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Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock PA, Mercier D, Myatra SN, O'Sullivan EP, Rosenblatt WH, Sorbello M, Tung A. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31-81. [PMID: 34762729 DOI: 10.1097/aln.0000000000004002] [Citation(s) in RCA: 364] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
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Comparison of i-Gel as a Conduit for Intubation between under Fiberoptic Guidance and Blind Endotracheal Intubation during Cardiopulmonary Resuscitation: A Randomized Simulation Study. Emerg Med Int 2019; 2019:8913093. [PMID: 31781398 PMCID: PMC6874990 DOI: 10.1155/2019/8913093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to compare intubation performances among i-gel blind intubation (IGI), i-gel bronchoscopic intubation (IBRI), and intubation using Macintosh laryngoscope (MCL) applying two kinds of endotracheal tube during chest compressions. We hypothesized that IGI using wire-reinforced silicone (WRS) tube could achieve endotracheal intubation most rapidly and successfully. Methods In 23 emergency physicians, a prospective randomized crossover manikin study was conducted to examine the three intubation techniques using two kinds of endotracheal tubes. The primary outcome was the intubation time. The secondary outcome was the cumulative success rate for each intubation technique. A significant difference was considered when identifying p < 0.05 between two devices or p < 0.017 in post hoc analysis of the comparison among three devices. Results The mean intubation time using IGI was shorter (p < 0.017) than that of using IBRI and MCL in both endotracheal tubes (17.6 vs. 29.3 vs. 20.2 in conventional polyvinyl chloride (PVC) tube; 14.6 vs. 27.4 vs. 19.9 in WRS tube; sec). There were no significant (p < 0.05) differences between PVC and WRS tubes for each intubation technique. The intubation time to reach 100% cumulative success rate was also shorter in IGI (p < 0.017) than that in IBRI and MCL in both PVC and WRS tubes. Conclusions IGI was an equally successful and faster technique compared with IBRI or MCL regardless of the use of PVC or WRS tube. IGI might be an appropriate technique for emergent intubation by experienced intubators during chest compressions.
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Anand L, Singh M, Kapoor D, Singh A. Comparative evaluation of Ambu Aura-i and Fastrach™ intubating laryngeal mask airway for tracheal intubation: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2019; 35:70-75. [PMID: 31057244 PMCID: PMC6495629 DOI: 10.4103/joacp.joacp_59_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and aims: Ambu Aura-i was compared with Fastrach™ (FT)-laryngeal mask airway (LMA) as a conduit for tracheal intubation. Material and Methods: A hundred consenting patients were randomly allocated into two groups of 50 patients each in a prospective randomized study. Standard anesthesia technique was used for all patients and FT-LMA or Ambu Aura-i was selected. After insertion of airway device, the cuff was inflated and ventilation was attempted. Once satisfactory ventilation was achieved, with or without maneuvers, a fiberoptic scoring for glottis view was noted. A polyvinylchloride (PVC) tracheal tube of appropriate size was inserted through the airway device as per procedure. If no resistance was felt while advancing the tracheal tube, it was fully inserted into the device and tracheal tube cuff was inflated. The device was removed and tracheal tube was left in situ. If the first attempt failed during tracheal tube insertion, the recommended maneuvers were used. A maximum of three attempts were allowed for intubation. First attempt for tracheal intubation attempt was a blind, second attempt was made with maneuver. If second attempt of intubation was unsuccessful, fiberoptic-guided intubation was performed as a third attempt. When tracheal intubation was unsuccessful, it was performed by direct laryngoscopy and considered as failed intubation. Rest of the anesthesia management was as per the discretion of attending anesthesiologists. The success rate of device insertion, fiberoptic score of glottis view, tracheal intubation via FT-LMA or Aura-i and time were recorded. Results: Both FT-LMA and Aura-i were successfully placed within two attempts. The success rate of blind intubation was 92% in FT-LMA and 76% in Aura-i (P < 0.01). Time taken for tracheal intubation at first attempt was lesser in group FT-LMA and Aura-i, respectively (P < 0.01). Fiberoptic-guided intubation success rate was higher with Aura-i than with FT-LMA. Conclusions: FT-LMA had a higher success rate in facilitating blind tracheal intubation compared with Ambu Aura-i.
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Affiliation(s)
- Lakesh Anand
- Department of Anaesthesia and Intensive Care, Govt. Medical College and Hospital, Sector 32, Chandigarh, India
| | - Manpreet Singh
- Department of Anaesthesia and Intensive Care, Govt. Medical College and Hospital, Sector 32, Chandigarh, India
| | - Dheeraj Kapoor
- Department of Anaesthesia and Intensive Care, Govt. Medical College and Hospital, Sector 32, Chandigarh, India
| | - Anjali Singh
- Department of Anaesthesia and Intensive Care, Govt. Medical College and Hospital, Sector 32, Chandigarh, India
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Oshika H, Koyama Y, Taguri M, Maruyama K, Hirabayashi G, Yamada SM, Kohno M, Andoh T. Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position: A randomized crossover manikin study. Medicine (Baltimore) 2018; 97:e11190. [PMID: 29924038 PMCID: PMC6023683 DOI: 10.1097/md.0000000000011190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is very rare but challenging to perform emergency airway management for accidental extubation in a patient whose head and neck are fixed in the prone position when urgently turning the patient to the supine position would be unsafe. The authors hypothesized that tracheal intubation with a videolaryngoscope would allow effective airway rescue in this situation compared with a supraglottic airway device and designed a randomized crossover manikin study to test this hypothesis. METHODS The authors compared airway rescue performances of the 3 devices-the ProSeal laryngeal mask airway (PLMA; Teleflex Medical, Westmeath, Ireland) as a reference; the Pentax AWS (AWS; Nihon Kohden, Tokyo, Japan) as a channeled blade-type videolaryngoscope; and the McGRATH videolaryngoscope (McGRATH; Medtronic, Minneapolis, MN) as a nonchanneled blade type in a manikin fixed to the operating table in the prone position. Twenty-one anesthesiologists performed airway management on the prone manikin with the 3 devices, and the time required for intubation/ventilation and the success rates were recorded. RESULTS The median (range) intubation/ventilation times with the PLMA, AWS, and McGRATH were 24.5 (13.5-89.5) s, 29.9 (17.1-79.8) s, and 46.7 (21.9-211.7) s, respectively. There was no significant difference in intubation/ventilation times between the PLMA and AWS. The AWS permitted significantly faster tracheal intubation than did the McGRATH (P = 0.006). The success rates with the PLMA (100%) and AWS (100%) were significantly greater than that with the McGRATH (71.4%). Airway management performance of the PLMA and AWS was comparable between devices and better than that of the McGRATH in the prone position. CONCLUSIONS Considering that tracheal intubation can provide a more secure airway and more stable ventilation than the PLMA, re-intubation with a channeled blade-type videolaryngoscope such as the AWS may be a useful method of airway rescue for accidental extubation in patients in the prone position.
