Intubating laryngeal mask for fibreoptic intubation — particularly useful during neck stabilization

Abstract

Purpose: To assess the ease of fibrescope-assisted tracheal intubation while the patient's head and neck were placed in the neutral or the manual in-line position, and to determine if the intubating laryngeal mask facilitated fibreoptic intubation in these positions. Methods:In 84 patients, the patient's head and neck were placed in the neutral position (pillow placed under occiput), and in another 40 patients the head and neck were stabilized by the manual in-line method (no pillows under occiput). In both groups, after induction of anesthesia with 2.0 -2.5 mg·kg -1 propofol, 50 -100 µg fentanyl and 1.0 mg·kg -1 vecuronium, patients were allocated randomly into two groups: in Group C tracheal intubation was attempted using only a fibrescope, whereas in Group L fibreoptic intubation through the intubating laryngeal mask was attempted.Results: In group C the success rate of fibreoptic tracheal intubation within two minutes was higher in the neutral position (31 of 42 patients (73%)) than in the manual in-line position (8 of 20 patients (40%)). In contrast, in group L the success rate was similar between the two positions. Tracheal intubation was easier in group L than in group C (P < 0.01 or 0.001) and the time for intubation was shorter in group L than in group C in both head and neck positions.Conclusions: Fibreoptic tracheal intubation was more difficult in the manual in-line position than in the neutral position. The intubating laryngeal mask facilitated fibreoptic intubation in both positions.Objectif : Évaluer la facilité de l'intubation endotrachéale fibroscopique alors que la tête et le cou du patient sont en position neutre ou en position en ligne manuelle. Déterminer aussi si le masque laryngé d'intubation facilite l'intubation fibroscopique dans ces positions.Méthode : Chez 84 patients, la tête et le cou ont été placés en position neutre (un oreiller sous l'occiput) et chez 40 autres patients, la tête et le cou ont été stabilisés manuellement par la méthode en ligne (sans oreiller). Après l'induction de l'anesthésie avec 2,0 -2,5 mg·kg -1 de propofol, 50 -100 µg de fentanyl et 1,0 mg·kg -1 de vécuronium, les patients ont été répartis au hasard en deux groupes : le groupe C où l'intubation endotrachéale a été tentée en utilisant seulement le fibroscope, tandis que dans le groupe L, l'intubation fibroscopique a été réa-lisée au travers du masque laryngé d'intubation.Résultats : Dans le groupe C, le taux de succès de l'intubation endotrachéale fibroscopique, réalisée en moins de deux minutes, a été plus élevé chez les patients en position neutre (31 des 42 patients ou 73 %) que chez les patients en ligne (8 des 20 patients ou 40 %). Par ailleurs, dans le groupe L, le taux de succès a été similaire pour les deux positions. L'intubation endotrachéale a été plus facile dans le groupe L que dans le groupe C (P < 0,01 ou 0,001) et le temps nécessaire à l'intubation a été plus court dans le groupe L que dans le groupe C pour les deux positions.Conclusion : L'intubation endotrachéale fibroscopique a été plus dif...

Comparison of learning performance of 2 intubating laryngeal mask airways in novice

“…It will be safer and more convenient to conduct endotracheal intubation via LMAs inner lumen without interrupting ventilation or compression in CPR, particularly for difficulty airways. [23,24] Up until now limited data were available for which intubating LMA had better learning performance than others, especially in hands of novice. Therefore we designed this study.…”

Supraglottic Airway DevicesDiscussion

“…First, SADs, in general, and the LMA Classic, in particular, were extremely versatile and could be used in a variety of patient positions. 9,10 Additionally, they offered a hands-free method of airway management associated with a low rate of failure and high patient satisfaction, likely related to reduced sore throat. 11 Finally, first-generation SADs were developed during the era of propofol, a drug with extremely beneficial effects on the upper airway reflexes in comparison to alternatives such as barbiturates.…”

“…Use of fiberoptic techniques through the intubating LMA is associated with significantly higher frequency of first-attempt successful intubation for patients with predicted or simulated difficult airways compared to standard fiberoptic intubation. 9,55 The intubating LMA was shown to have extremely high success rates for blind and fiberoptic bronchoscope-guided intubations (97 and 100%, respectively) in patients with Cormack-Lehane grade 4 views; immobilized cervical spines; airways distorted by tumors, surgery, or radiation therapy; and stereotactic frames. 42 Other observational studies cite 71.4 -100% intubation success rates in patients with difficult airways with the intubating LMA.…”

Potential cervical spine injury and difficult airway management for emergency intubation of trauma adults in the emergency department--a systematic review

“…[83][84][85] This review concentrates on those trauma adults requiring immediate airway control in the ED, which will limit these options. The use of fiberscope guided intubation in the ED is generally not feasible because of availability of fibreoptic equipment in emergent situations and practitioners experienced in its use.…”