was certain she had suffered frightening dreams on that occasion, although there was no record of it in the hospital notes. Despite this history and her fear, she expressed a clear preference for general over regional anaesthesia.Without making any assurances, it was explained that all would be done to try to prevent her from having distressing dreams in a way consistent with day care anaesthesia. No premeditation was prescribed. In the anaesthetic room she was given metoclopramide I0 mg and midazolam 5 mg/v, immediately followed by fentanyl 50 ~g and propofol 150 mg /v for induction. A laryngeal mask airway was inserted and anaesthesia was maintained by spontaneous ventilation with oxygen, nitrous oxide (FRO2 = 0.33) and isoflurane 2%. The blood pressure, ECG, and pulse oximeter recordings were unremarkable throughout. She recovered in a quiet, darkened room. On questioning 20 min after waking in the recovery room, she reported that she had had no bad dreams or hallucinations but had experienced the sensation of "being covered with leaves." She was fit for discharge in the company of her husband some three hours later.The most recent figures from the South West Region Drug Problem Database, Bristol, UK (Boulton, personal communication) showed that 6.5% of their new clients were using LSD. It is more popular than other commonly used hallucinogens whose quoted incidence of clients are: ketamine 0.1% (super-K/vitamin K.I), psilocybin and psilocin 0.6% (the active alkaloids in the Mexican "magic mushroom"), and 3,4 methylenedioxymethamphetamine "MDMA" 1% (ecstasy). The effects of the concurrent ingestion of LSD on anaesthesia are well described. 2-4 The long-term effects of the past use of LSD are largely unknown. We wonder if the hallucinations experienced by our patient during anaesthesia were due to her LSD intake many years before. We would be interested to know if others have had experience anaesthetising patients who are past users of phencyclidine-derived drugs.

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Comparison of times to achieve tracheal intubation with three techniques using the laryngeal or intubating laryngeal mask airway*

et al. 2002

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SummaryWe compared the times to intubate the trachea using three techniques in 60 healthy patients with normal airways: (i) ®breoptic intubation with a 6.0-mm reinforced tracheal tube through a standard laryngeal mask airway (laryngeal mask)®breoptic group); (ii) ®breoptic intubation with a dedicated 7.0-mm silicone tracheal tube through the intubating laryngeal mask airway (intubating laryngeal mask)®breoptic group); (iii) blind intubation with the dedicated 7.0-mm silicone tracheal tube through the intubating laryngeal mask airway (intubating laryngeal mask)blind group). Mean (SD) total intubation times were signi®cantly shorter in the intubating laryngeal mask)blind group (49 (20) s) than in either of the other two groups (intubating laryngeal mask)®breoptic 74 (21) s; laryngeal mask)®breoptic group 75 (36) s; p < 0.001). However, intubation at the ®rst attempt was less successful with the intubating laryngeal mask)blind technique (15 ¤ 20 (75%)) than in the other two groups (intubating laryngeal mask)®breoptic 19 ¤ 20 (95%) and laryngeal mask)®breoptic 16 ¤ 20 (80%)) although these differences were not statistically signi®cant. We conclude that in this patient group, all three techniques yield acceptable results. If there is a choice of techniques available, the intubating laryngeal mask)blind technique would result in the shortest intubation time.

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Fiber-Optic intubation through a Modified Laryngeal Mask

Cited by 5 publications

References 0 publications

The ‘dedicated airway’: a review of the concept and an update of current practice

The ‘dedicated airway’: a review of the concept and an update of current practice

A new solution to fibreoptic intubation in the presence of blood and secretions

Comparison of times to achieve tracheal intubation with three techniques using the laryngeal or intubating laryngeal mask airway*

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