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Affiliation(s)
- Hiroyuki Oshika
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Yukihide Koyama
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Masataka Taguri
- Department of Biostatics, Yokohama City University Graduate School of Medicine, Yokohama
| | - Koichi Maruyama
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Go Hirabayashi
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Shoko Merrit Yamada
- Department of Neurosurgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
| | - Masashi Kohno
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
- Department of Anesthesia, Tomei Atsugi Hospital, Atsugi, Japan
| | - Tomio Andoh
- Department of Anesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki
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Chhatrapati S, Sahu A, Auti SS, Aswar SG. Evaluation of the Effect of Tracheal Tube Orientation on Success of Intubation through Intubating Laryngeal Mask Airway. J Clin Diagn Res 2016; 10:UC06-9. [PMID: 27437330 DOI: 10.7860/jcdr/2016/19859.7882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/20/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Polyvinyl Chloride Endotracheal Tube (PVC ETT) can be used as an alternative to Fastrach Silicone Wire-Reinforced Tube (FTST) for intubation through Intubating Laryngeal Mask Airway (ILMA) as the latter is expensive and has low volume high pressure cuff. AIM To evaluate the effects of orientation of PVC ETT (normal curve and reverse curve) on the success of intubation through ILMA, haemodynamic response and postoperative sore throat. MATERIALS AND METHODS Sixty healthy adult patients of ASA physical status I & II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were randomly divided into two groups. In Normal (N) group (n=30), the tracheal tube was inserted with its natural curve following the 90° curvature of ILMA. In Reverse (R) group (n=30), the tracheal tube was inserted with its natural curve directed opposite to the curvature of ILMA. The time taken to intubate, number of attempts, and maneuvers required for successful endotracheal intubation along with haemodynamics and oxygen saturation were noted. Postoperative sore throat was evaluated using a Verbal Analogue Scale (VAS) (0-10). Qualitative data was analysed by Chi-Square test and Fisher's exact test. Quantitative data was analysed by unpaired t-test and Mann-Whitney test. RESULTS Placement of ILMA was successful in all patients. Total Intubation Time (mean±SD) in Group N was 12.53±1.78 seconds and in Group R was 11.97±1.33 seconds (p>0.05). Tracheal intubation through ILMA was successful in all patients. First attempt success rate in R Group (26 patients, 86.7%) was higher than N Group (22 patients, 73.3%) (p>0.05). Four patients (13.3%) in R Group and 8 patients (26.7%) in N Group required 2nd step of Chandy's maneuver during second attempt for successful intubation. Incidence of sore throat 6 hours postoperatively was statistically significant (median value 2.00 in N Group vs. 0.00 in R Group) between two groups. CONCLUSION PVC ETT with reverse orientation increases first attempt success rate of intubation through ILMA with less immediate postoperative laryngeal morbidity.
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Affiliation(s)
- Swati Chhatrapati
- Professor, Department of Anaesthesiology, B.Y.L Nair Ch. Hospital & Topiwala National Medical College , Mumbai, India
| | - Anjana Sahu
- Assistant Professor, Department of Anaesthesiology, B.Y.L Nair Ch. Hospital & Topiwala National Medical College , Mumbai, India
| | - Subhhash Sadashiv Auti
- Senior Registrar, Department of Anaesthesiology, B.Y.L Nair Ch. Hospital & Topiwala National Medical College , Mumbai, India
| | - Swapnil Ganesh Aswar
- Senior Resident, Department of Anaesthesiology, Tata Memorial Hospital , Mumbai, India
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Neoh EU, Choy YC. Comparison of the air-Q ILA™ and the LMA-Fastrach™ in airway management during general anaesthesia. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2012.10872844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- EU Neoh
- Department of Anaesthesiology and Intensive Care, Hospital Universiti, Kebangsaan, Malaysia
| | - YC Choy
- Department of Anaesthesiology and Intensive Care, Hospital Universiti, Kebangsaan, Malaysia
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Shah VR, Bhosale GP, Mehta T, Parikh GP. A comparison of conventional endotracheal tube with silicone wire-reinforced tracheal tube for intubation through intubating laryngeal mask airway. Saudi J Anaesth 2014; 8:183-7. [PMID: 24843329 PMCID: PMC4024673 DOI: 10.4103/1658-354x.130702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: A specially designed wire-reinforced endotracheal tube — the Fastrach silicone tube (FTST) designed to facilitate endotracheal intubation through intubating laryngeal mask airway (ILMA) are expensive and not readily available. Hence, it is worth considering alternative such as polyvinyl chloride tracheal tube (PVCT), which is disposable, cheap and easily available. The aim of the present study was to compare the clinical performance of FTST with conventional PVCT for tracheal intubation through ILMA. Methods: After informed consent, 60 ASA I-II adults with normal airway undergoing elective surgery were randomly allocated to undergo blind tracheal intubation through ILMA with a FTST or conventional PVCT. Overall success rate, ease of insertion, number of attempts for successful intubation, critical incidence during intubation and post-operative sore throat were compared. Results: The overall success rate with FTST was 96.63% and 93.33% with PVCT; in addition, the first-attempt success rate was 86.25% with FTST compared to 82.14% with PVCT. The time taken for intubation was 18.6 ± 6.8 s. in FTST group and 22.42 ± 8.5 s. in PVCT group. Incidence of sore throat was 21.42% in PVCT group compared with 6.89% in FTST group. Conclusion: Blind tracheal intubation through an ILMA with the conventional PVCT instead of FTST is a feasible alternative in patients with normal airways.
