Yet another foreign body in a laryngeal mask airway

An Avulsed Tooth Detected Prior to Insertion of a Laryngeal Mask Airway

This case report describes the importance of inspecting the hypopharynx via direct laryngoscopy prior to laryngeal mask airway (LMA) insertion during induction of general anesthesia for dental patients with special needs. A 51-year-old man with cerebral palsy underwent induction of general anesthesia for dental extractions and subsequently was noted to be missing a tooth. Prompt inspection of the airway via direct laryngoscopy revealed the tooth resting within the pharynx, which was subsequently retrieved, prior to insertion of the LMA. Visual inspection of the oropharynx and hypopharynx by laryngoscopy prior to LMA insertion can be useful in preventing accidental aspiration and ingestion of foreign bodies, particularly with certain high-risk patients. Use of laryngoscopy should also be considered if an object is lost or possibly impinging upon the airway.

An Unusual Cause of Intubating Laryngeal Mask Obstruction Preventing Successful Intubation in the Emergency Department

BACKGROUND

The intubating laryngeal mask airway (ILMA) allows providers to blindly intubate through the device. We report a case of foreign material obstructing passage of an endotracheal tube (ET) through an ILMA.

CASE REPORT

A 45-year-old man with unknown past medical history was found obtunded with an apparent intentional drug and alcohol overdose, and required tracheal intubation. We opted to use an ILMA to optimize preoxygenation prior to intubation. His upper dentures were removed and an ILMA was inserted without complication; ventilation was easily performed. Blind tracheal intubation was attempted; the ET was inserted through the ILMA and was unable to be advanced past 15 cm despite multiple attempts, including repositioning the ILMA and rotating the ET. The ILMA was removed to prepare for video laryngoscopy. He was subsequently successfully intubated using a standard geometry video laryngoscope, which showed no anatomical abnormalities. After the case, the ILMA was inspected and the bowl of the ILMA was found to be occluded with denture adhesive. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report demonstrates that it is possible that foreign material within the ILMA can make successful intubation impossible, despite successful placement and ventilation through the device. Maneuvers may be performed to attempt successful ET intubation, but when unsuccessful, removal of the ILMA and alternate airway management must be performed.

Common faults in resuscitation equipment--guidelines for checking equipment and drugs used in adult cardiopulmonary resuscitation

Successful advanced life support relies, in part, upon the availability and correct functioning of resuscitation equipment. However, numerous publications report deficiencies and defects in key items of resuscitation equipment, particularly those relating to airway management and defibrillation. Some of these are generic and relate to basic device failure (e.g. intrinsic design faults, manufacturing errors, random component failure), external factors (e.g. power failure, gas supply failure, electromagnetic interference) and human error (notably, inadequate knowledge, lack of experience and training, inadequate checking, insufficient maintenance). However, others are device specific. This paper identifies the common, generic faults that lead to equipment malfunction and recommends the resuscitation equipment essential for successful cardiopulmonary resuscitation. It also describes examples of specific equipment malfunction and makes suggestions for the nature and frequency of resuscitation equipment and drug checks, using a structured, and easy-to-recall list.