Seventy consecutive patients were randomly allocated for intubation through the intubating laryngeal mask airway using a straight reinforced silicone tracheal tube with either a conventional or a modified bevel. The conventional bevel was firm, wedge-shaped and with a leading edge at the side. The modified bevel was soft, hemispherical and with a leading edge in the midline. The intubating laryngeal mask position was adjusted until optimal ventilation was obtained and intubation was attempted using the randomised device. If tactile resistance was felt, a predetermined sequence of adjusting manoeuvres were utilised before a subsequent attempt. The first-attempt successful intubation rate with the conventional bevel was 23/37 (62%) and with the modified bevel was 28/33 (85%). The second-attempt successful intubation rate for the conventional bevel was 12/37 (32%) and for the modified bevel was 4/33 (12%). Intubation failed after three attempts for one patient in each group. Fewer overall intubation attempts were required with the modified bevel (p = 0.033). We conclude that intubation success rates through the intubating laryngeal mask with a straight silicone-reinforced tube are higher with a soft, hemispherical bevel with a leading edge in the midline compared with the firm, wedge-shaped bevel with a leading edge at the side.
We describe a case of an uncooperative patient with recessive dystrophic epidermolysis bullosa in whom difficult tracheal intubation was anticipated and fibreoptic bronchoscope guided tracheal intubation was successfully achieved after induction of general anaesthesia. Other problems in airway management associated with this disorder are discussed.
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