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Affiliation(s)
- Veena R Shah
- Department of Anesthesia and Critical Care, Smt. K.M. Mehta and Smt. G.R. Doshi Institute of Kidney Diseases and Research Center, Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Guruprasad P Bhosale
- Department of Anesthesia and Critical Care, Smt. K.M. Mehta and Smt. G.R. Doshi Institute of Kidney Diseases and Research Center, Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Tanu Mehta
- Department of Anesthesia and Critical Care, Smt. K.M. Mehta and Smt. G.R. Doshi Institute of Kidney Diseases and Research Center, Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
| | - Geeta P Parikh
- Department of Anesthesia and Critical Care, Smt. K.M. Mehta and Smt. G.R. Doshi Institute of Kidney Diseases and Research Center, Dr. H.L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
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Abstract
BACKGROUND The EasyTube (EzT) is a new sterile, disposable airway device approved by the European Union in February 2003 and by the U.S. Food and Drug Administration in January 2005. The two-lumen design of the EzT enables it to be used as an endotracheal tube or as a supraglottic emergency airway. OBJECTIVE To report the preliminary experiences with the EzT airway device in prehospital and in-hospital emergency airway management procedures. METHODS All airway management procedures involving the EzT were recorded for a period of 18 months. RESULTS The EzT was successfully used to intubate 15 patients with unanticipated airway difficulties during either anesthesia induction or prehospital airway management. In all patients, the EzT was positioned successfully in the first attempt, within a median time of 31 seconds until start of ventilation. Effective supraglottic ventilation and oxygenation was achieved within 25 to 40 seconds. In three patients, the EzT needed one additional repositioning maneuver. On removal of the EzT, no blood was observed on the surface of the device, as a sign of absence of potential mucosal lesion. No injuries were observed in the mouth, pharynx, or esophagus. CONCLUSIONS The first experiences with the use of the EzT are promising. In emergency airway management procedures presenting problems, the device successfully established sufficient ventilation and oxygenation. Further studies are needed to compare its value with those of other supraglottic devices.
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Affiliation(s)
- Andreas R Thierbach
- Department of Anesthesiology, Johannes Gutenberg-University, Mainz, Germany.
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Ahmed SM, Khan RM, Maroof M, Ahmed M. Assessment of manoeuvres required for successful blind tracheal intubation through the PAXpress. Anaesthesia 2007; 63:32-5. [PMID: 18086068 DOI: 10.1111/j.1365-2044.2007.05300.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A PAXpress (Vital Signs Inc., Barnham, UK) airway device was placed in 50 adult ASA grade I and II patients undergoing elective surgery under general anaesthesia. The alignment of the PAXpress to the larynx was scored fibreoptically. The patients were then intubated blindly through the PAXpress and the adjusting manoeuvres required for successful intubation and complications of intubation observed. Insertion of the PAXpress was successful in all patients, and intubation was successful in 42 (84%) patients. Eleven patients were intubated in the neutral position, seven with a flexion manoeuvre and 24 with an extension manoeuvre. Intubation was successful in 17/20, 18/20, 6/8 and 1/2 of patients with a fibreoptic alignment score of 1, 2, 3 and 4, respectively. When the fibreoptic alignment score was between 2 and 4 intubation was achieved predominantly with the extension manoeuvre (20/30, 66%) rather than the flexion manoeuvre (1/30, 3%) or the neutral position (5/30, 16%). Blood staining was observed in 20 patients. We conclude that blind tracheal intubation through PAXpress has a moderately good success rate and a high incidence of mucosal trauma. 'Extension' is the predominant adjusting manoeuvre required for blind tracheal intubation, especially when the alignment of the PAXpress to the larynx is poor.
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Affiliation(s)
- S M Ahmed
- Department of Anaesthesiology, J N Medical College, AMU, Aligarh, India.
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Abstract
This article reviews the more recent theoretic and practical information that pertains to airway management in the trauma setting. This is followed by a presentation of the newer airway devices that may be advantageous in the management of the airway in trauma as well as a discussion of other devices, techniques, or maneuvers that are useful in the trauma setting but may be underused. Each clinician needs to be knowledgeable about the various airway options and then, based on one's own particular skills and resources, construct an airway management algorithm that works best for him or her. Each clinician needs to be knowledgeable about the various airway options, and then, based on the clinician's particular skills and resources, construct an airway management algorithm that works best.
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Affiliation(s)
- John McGill
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue North, Minneapolis, MN 55415, USA.
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Hung OR, Tibbet JS, Cheng R, Law JA. Proper preparation of the Trachlight™ and endotracheal tube to facilitate intubation. Can J Anaesth 2006; 53:107-8. [PMID: 16371621 DOI: 10.1007/bf03021539] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kundra P, Sujata N, Ravishankar M. Conventional tracheal tubes for intubation through the intubating laryngeal mask airway. Anesth Analg 2005; 101:1245. [PMID: 16192561 DOI: 10.1213/01.ane.0000173752.30351.9d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Pankaj Kundra
- Department of Anaesthesiology and Critical Care; JIPMER; Pondicherry, India;
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Stopar T, Novak Jankovic V, Casati A. Four different airway-management strategies in patient with Launois-Bensaude syndrome or Madelung's disease undergoing surgical excision of neck lipomatosis with a complicated postoperative course. J Clin Anesth 2005; 17:300-3. [PMID: 15950858 DOI: 10.1016/j.jclinane.2004.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Accepted: 07/16/2004] [Indexed: 12/15/2022]
Abstract
Launois-Bensaude syndrome, otherwise known as Madelung's disease, is a rare disorder characterized by fatty accumulations of the upper trunk, neck and head, causing serious cosmetic deformity and neck immobility. We report a case of a patient with Launois-Bensaude syndrome who required 4 different airway management strategies during his hospitalization for postoperative complications after an elective surgical excision of a severe neck lipomatosis. Anesthesiologists who treat patients with Madelung's disease should be aware of 2 major problems: difficult airway and increased frequency of postoperative bleeding. A proper choice of airway management technique is therefore necessary, including a safe intubation and extubation plan to reduce the consequences of airway complications.
