Use of the Intubating LMA-Fastrach™  in 254 Patients with Difficult-to-manage Airways

Ferson, David; Rosenblatt, William H.; Johansen, Mary; Osborn, Irene P.; Ovassapian, Andranik

doi:10.1097/00000542-200111000-00022

Cited by 285 publications

(200 citation statements)

References 20 publications

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“…Unfortunately, the success rate of FOBassisted intubation through the FT-LMA is less predictable following a failed blind technique in patients with a difficult airway. While Ferson et al reported a 100% success rate of FOB-assisted intubation through the FT-LMA (seven of the seven patients), 11 Joo et al reported a success rate of only 50% (five of the ten patients). 31 …”

Section: Use Of the Airway Exchanger Cathetermentioning

confidence: 96%

“…B Before blind intubation or intubation assistance with an EschmannÒ Tracheal Tube Introducer (gum elastic bougie) or with an airway exchanger catheter (AEC), the FT-LMA is slightly lifted (but not tilted) away from the posterior pharyngeal wall using the metal handle. This ''second'' maneuver prevents the endotracheal tube (ETT) from impacting the arytenoids or vestibule of the larynx and helps guide the passage of an ETT, bougie, or AEC into the trachea 11 The Fastrach TM Intubating Laryngeal Mask AirwayÒ: an overview and update 591 57% with clockwise or counterclockwise manipulation. However, they also compared the use of the relatively inexpensive Parker Flex-Tip ETT (Parker Medical, Highlands Ranch, CO, USA) with a posterior opening bevel and achieved a success rate similar to that of a PVC ETT after the first attempt (54% vs 48%, respectively), which increased to 86% after manipulation 15 ( Figure 4).…”

Section: Endotracheal Tube Selectionmentioning

confidence: 99%

“…36 In 2001, Ferson et al published a retrospective review of the anesthetic and medical records of patients with known or suspected difficult airways (including patients with Cormack-Lehane grade 4 views, patients with immobilized cervical spines, patients with airways distorted by tumours, surgery, or radiation therapy, and patients wearing stereotactic frames) in whom the FT-LMA was used electively or emergently. 11 All providers in their review had significant prior experience with the use of the C-LMA. Insertion of the FT-LMA was accomplished in three attempts or fewer in all patients, with overall success rates for blind and FOB-guided intubations of 96.5% and 100%, respectively.…”

Section: Indications For Placementmentioning

confidence: 99%

“…They found that maximal cervical pressures were higher for the FT-LMA than for the C-LMA over various cuff inflation ranges, and both the C-LMA and FT-LMA exert transient pressures of [ 220 cm H 2 O against the cervical vertebra during insertion, with resultant posterior displacement of cervical vertebra. 55 11 a subgroup of 70 patients with known unstable c-spines was specifically examined. The FT-LMA was used in 70 patients with unstable c-spines who were immobilized in rigid collars that remained in place during FT-LMA insertion.…”

Section: Unanticipated Difficult Intubation In the Operating Roommentioning

confidence: 99%

See 3 more Smart Citations

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

Gerstein

Braude

Hung

et al. 2010

Can J Anesth/J Can Anesth

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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...

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Section: Use Of the Airway Exchanger Cathetermentioning

confidence: 96%

Section: Endotracheal Tube Selectionmentioning

confidence: 99%

Section: Indications For Placementmentioning

confidence: 99%

Section: Unanticipated Difficult Intubation In the Operating Roommentioning

confidence: 99%

See 2 more Smart Citations

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

Gerstein

Braude

Hung

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…The cords may act like unidirectional valves that offer resistance to pressure, provided by the flow of gases during forced inspiration. 2 In Hemmerling's report, flow volume is not mentioned. We hypothesize that with higher gas flows during IPPV, there is a greater propensity to involuntary vibration and irritation of the un-paralyzed vocal cords which may lead to further irritation and potential injury.…”

Section: Air Humidification Might Help To Prevent Irritation and Damamentioning

confidence: 99%

Air humidification might help to prevent irritation and damage to the vocal cords during intermittent positive pressure ventilation using a laryngeal mask airway

Fabregat

Arce²,

Hemmerling

2006

Can J Anesth/J Can Anesth

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Comparison of Ultrasound Examination and Fiberoptic Laryngoscopy for Confirmation of Laryngeal Mask Airway Placement

Malik

Arora

Kakkar

et al. 2023

J of Ultrasound Medicine

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Objectives 1) To compare ultrasound (US) examination and fiberoptic laryngoscopy (FOL) for confirmation of laryngeal mask airway (LMA) placement. 2) To evaluate the necessity for reinsertion of LMA based on FOL. Methods This prospective observational study included 100 adult patients of American Society of Anesthesiologists (ASA) Grade I and II, undergoing elective surgery under General Anesthesia requiring Proseal LMA™ placement as an airway device. LMA placement was first confirmed by clinical tests. Clinically acceptable patients were further assessed by US and categorized as acceptable (US‐A) or unacceptable (US‐U) and again by FOL as (FOL‐A and FOL‐U). Categorical variables presented in number, percentage (%), and continuous variables presented as mean ± SD and median. Inter‐rater kappa agreement was used to find out the strength of agreement of acceptability between FOL and US. Results The LMA placement was clinically acceptable in 82% of patients on first attempt. FOL had 63% (FOL‐A) acceptable LMA placement as compared with US examination which had 56% (US‐A). In 85% of patients, US and FOL findings were in good agreement with each other for LMA placement (κ = 0.690 and P < .05). In all patients of FOL of unacceptable (FOL‐U) category (37%), LMA was replaced with endotracheal tube. Conclusion US provides a safe, non‐invasive, and real‐time dynamic assessment with 85% diagnostic accuracy for confirmation of LMA placement as compared with FOL.

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Use of the Intubating LMA-Fastrach™ in 254 Patients with Difficult-to-manage Airways

Cited by 285 publications

References 20 publications

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

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

Air humidification might help to prevent irritation and damage to the vocal cords during intermittent positive pressure ventilation using a laryngeal mask airway

Comparison of Ultrasound Examination and Fiberoptic Laryngoscopy for Confirmation of Laryngeal Mask Airway Placement

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