The Intubating Laryngeal Mask Airway: Suggestions for Use in the Emergency Department

Abstract

Abstract. With the increased use of rapid-sequence induction and its potential complications, emergency physicians need a rescue device for unexpected difficult intubations. The intubating laryngeal mask airway (ILMA) is an ideal rescue airway since it can be placed quickly and can provide adequate ventilation in nearly all patients. It can then be used as conduit for endotracheal intubation, while ventilation is ongoing. The authors review the current literature on the ILMA. In conjunction with their experience using the ILMA in the emergency department (ED), a modification of the American Society of Anesthesiologists difficult airway algorithm was derived for use in the ED. The ILMA appears to be valuable for managing difficult airways.

Initial Experience of Emergency Physicians Using the Intubating Laryngeal Mask Airway: A Case Series

“…This occurred because a novice operator forgot to use the stabilizing rod during ILMA removal. 3 The patient was quickly re-intubated and suffered no adverse effects.…”

“…The ILMA was placed in the recommended fashion. 3 Paralysis and sedation with succinylcholine and etomidate were used in all cases, to avoid gagging or active vomiting while the ILMA was in place. Sellick's maneuver was used in all cases to avoid passive regurgitation of stomach contents.…”

“…The ILMA is described in more detail elsewhere. 3 To the best of our knowledge, reports of emergency physician (EP) use of the ILMA in the clinical setting have not been published. Nevertheless, many EPs and anesthesiologists believe that the ILMA is a good rescue device for difficult emergency airways.…”

Alternate Airways in the Prehospital Setting (Resource Document to NAEMSP Position Statement)

“…Although the LMA is used primarily in the operating room setting, several authors have promoted its use in the emergency department and other in-hospital settings. [24][25][26][27][28] The LMA is believed to cause less damage to the airway than other airway devices. 27 Because there is no balloon securing the device beneath the vocal cords, the risk of aspiration is theoretically higher with the LMA than the ETC or ETI.…”

La sédation au propofol permet l’intubation difficile vigile avec le masque laryngé FastrachTM

“…5 Chez le patient endormi, il a été montré que cette technique pouvait se substituer à la fibroscopie. [6][7][8][9][10][11][12] L'intubation vigile avec le MLF a été décrite sous sédation associant le midazolam et le fentanyl; mais les protocoles utilisés n'étaient pas standardisés, et ne précisaient pas le vécu du patient (satisfaction ou inconfort). 13,14 L'intubation vigile nécessite une sédation pour limiter l'inconfort du patient et faciliter la procédure.…”