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Affiliation(s)
- Tatjana Stopar
- Department of Anesthesiology, Institute of Oncology, 1000 Ljubljana, Slovenia.
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Wahlen BM, Gercek E. Three-dimensional cervical spine movement during intubation using the Macintosh and Bullard™ laryngoscopes, the Bonfils fibrescope and the Intubating Laryngeal Mask Airway. Eur J Anaesthesiol 2004. [DOI: 10.1097/00003643-200411000-00013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Obstetric anesthesia is considered to be a difficult, high-risk practice that exposes the anesthesiologist to increased medicolegal liability. Anesthetic management of parturient patients is a challenge, as it involves simultaneous care of two lives. The anesthesia practitioner has a duty to provide safe anesthetic care, including effective airway management when providing regional or general anesthesia. The potential need to manipulate the airway is perhaps the leading cause of concern among obstetric anesthesiologists.
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Affiliation(s)
- Uma Munnur
- Department of Anesthesiology, Baylor College of Medicine, 6550 Fannin, Smith Tower, Suite 1003, Houston, TX 77030, USA.
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Asai T, Shingu K. Difficulty in advancing a tracheal tube over a fibreoptic bronchoscope: incidence, causes and solutions. Br J Anaesth 2004; 92:870-81. [PMID: 15121723 DOI: 10.1093/bja/aeh136] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- T Asai
- Department of Anaesthesiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi City, Osaka 570-8507, Japan.
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Affiliation(s)
- Linda I Wat
- Department of Anesthesiology, Loma Linda Medical Center, Loma Linda, CA 92350, USA
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Young B. The intubating laryngeal-mask airway may be an ideal device for airway control in the rural trauma patient. Am J Emerg Med 2003; 21:80-5. [PMID: 12563589 DOI: 10.1053/ajem.2003.50012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A review of the literature on advanced airway management indicates that the intubating laryngeal-mask airway (ILMA) may be an ideal device for airway control in the rural trauma patient. The ILMA is an advanced laryngeal-mask airway designed to allow oxygenation of the unconscious patient as well as blind tracheal intubation with an endotracheal tube. The ILMA is an easy-to-use airway with a high success rate of insertion, and requires little training. For the rural physician managing a difficult airway in a trauma patient, the ILMA has been found to be reliable and successful when other techniques fail, such as fiberoptic intubation and direct laryngoscopy. The ILMA has also been reported to cause less hemodynamic change and less injury to the teeth and lips than direct laryngoscopy. Further, the ILMA was found to be easier and faster to use with a higher success rate than either the combitube or endotracheal tube for unskilled healthcare providers. Limitations and complications of the ILMA may include aspiration, esophageal intubation, damage to the larynx or other tissues during blind passage of a tracheal tube, and edema of the epiglottis.
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Affiliation(s)
- Barb Young
- Department of Anesthesiology, Regions Hospital, St. Paul, MN, USA
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Abstract
Emergency ventilation is an essential component of basic life support. Respiratory emergencies occur far more frequently than cardiac arrest and, if not treated promptly and effectively, may lead to cardiac arrest. Many respiratory emergencies require assisted ventilation to prevent the occurrence of hypoxemia, hypercarbia, and cardiac decompensation. Emergency assisted ventilation is often difficult to perform and is associated with several adverse complications, such as gastric inflation, regurgitation, and pulmonary aspiration. The American Heart Association sponsored conferences in 1999 and 2000 to review and revise guidelines for cardiopulmonary resuscitation. This article reviews the science behind guideline changes related to pulmonary resuscitation and discusses recent advances in emergency airway management, focusing on noninvasive techniques for ventilation (mouth-to-mouth ventilation, bag-mask ventilation) and alternative airway devices (laryngeal mask airway, the Combitube).
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Affiliation(s)
- Ahamed H Idris
- University of Florida College of Medicine, Department of Emergency Medicine and Department of Anesthesiology, P.O. Box 100186, Gainesville, FL 32610-0186, USA.
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Joo HS, Kataoka MT, Chen RJB, Doyle J, Mazer CD. PVC tracheal tubes exert forces and pressures seven to ten times higher than silicone or armoured tracheal tubes--an in vitro study. Can J Anaesth 2002; 49:986-9. [PMID: 12419730 DOI: 10.1007/bf03016888] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Many types of tracheal tubes (TT) including silicone, polyvinylchloride (PVC) and armoured have been used for blind tracheal intubation (TI) via the intubating laryngeal mask airway (ILMA) and may cause trauma to the airway. We examined the maximal in vitro forces and pressures exerted by the tip of various TT as it exits the ILMA. METHODS Silicone, PVC and armoured TT were studied. A #5 ILMA was secured on a wooden platform. With the use of a Harvard pump, force was applied to push the TT through the ILMA at 0.34 cm*sec(-1). Forces exerted to push the TT and forces exerted by the TT tips on distal objects were calculated using proximal and distal pressure manometres. The areas of contact between the distal TT tips and the distal objects were measured by planimetry of an imprint. The final pressures exerted by the TT tips on a fixed distal object were calculated by dividing the forces exerted by the areas of contact. RESULTS When compared to silicone and armoured TT, PVC TT exerted seven to ten times higher forces and pressures on distal objects. (P < 0.05). Heating PVC TT and inserting PVC TT with reverse curvature to the ILMA did not decrease the forces and pressures exerted by the distal tip. CONCLUSION The high forces and pressures exerted by PVC TT may theoretically contribute to increased morbidity to patients' airway and esophagus. Caution should be exercised before attempting blind TI via the ILMA with a PVC TT.
