The use of bougie‐guided insertion of a laryngeal mask airway device in neonatal piglets after unexpected complications

Abstract

After marked airway obstruction with laryngeal mask (LM) placement in neonate piglets, anatomical observations in cadavers revealed a large epiglottis advancing markedly over the soft palate. CT imaging in vivo confirmed that the LM pushes the epiglottis caudally thereby obstructing the larynx. As a new approach, in 20 piglets a flexible PVC bougie placed under laryngoscopy was used to guide the LM to the correct position at the larynx. Placement of the bougie was easy and the LM was positioned successfully in all piglets at first attempt. In 14 piglets, the epiglottis was positioned dorsal to the soft palate before LM insertion and had to be pushed downwards to advance the bougie. In case of failure of LM placement with potential airway obstruction, the use of a bougie to guide the LM over the epiglottis was simple, rapid, and improved the success rate without complication.

Pig Sedation and Anesthesia for Medical Research

“…The mask is designed to be positioned over the larynx and enable positive pressure ventilation if required [1]. In neonatal piglets, ETT can be very difficult, so the use of a bougie to guide a laryngeal mask during placement can reduce the potential of airway obstruction [75].…”