Airway rescue in acute upper airway obstruction using a ProSeal^™ Laryngeal mask airway and an Aintree Catheter^™: a review of the ProSeal^™ Laryngeal mask airway in the management of the difficult airway

Abstract

SummaryWe report the successful use of a ProSeal TM Laryngeal mask airway (PLMA) to rescue the airway when emergency tracheal intubation and ventilation of the lungs were impossible after haemorrhage into the neck following carotid endarterectomy, despite evacuation of the clot. The airway was re-established after placement of a PLMA. Fibreoptic examination of the airway revealed severe supraglottic swelling compromising airway patency. An Aintree catheter was placed in the trachea under fibreoptic guidance and a tracheal tube railroaded over this. The use of the PLMA in seven cases of difficult airway management and 11 cases of airway rescue is reviewed. Use of the PLMA was associated with high levels of success, often rescuing the airway when other techniques had failed. No complications of use of the PLMA were reported in these cases. The PLMA appears to be a useful device to assist in management of the difficult airway and for airway rescue. Potential advantages over the classic laryngeal mask airway include improved airway seal and reduced risk of aspiration. The gum elastic bougie-guided insertion technique is recommended when the PLMA is used for airway rescue.

Supraglottic airways in difficult airway management: successes, failures, use and misuse

“…Also the ILMA, designed especially for the management of the difficult airway, has been described as being successfully used for ventilation in the anticipated [26][27][28][29][30][31][32] and unanticipated [33,34] difficult airway in 97-100% of cases. Case reports or series (level 4) of successful ventilation in patients with difficult airways have been described for many other SADs: the LMA PLMA [35][36][37][38][39][40][41], the SLMA [42][43][44], the i-gel [45][46][47][48][49][50], the Ambu-i TM [51], the Air-Q [52][53][54][55], the CobraPLA [56] and the CobraPLUS [57]. The Laryngeal Tube, designed for emergency ventilation, is also successfully described in difficult airway management in elective adult [58] and paediatric [59] patients in the operation room.…”

Use of intubation introducers through a supraglottic airway to facilitate tracheal intubation: a brief review

“…In three case reports, tracheal intubation with an AIC through the LMA ProSeal TM was attempted in ten patients with difficult or failed intubation (Table 1). 14,19,23 Seven of the ten cases were successful (70%). Of the three failed cases, the first failed case was subsequently managed by AIC-aided intubation through an LMA Classic TM .…”

“…The device is 57 cm long with an ID of 4.7 mm, which allows the passage of a 4.5-mm bronchoscope through its lumen and leaves the distal 3-10 cm of the bronchoscope unsheathed for ease of manipulation. 14 The AIC has an outer diameter of 6.3 mm, which allows ETTs size 6.5 mm or greater to be inserted. 13 During tracheal intubation, the AIC is mounted over a bronchoscope (Fig.…”

S1 guidelines on airway management

“…If the blind endotracheal intubation fails or if a different EGA is primarily chosen, a flexible intubation endoscope can be used for endotracheal guidance; alternatively an intubation catheter can be initially placed serving as a tracheal guide splint for secondary tube advancement [34][35][36].…”