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Affiliation(s)
- Hwan S Joo
- Departments of Anaesthesia, St. Michael's Hospital and the University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Abstract
The Intubating Laryngeal Mask Airway (ILMA) was introduced into clinical practice in 1997 following numerous clinical trials involving 1110 patients. The success rate of blind intubation via the device after two attempts is 88% in "routine" cases. Successful intubation in a variety of difficult airway scenarios, including awake intubation, has been described, with the overall success rate in the 377 patients reported being approximately 98%. The use of the ILMA by the novice operator has also been investigated with conflicting reports as to its suitability for emergency intubation in this setting. Blind versus visualized intubation techniques have also been investigated. These techniques may provide some benefits in improved safety and success rates, although the evidence is not definitive. The use of a visualizing technique is recommended, especially whilst experience with intubation via the ILMA is being gained. The risk of oesophageal intubation is reported as 5% and one death has been described secondary to the complications of oesophageal perforation during blind intubation. Morbidity described with the use of the ILMA includes sore throat, hoarse voice and epiglottic oedema. Haemodynamic changes associated with intubation via the ILMA are of minimal clinical consequence. The ILMA is a valuable adjunct to the airway management armamentarium, especially in cases of difficult airway management. Success with the device is more likely if the head of the patient is maintained in the neutral position, when the operator has practised at least 20 previous insertions and when the accompanying lubricated armoured tube is used.
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Affiliation(s)
- G Caponas
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United Kingdom
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22
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Joo H. The intubating laryngeal mask airway in severe ankylosing spondylitis. Can J Anaesth 2002; 49:439. [PMID: 11927491 DOI: 10.1007/bf03017340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Choyce A, Avidan MS, Harvey A, Patel C, Timberlake C, Sarang K, Tilbrook L. The cardiovascular response to insertion of the intubating laryngeal mask airway. Anaesthesia 2002; 57:330-3. [PMID: 11939990 DOI: 10.1046/j.1365-2044.2002.02463.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sixty-one patients received a standardised anaesthetic and were randomly assigned to three groups: tracheal intubation via direct laryngoscopy, tracheal intubation via an intubating laryngeal mask airway with immediate removal of the device, and tracheal intubation via an intubating laryngeal mask airway with delayed removal. The cardiovascular response to intubation was of a similar magnitude in all groups, although delayed removal of the intubating laryngeal mask airway was associated with a second pressor response. Norepinephrine changed significantly over time following direct laryngoscopy and following immediate removal of the intubating laryngeal mask airway, but not after delayed removal. The findings of this study do not support using the intubating laryngeal mask instead of direct laryngoscopy purely to decrease the response to intubation.
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Affiliation(s)
- A Choyce
- Anaesthetic Department, Kings College Hospital, London SE5 9RS, UK
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Martel M, Reardon RF, Cochrane J. Initial experience of emergency physicians using the intubating laryngeal mask airway: a case series. Acad Emerg Med 2001; 8:815-22. [PMID: 11483458 DOI: 10.1111/j.1553-2712.2001.tb00213.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although the intubating laryngeal mask airway (ILMA) is widely available, its use by emergency physicians (EPs) has not been reported. The authors report the initial experience of EPs using the ILMA. A review of their experience and the relevant anesthesia literature provides a basis for EPs to use the ILMA more confidently and effectively. METHODS Between January 2000 and January 2001, the ILMA was used on a convenience sample of emergency department (ED) patients undergoing "routine" intubations, and "rescue" situations, after failed rapid-sequence intubation (RSI). Patients were identified from the ED resuscitation case database. Chart review and intubating physician interviews focused on success of the device, complications encountered, and "pearls" of the device's use as perceived by the intubating physician. RESULTS Ventilation with the appropriate-size ILMA occurred in less than 15 seconds in all "routine" intubations; tracheal intubation was subsequently accomplished in less than 1 minute. Eight of nine "routine" patients had blind tracheal intubation through the ILMA. One patient required fiberoptic bronchoscopy to guide the endotracheal tube into the trachea. Of the "rescue" intubations, all patients (n = 7) were successfully ventilated and five were successfully intubated using the ILMA. CONCLUSIONS In this case series, the ILMA was easy to use in acute resuscitations, and proved to be invaluable in cases of failed RSI.
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Affiliation(s)
- M Martel
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA
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Reardon RF, Martel M. The intubating laryngeal mask airway: suggestions for use in the emergency department. Acad Emerg Med 2001; 8:833-8. [PMID: 11483462 DOI: 10.1111/j.1553-2712.2001.tb00217.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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.
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Affiliation(s)
- R F Reardon
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
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Joo HS, Kapoor S, Rose DK, Naik VN. The intubating laryngeal mask airway after induction of general anesthesia versus awake fiberoptic intubation in patients with difficult airways. Anesth Analg 2001; 92:1342-6. [PMID: 11323374 DOI: 10.1097/00000539-200105000-00050] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We performed the current study to compare tracheal intubation (TI) using awake fiberoptic intubation (AFOI) and TI using the intubating laryngeal mask airway (ILMA) in patients with difficult airway. Our hypothesis was that patients with difficult airways could be safely intubated after induction of anesthesia using the ILMA. After ethics approval and informed consent, 38 patients who were identified to have difficult airways were randomly assigned to AFOI or TI using the ILMA. Patients in the AFOI group had the usual sedation and airway topicalization. Patients in the ILMA group were induced with propofol for ILMA insertion and succinylcholine for TI. The first TI attempt was done blindly via the ILMA and all subsequent attempts were performed with fiberoptic guidance. All patients in the ILMA group were successfully ventilated. Successful TI was achieved in all patients in both groups. However, in 10% of the patients in the ILMA group, TI was achieved by a second anesthesiologist who was more experienced with the use of the ILMA. In a postoperative questionnaire, patients in the ILMA group were more satisfied with their method of TI (P < 0.01). The ILMA is a useful device in the management of patients with difficult airways and may be a valuable alternative to AFOI when AFOI is contraindicated or in the patient with the unanticipated difficult airway. IMPLICATIONS The intubating laryngeal mask airway is a useful device in the management of patients with difficult airways and may be a valuable alternative to awake fiberoptic intubation (AFOI) when AFOI is contraindicated or in the patient with the unanticipated difficult airway.
