Is Laryngeal Mask Easy to Use in Case of Difficult Intubation ?

Mahiou, P.; Narchi, P.; Veyrac, P; Germond, Marc; Gory, G.; Bazin, G

doi:10.1097/00000542-199209001-01228

Cited by 38 publications

(7 citation statements)

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“…Mouth opening of at least 2 cm is needed to accommodate the ILM. Our results indicate that, in common with the standard LMA, success of placement of the ILM is independent of factors used to predict or score difficult conventional intubation [14][15][16]. The ILM allows both fibreoptic and blind tracheal intubation and permits ventilation during attempts at intubation.…”

Section: Discussionmentioning

confidence: 73%

The intubating laryngeal maskResults of a multicentre trial with experience of 500 cases

1998

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SummaryA multicentre trial of the use of the intubating laryngeal mask was carried out at seven centres in the United Kingdom using the same agreed protocol. Lung ventilation followed by blind tracheal intubation through the intubating laryngeal mask was attempted on 500 ASA grade 1 and 2 patients. It was possible to insert the intubating laryngeal mask in all 500 cases. Ventilation via the intubating laryngeal mask was described as satisfactory in 475 (95%) cases, difficult in 20 (4%) cases and unsatisfactory in 5 (1%) cases. Blind tracheal intubation through the intubating laryngeal mask was possible in 481 (96.2%) cases within three attempts. Intubation was successful at the first attempt in 399 (79.8%) cases, at the second attempt in 62 (12.4%) cases and at the third attempt in 20 (4%) cases. The tracheas of 19 (3.8%) patients were not successfully intubated within the three attempts. Ventilation via the intubating laryngeal mask was described as unsatisfactory during two of these cases but oxygenation remained satisfactory in spite of this. Seventeen of the 19 failures occurred during the individual operator's first 20 attempts. The intubating laryngeal mask provides a successful method for blind tracheal intubation in a large proportion of cases and appears to be superior to the standard laryngeal mask airway for this purpose. The intubating laryngeal mask may be of use when tracheal intubation has failed using conventional methods.

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Section: Discussionmentioning

confidence: 73%

The intubating laryngeal maskResults of a multicentre trial with experience of 500 cases

1998

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“…By avoiding the manipulations associated with laryngoscopy, intubation via the intubating laryngeal mask may have the potential to avoid the main causes of difficulty in intubation. Like the standard laryngeal mask airway, placement of the intubating laryngeal mask is probably independent of factors used to predict [10,23] or score [24] difficult intubation. In this study, the tracheas of patients in whom difficulty in tracheal intubation was known or predicted were intubated as easily as were those of normal patients.…”

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confidence: 99%

The intubating laryngeal maskClinical appraisal of ventilation and blind tracheal intubation in 110 patients

et al. 1998

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SummaryThis study assesses the efficacy of the intubating laryngeal mask as a ventilation device and blind intubation guide. Following induction of anaesthesia with propofol, the device was successfully inserted at the first attempt in 110/110 (100%) patients. Placement took less than 10 s in all patients. Size selection was based on nose-chin distance. Adequate ventilation was achieved in 104/110 (95%) patients. Blind tracheal intubation using an 8-mm internal diameter straight silicone cuffed tracheal tube was attempted 3 min after the administration of vecuronium. Passage of a lighted stylet through the intubating laryngeal mask was used to determine the position of the intubating laryngeal mask cuff before blind intubation. If resistance was felt during intubation, a sequence of adjusting manoeuvres was used, based on the depth at which resistance occurred. Tracheal intubation was possible in 104/104 (100%) patients. In 42 (40%) patients, no resistance was encountered and the trachea was intubated at the first attempt. Sixty-two (60%) patients required one adjusting manoeuvre. The mean (range) time taken to successful intubation, i.e. the time from disconnection of the intubating laryngeal mask from the breathing system to successful tracheal intubation, was 79 (12-315) s. Six patients with potential or known intubation problems were included in the study. The tracheas of all six patients were successfully intubated. We conclude that the intubating laryngeal mask is an effective ventilation device and intubation guide with potential for use in patients who may present difficulty in tracheal intubation.

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“…There is also debate about the use of the LMA in the predicted difficult airway. Controlled studies have shown that ease of insertion is unaffected by anatomical features used to predict [7, 81 or score [7] difficult intubation, and is unaffected by manual in-line traction [9] or the presence of a hard collar [ 101. The Mallampati classification system [I I], which was modified by Samsoon and Young to include a class IV [12], is well established as a useful predictor of difficult intubation.…”

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confidence: 99%

Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia

Brimacombe

1996

Anaesthesia

160

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SummaryAn analysis of 1500 laryngeal mask airway uses by one anaesthetist using the standard insertion technique was conducted to determine successful insertion rates, position by fibreoptic laryngoscopy, complication rates and whether there is a long-term learning curve. The correlation between laryngeal mask airway placement and modiJied Mallampati grade was also determined. Thejrst time insertion rate was 95.5% with an overall failure rate after three attempts of 0.4%. One hundred andjyteen patients were Mallampati III or I V . All failedplacements were Mallampati I or II. Problems occurred in 94patients (6.27%), but oxygen saturation decreased below 90% on only ten occasions and below 80% on one occasion. There were no episodes of regurgitation. The vocal cords were visible from the mask aperture bars in 97.1 %. Comparison of insertion rates, fibreoptic position and complicationsfor thejrst and second 750 insertions provides evidence.for a 'long' term learning curve. These data could be used as a guide for 'optimal' or expected successful laryngeal mask airway insertion rates in adults undergoing routine anaesthesia.

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Is Laryngeal Mask Easy to Use in Case of Difficult Intubation ?

Cited by 38 publications

References 0 publications

The intubating laryngeal maskResults of a multicentre trial with experience of 500 cases

The intubating laryngeal maskResults of a multicentre trial with experience of 500 cases

The intubating laryngeal maskClinical appraisal of ventilation and blind tracheal intubation in 110 patients

Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia

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