Tracheal intubation in the prone position with an intubating laryngeal mask airway following posterior spine impaled knife injury

Abstract

A prone position is not a standard position for anesthesia induction and associated with problems like difficult mask fit, impairment of orotracheal intubation by direct laryngoscopy, and reduction of pulmonary compliance. However anesthetic management of trauma victims presenting with penetrating posterior lumbar spine injury requires airway securement and induction of anesthesia in the prone position to avoid further neurological impairment. We herein present the first reported case of an adult trauma patient presented with an impaled knife protruding out of lower back, who underwent endotracheal intubation with an intubating laryngeal mask airway under general anesthesia in the prone position. Our experience indicates that this technique would be easier and less risky compared to direct laryngoscopy or awake fiber optic intubation and might be considered in an emergency situation.

The Use of Laryngeal Mask Airway in Pilonidal Cyst Excision after Muscle Relaxant (Atracurium) Injection in Prone Position

“…During general anesthesia a large number of surgeries such as pilonidal sinus excision are conducted in prone position 1 . This position is not an ideal position for anesthesia, on account of problems such as impairment in endotracheal intubation or difficult mask ventilation or pulmonary compliance reduction 2 . The usual technique in anesthetizing in prone position is conducted as follows: anesthesia induction and tracheal intubation on a trolley in supine position, then turning over to prone position on the operating table (1).…”

Endotracheal intubation for penetrating neck trauma

“…The different techniques for airway management in the unsuitable position for intubation are awake fiber-optic intubation, DL, endotracheal intubation (ETI), and the intubating laryngeal mask airway. [ 1 2 3 4 5 ] The unsuitable position for intubating may be a variety. Right and left lateral and prone position are some of these positions.…”

“…Management of airway for cases with suboptimal lateral decubitus (left or right) or prone positions are reported. [ 1 2 3 ] However, to the best of our knowledge, a case of airway management with direct laryngoscopy (DL) technique while the head of the patient was also held by the anesthesiologist for stabilization has not been reported. We present a case of penetrating neck trauma in which the DL technique was used to secure the airway while the head of the patient was also held by an anesthesiologist.…”

Penetrating abdomino-thoracic injury with an iron rod: An anaesthetic challenge

“…Positioning problem during induction of anaesthesia is the common problem faced by anaesthesiologist in these patients. [ 3 9 10 ] Many alternative techniques of positioning have been reported in the literature. Few authors reported arranging two parallel tables and positioning patient in such a way that the projecting rod takes the space between the two.…”