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Affiliation(s)
- H S Joo
- Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada.
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29
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Abstract
The Laryngeal Mask Airway (LMA) was developed in the 1980s, but has only recently begun to be used in Emergency Medicine. The LMA affords effective assisted ventilation without requiring endotracheal intubation or visualization of the glottis. In doing so, it is more efficacious than a bag-valve-mask apparatus, although the risk of aspiration of gastric contents persists, particularly if the device is not properly placed. The LMA also has significant potential utility in management of the difficult airway. Most reported clinical experience with the LMA has come from the operating room. This article provides an overview of the extensive potential utility of the LMA in the Emergency Department and prehospital settings as well as a comprehensive review of the pertinent advantages, disadvantages, and complications associated with its use.
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Affiliation(s)
- C V Pollack
- Department of Emergency Medicine, Arizona Heart Hospital, Phoenix, Arizona, USA
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Fan KH, Hung OR, Agro F. A comparative study of tracheal intubation using an intubating laryngeal mask (Fastrach) alone or together with a lightwand (Trachlight). J Clin Anesth 2000; 12:581-5. [PMID: 11172996 DOI: 10.1016/s0952-8180(00)00219-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine if the Trachlight lightwand can facilitate Fastrach intubation by guiding the tip of the endotracheal tube into the trachea. DESIGN Open-label, prospective, randomized, comparative study. SETTING General operating suites of a tertiary teaching hospital. PATIENTS 172 elective surgical patients requiring general anesthesia with endotracheal intubation. INTERVENTIONS With general anesthesia, the Fastrach, which is a new intubating laryngeal mask airway, was inserted into the oropharynx. Ventilation was ensured before the insertion of an endotracheal tube via the Fastrach. Tracheal intubation was then performed randomly (coin toss) using either the endotracheal tube alone (Fastrach group), or endotracheal tube with the Trachlight, a lightwand (Fastrach/Trachlight group). The time to place the Fastrach and endotracheal tube, to remove the Fastrach, and the total time to intubate were recorded. The number of attempts, failures, trauma, sore throats, and hemodynamic changes were also recorded. Data were analyzed using unpaired t-test, ANOVA with repeated measures, or Chi-squares contingency table where appropriate. MEASUREMENTS AND MAIN RESULTS Although there were no differences in the times to place the Fastrach, and endotracheal tube, the hemodynamic changes, and postoperative complications, there were significantly more attempts and failures in the Fastrach group compared to the Fastrach/Trachlight group. There were no differences in the incidence of sore throat and trauma in between the groups. CONCLUSIONS Although tracheal intubation is effective using a Fastrach alone (76% success rate), it is more effective when the Fastrach is used in conjunction with the Trachlight (95%). These results suggest that the lightwand is a useful adjunct for Fastrach intubation. However, the role of Fastrach intubation together with the Trachlight in the management of patients with a potential difficult airway remains to be determined.
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Affiliation(s)
- K H Fan
- Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada.
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31
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Lu PP, Yang CH, Ho AC, Shyr MH. The intubating LMA: a comparison of insertion techniques with conventional tracheal tubes. Can J Anaesth 2000; 47:849-53. [PMID: 10989853 DOI: 10.1007/bf03019663] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare the performance of the intubating laryngeal mask airway (ILMA) in assisting blind tracheal intubation with conventional tracheal tubes of different curvatures and the frequency of possible associated complications. METHODS After informed consent, 240 ASA I-II adults undergoing elective surgery participated in a randomized, single blind clinical trial to receive blind trachea intubation via ILMA with a conventional tracheal tube curved with normal (Normal group) or reversed (Reverse group) direction. More than three attempts at intubation was regarded as failure. The lowest oxygen saturation during intubation was recorded and postintubation sore throat and hoarseness were evaluated with verbal analog scales. RESULTS The overall success rates of intubation with Normal and Reverse groups were not different (96.7% and 94.2% respectively). Successful intubation at the first attempt was higher in the Reverse group than in the Normal group (86.7% vs 75.0%, P=0.033). The incidence of sore throat was higher in the Normal group than in the Reverse group (19.2% vs 9.2% respectively, P =0.042). CONCLUSIONS Blind trachea intubation via an ILMA with the conventional curved tracheal tube is feasible and highly successful. Reverse curve direction is preferable at the first attempt of intubation for its higher success rate and lower incidence of complications.
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Affiliation(s)
- P P Lu
- Department of Anaesthesia, Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China
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Asai T, Eguchi Y, Murao K, Niitsu T, Shingu K. Intubating laryngeal mask for fibreoptic intubation--particularly useful during neck stabilization. Can J Anaesth 2000; 47:843-8. [PMID: 10989852 DOI: 10.1007/bf03019662] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the ease of fibrescope-assisted tracheal intubation while the patient's head and neck were placed in the neutral or the manual in-line position, and to determine if the intubating laryngeal mask facilitated fibreoptic intubation in these positions. METHODS In 84 patients, the patient's head and neck were placed in the neutral position (pillow placed under occiput), and in another 40 patients the head and neck were stabilized by the manual in-line method (no pillows under occiput). In both groups, after induction of anesthesia with 2.0-2.5 mgxkg(-1) propofol, 50-100 microg fentanyl and 1.0 mgxkg(-1) vecuronium, patients were allocated randomly into two groups: in Group C tracheal intubation was attempted using only a fibrescope, whereas in Group L fibreoptic intubation through the intubating laryngeal mask was attempted. RESULTS In group C the success rate of fibreoptic tracheal intubation within two minutes was higher in the neutral position (31 of 42 patients (73%)) than in the manual in-line position (8 of 20 patients (40%)). In contrast, in group L the success rate was similar between the two positions. Tracheal intubation was easier in group L than in group C (P < 0.01 or 0.001) and the time for intubation was shorter in group L than in group C in both head and neck positions. CONCLUSIONS Fibreoptic tracheal intubation was more difficult in the manual in-line position than in the neutral position. The intubating laryngeal mask facilitated fibreoptic intubation in both positions.
