Awake tracheal intubation through the intubating laryngeal mask

Department of Anaesthesiology, Kansai Medical University, Osaka, Japan.
Canadian Journal of Anaesthesia (Impact Factor: 2.53). 02/1999; 46(2):182-4. DOI: 10.1007/BF03012555
Source: PubMed


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.
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 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.
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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Available from: Takashi Asai, Sep 03, 2014
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    • "The ILMA allows for easy passage of a well-lubricated 8.0-mm internal diameter (ID) cuffed ETT, and it optimizes the angle at which the trachea is intubated. However, the ILMA has several disadvantages that become apparent with use: because of its cost, the ILMA may not always be available at every anesthesia workstation, and there are concerns about using the ILMA in patients with limited mouth opening [12,13] and in patients wearing semi-rigid neck collars [14]. Additionally, the ETT designed for use with the ILMA has a low volume/high pressure cuff, and anesthesiologists are reluctant to use these ETTs for prolonged periods [15]. "
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    ABSTRACT: A 28-year-old male patient with occipito-atlanto-axial instability underwent a cervical fusion with posterior technique. Post-operatively, the endotracheal tube (ETT) was removed, and the patient was transferred to the intensive care unit. After transfer, an upper airway obstruction developed and reintubations with a laryngoscope were attempted but failed. We inserted a #4 proseal laryngeal mask airway (LMA) and passed a 5.0 mm ETT through the LMA with the aid of a fiberoptic bronchoscope. We passed a tube exchanger through the 5.0 mm ETT and exchanged it with a 7.5 mm ETT. This method may be a useful alternative for difficult tracheal intubations.
    Korean journal of anesthesiology 03/2014; 66(3):237-9. DOI:10.4097/kjae.2014.66.3.237
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    Canadian Journal of Anaesthesia 09/1999; 46(8):807-8. DOI:10.1007/BF03013923 · 2.53 Impact Factor
  • Anesthesiology 05/2000; 92(4):1199-1200. · 5.88 Impact Factor
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