The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Abstract

Purpose To provide an evidence-based overview and update on the use of the Fastrach TM Intubating Laryngeal Mask AirwayÒ (FT-LMA) when used within operative and non-operative settings. Principal findings The FT-LMA is available in three sizes to provide ventilation and the ability to pass an endotracheal tube (ETT) into the trachea blindly, semi-blindly, or with indirect visualization for patients over 30 kg. The Chandy maneuver is recommended routinely; the first maneuver optimizes ventilation, and the second maneuver increases success at endotracheal intubation (ETI). The manufacturer's reinforced tube or a pre-warmed or reversed standard ETT may be utilized. Insertion and ventilation are successful in almost all patients. Blind ETI is highly successful; adjuncts are generally not necessary. The FT-LMA has a proven role in the airway management of anticipated difficult operating room (OR) intubations, unanticipated OR intubations, cervical spine injuries, and limited airway access situations. Literature in the pre-hospital and emergency department settings is limited but favourable. The FT-LMA has compared favourably with fibreoptic intubation, the LMA-Classic TM , the laryngeal tube, and the CobraPLA TM . Initially, the more expensive LMA CTrach TM appeared to be more successful, but overall it is not. The FT-LMA airway seal pressures are excellent; serious complications are uncommon, and the FT-LMA figures prominently in most difficult airway guidelines. Conclusions The FT-LMA has proven to be a useful difficult airway device both within and outside of the operating room. Effective ventilation is established in nearly all cases, and blind ETI is possible in the vast majority of cases if the optimal techniques described are used. Serious complications are uncommon. Constatations principales Le FT-LMA est disponible en trois tailles pour permettre la ventilation et le passage d'une sonde endotrache´ale (SET) dans la trache´e de façon aveugle, semi-aveugle ou avec visualisation directe chez les patients pesant plus de 30 kg. La manoeuvre de Chandy est recommande´e de façon routinie`re; la premie`re manoeuvre optimise la ventilation, et la seconde augmente le succe`s lors d'une intubation endotrache´ale (IET). La sonde arme´e du fabricant ou une SET standard pre´chauffe´e ou inverse´e peut eˆtre utilise´e. L'insertion et la ventilation re´ussissent chez presque tous les patients. L'IET en aveugle a un taux de re´ussite e´leve´; en re`gle ge´ne´rale, les accessoires ne sont pas ne´cessaires. Le FT-LMA joue un rôle e´prouve´dans la prise en charge des voies ae´riennes lors d'intubations anticipe´es comme difficiles dans la salle d'ope´ration (SOP), d'intubations impre´vues en SOP, de le´sions de la colonne cervicale et dans les situations oul 'acce`s aux voies ae´riennes est limite´. La litte´rature portant sur son utilisation dans des contextes pre´-hospitaliers et dans le de´partement des urgences est restreinte mais favorable. Le FT-LMA a e´te´favorablement compare´al 'intubation par fibroscopie, au LMA...

LMA CTrach^TM in patients with anticipated difficult airway : A retrospective study

“…This made the process more cumbersome. 6,7,8 However, the newer LMA CTrach™ has the added advantage that it can be managed independently, making it a potential instrument in emergency airway management. Oesophageal intubation, a potential complication of blind intubation through the LMA Fastrach™, should be overcome by the direct visualization of the glottis in LMA CTrach™ with its better ability to align the laryngeal inlet.…”

Evaluation of the Intubating Laryngeal Mask Airway (ILMA) as an intubation conduit in patients with a cervical collar simulating fixed cervical spine

“…The immobility of the neck was due either to pathology or to stabilising aids such as a halo-vest, cervical collar or manual inline stabilisation (MILS). 24 Ferson reported 100% success rate in patients wearing a collar but that study was retrospective. 12 Moller too reported 100% success rate in these patients 25 but in the same year Wakeling found it successful in only 3 patients out of 10.…”

“…27 Lightwand-guided intubation and gum-elastic bougies have also been used in the past to aid intubation. 24,28 In our study, all the procedures were carried out by a single person who had experience of intubation through an ILMA in more than 20 patients with normal as well as difficult airways. Hence, we cannot comment on its use by novices.…”

Use of intubation introducers through a supraglottic airway to facilitate tracheal intubation: a brief review

“…[4][5][6][7][8][9] An adult ETT can be placed directly into the trachea via these SGAs, either blindly or with bronchoscopic guidance. However, these SGAs designed for intubation may not be readily available in the operating room, 10 and many anesthesiologists are not familiar with using them as stand-alone airways or intubating devices.…”