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Affiliation(s)
- T Asai
- Department of Anesthesiology, Kansai Medical University, Moriguchi City, Osaka, Japan.
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Abstract
Over the last decade there has been significant advancement in airway management and a recent closed claims analysis indicates a decrease in claims since the 1980s. Studies and new airway devices have focused on managing the difficult airway and the failed intubation, problems which are common to the trauma patient. Although new airway devices have improved our ability to ventilate these patients, they are not 100% reliable nor do they provide a definitive airway. Formal training in airway management and the use of these airway devices has much room for improvement. With increased emphasis on training and the development of improved intubating aids, modern management of the difficult airway may approach 100% success.
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Affiliation(s)
- V Shearer
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9068, USA
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Stamer UM, Messerschmidt A, Wulf H, Hoeft A. Equipment for the difficult airway in obstetric units in Germany. J Clin Anesth 2000; 12:151-6. [PMID: 10818331 DOI: 10.1016/s0952-8180(00)00131-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To examine the availability of specialized equipment for the difficult airway management in obstetric units of German departments of anesthesiology. DESIGN AND SETTING An anonymous questionnaire survey was mailed to the directors of 993 German departments of anesthesiology. Completed replies were grouped by number of deliveries performed each year. MAIN RESULTS 55.5% of the hospitals responded. Data of 449 answers were evaluated for this investigation. A difficult airway cart was available in 99.3% of the departments. More detailed investigation revealed that different shaped laryngoscope blades (74.9% of the departments), laryngeal masks (91.0%), a fiberoptic bronchoscope (85.9%), and transtracheal puncture devices (59.9%) were available in the majority of the units. However, only a minority of the departments had these devices directly available in their obstetric operating rooms (OR; laryngeal masks 36.2%, fiberoptic bronchoscope 23.9%, transtracheal puncture set 22.0%). Larger units with more than 1,000 deliveries per year provided their equipment more often directly in the obstetric OR or the facility housing the obstetric unit than did smaller units with less than 1,000 deliveries per year (p< 0.001). CONCLUSIONS The survey of German departments of anesthesia revealed that specialized equipment for the difficult airway management often is not directly available in the obstetric OR. Anesthesiologists must familiarize themselves as to which difficult airway equipment is available in their unit and where it is stored.
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Affiliation(s)
- U M Stamer
- Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Germany.
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Selim M, Mowafi H, Al-Ghamdi A, Adu-Gyamfi Y. Intubation via LMA in pediatric patients with difficult airways. Can J Anaesth 1999; 46:891-3. [PMID: 10490160 DOI: 10.1007/bf03012981] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To report two cases of successful tracheal intubation in difficult pediatric airways using a conventional laryngeal mask airway (LMA) with an extended polyvinyl chloride (PVC) tube after laryngeal assessment with a fibreoptic device. CLINICAL FEATURES Two cases, Dandy-Walker and Pierre Robin syndromes, were scheduled for surgery. They were premedicated with 0.5 mg x kg(-1) promethazine p.o. 90 min before surgery. Both patients arrived in the operating room sedated, with dry mouth, and without evidence of increased intracranial tension or airway obstruction. Inhalational induction with isoflurane 0.5-3% was commenced. Conventional tracheal intubation was impossible in both cases. In each an LMA was inserted to maintain ventilation, anesthesia, and to facilitate intubation. Fibreoptic bronchoscopy was used to assess the larynx, followed by blind intubation via the LMA using extended PVC tracheal tube (TT). Anesthesia was maintained during intubation using Mapleson F anesthesia circuit attached to a connector with fibreoptic bronchoscope adapter. CONCLUSION This report describes the assessment of the airway with fibreoptic bronchoscopy after LMA insertion facilitated blind tracheal intubation in two children with difficult airways.
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Affiliation(s)
- M Selim
- Department of Anaesthesia, King Fahd Hospital, Faculty of Medicine and Medical Sciences, King Faisal University, Saudi Arabia
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37
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Kiyama S. Use of a Laryngeal Mask in a Patient with an Unstable Neck. Anesth Analg 1999. [DOI: 10.1213/00000539-199908000-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kiyama S. Use of a laryngeal mask in a patient with an unstable neck: at induction or during emergence? Anesth Analg 1999; 89:537-8. [PMID: 10439792 DOI: 10.1097/00000539-199908000-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Reid AW, Warmington AD, Wilkinson LM. Management of a pregnant patient with airway obstruction secondary to goitre. Anaesth Intensive Care 1999; 27:415-7. [PMID: 10470401 DOI: 10.1177/0310057x9902700416] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A case of airway obstruction in advanced pregnancy is presented. The patient was successfully managed with an awake fibreoptic intubation performed orally followed by a caesarean section and thyroidectomy as a combined procedure. On resection, a thyroid gland weighing 370 g was removed. The patient made an uneventful recovery.
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Affiliation(s)
- A W Reid
- Department of Anaesthesia, National Women's Hospital, Auckland, New Zealand
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Wong JK, Tongier WK, Armbruster SC, White PF. Use of the intubating laryngeal mask airway to facilitate awake orotracheal intubation in patients with cervical spine disorders. J Clin Anesth 1999; 11:346-8. [PMID: 10470641 DOI: 10.1016/s0952-8180(99)00052-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Airway management in patients with unstable cervical spines remains a challenge for anesthesia providers. Because neurologic evaluations may be required following tracheal intubation and positioning for the surgical procedure, an awake intubation technique is desirable in this patient population. In this report, we describe the use of an intubating laryngeal mask airway (ILMA) to facilitate awake tracheal intubation in two patients with cervical spine disorders. After topical local analgesia, the ILMA was inserted easily, and a tracheal tube was passed through the glottic opening without complications. Thus, the ILMA may be an acceptable alternative to the fiberoptic bronchoscope for awake tracheal intubation.
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Affiliation(s)
- J K Wong
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068, USA
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Watson NC, Hokanson M, Maltby JR, Todesco JM. The intubating laryngeal mask airway in failed fibreoptic intubation. Can J Anaesth 1999; 46:376-8. [PMID: 10232724 DOI: 10.1007/bf03013232] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Prediction of difficult tracheal intubation is not always reliable and management with fibreoptic intubation is not always successful. We describe two cases in which blind intubation through the intubating laryngeal mask airway (ILMA FasTrach) succeeded after fibreoptic intubation failed. CLINICAL FEATURES The first patient, a 50 yr old man, was scheduled for elective craniotomy for intracerebral tumour. Difficulty with intubation was not anticipated. Manual ventilation was easily performed following induction of general anesthesia, but direct laryngoscopy revealed only the tip of the epiglottis. Intubation attempts with a styletted 8.0 mm endotracheal tube and with the fibreoptic bronchoscope were unsuccessful. A #5 FasTrach was inserted through which a flexible armored cuffed 8.0 mm silicone tube passed into the trachea at the first attempt. The second patient, a 43 yr old man, presented with limited mouth opening, swelling of the right submandibular gland that extended into the retropharynx and tracheal deviation to the left. He was scheduled for urgent tracheostomy. Attempted awake fibreoptic orotracheal intubation under topical anesthesia showed gross swelling of the pharyngeal tissues and only fleeting views of the vocal cords. A #4 FasTrach was easily inserted, a clear airway obtained and a cuffed 8.0 mm silicone tube passed into the trachea at the first attempt. CONCLUSION The FasTrach may facilitate blind tracheal intubation when fibreoptic intubation is unsuccessful.
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Affiliation(s)
- N C Watson
- Department of Anesthesia, Foothills Medical Centre, Calgary, Alberta
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Abstract
UNLABELLED We conducted this feasibility study using the intubating laryngeal mask airway (ILMA) and a polyvinyl chloride tracheal tube to compare success rates, hemodynamic effects, and postoperative morbidity with two methods of tracheal intubation. After ethics approval and informed consent, 90 healthy ASA physical status I or II women with normal airways were enrolled in the randomized, controlled study. After a standardized inhaled anesthesia induction protocol, tracheal intubations using ILMA with fiberoptic guidance (ILMA-FOB) and ILMA inserted blindly without fiberoptic guidance (ILMA-Blind) were compared with the control group of direct laryngoscopy (laryngoscopy group). All 90 patients were successfully ventilated. For tracheal intubation, success rates were equal in all three groups (97%). Total intubation times were longer for the ILMA-FOB group (77 s versus 48.5 s for laryngoscopy and 53.5 s for ILMA-Blind). The laryngoscopy group had a larger increase in mean arterial blood pressure to tracheal intubation. There were no differences in postoperative sore throat or hoarseness among the groups. In conclusion, success rates are equally high for tracheal intubation using ILMA-Blind and ILMA-FOB techniques in women with normal airways. IMPLICATIONS The intubating laryngeal mask airway (ILMA) can be used as a primary airway for oxygenation and ventilation. Both methods of tracheal intubation using the ILMA were equally successful. Postoperative morbidity in the ILMA groups was similar to that in the laryngoscopy group. For women with normal airways, both the ILMA inserted blindly and the ILMA with fiberoptic guidance are suitable alternatives to laryngoscopy for tracheal intubation.
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Affiliation(s)
- H S Joo
- Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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Asai T, Matsumoto H, Shingu K. Awake tracheal intubation through the intubating laryngeal mask. Can J Anaesth 1999; 46:182-4. [PMID: 10084001 DOI: 10.1007/bf03012555] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To report successful awake insertion of the intubating laryngeal mask (Fastrach) and subsequent tracheal intubation through it, in a patient with predicted difficult tracheal intubation, due to limited mouth opening, and difficult ventilation through a facemask, due to a large mass at the corner of the mouth. CLINICAL FEATURES A 53-yr-old woman with a large post-gangrenous mass on the right cheek to the angle of the mouth was scheduled for its resection. The right side of her face was damaged by a bomb attack followed by cancrum oris 50 yr ago. The distance between the incisors during maximum mouth opening was 2 cm and that between the gums on the right side < 1 cm. After preoxygenation and 50 micrograms fentanyl and 30 mg propofol i.v., propofol was infused at 2 mg.kg-1.hr-1. Lidocaine, 8%, was sprayed on the oropharynx. A #4 intubating laryngeal mask was inserted with a little difficulty. A fibrescope was passed through a 7.5-mm ID RAE tracheal tube, and the combination was easily passed through the laryngeal mask into the trachea. General ansthesia was then induced. Finally, the intubating laryngeal mask was removed, while the RAE tube was being stabilized using an uncuffed 6.0-mm ID tracheal tube. CONCLUSION Awake tracheal intubation through the intubating laryngeal mask is a useful technique in patients with limited mouth opening in whom ventilation via a facemask is expected to be difficult.
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Affiliation(s)
- T Asai
- Department of Anaesthesiology, Kansai Medical University, Osaka, Japan.
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Brimacombe J, Keller C, Berry A. Pharyngolaryngeal morbidity with the intubating laryngeal mask airway. Anaesthesia 1998; 53:1231. [PMID: 10193236 DOI: 10.1046/j.1365-2044.1998.0716f.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Beriault M. Intubation with the LMA. Can J Anaesth 1998; 45:1222-3. [PMID: 10051950 DOI: 10.1007/bf03012475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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