An evaluation of poor LMA CTrach™ ‡ views with a fibreoptic laryngoscope and the effectiveness of corrective measures †

Abstract

Despite the ability to ventilate the lungs in all patients with the CTrach, poor initial views were very frequent, indicating suboptimal placement, although most poor views can be improved, leading to a high intubation success rate.

A Study of the Lma C - Trach Tm Guided Intubation With Special Reference to the Conventional Laryngoscopic Cormack and Lehane Grading System

“…We did not find any correlation between Cormack and Lehane laryngoscopic grading and the EVGS through LMA CTrach TM in our study ( Table 2) that corroborated with the study conducted by Liu EHC et al 8 In another study by Liu EHC et al, 7 they found no meaningful correlation between the Cormack and Lehane laryngoscopy grade in the LMA Fastrach™ and LMA CTrach™ groups. Table 3 shows the number of patients in different EVGS grades after initial placement of the CTrach and respective numbers in final view after manipulation of the CTrach and also the comparison of percentages of patients in each grade in initial and final view.…”

“…7 We attempted to see an agreement of 0.16 between the procedures in our sample. The prevalence of difficult intubation in the general population was considered 2%.…”

Comparison of the laryngeal mask airway - CTrachTM and direct coupled interface-video laryngoscope for endotracheal intubation: A prospective, randomized, clinical study

“…Some adjustment maneuvers can be performed to improve ventilation and optimize the glottic view with CT. The up-down maneuver is an effective corrective maneuver because epiglottic downfolding is seen frequently (12). In our study, we found that the forward maneuver was the most useful maneuver in the CT group to optimize the glottic view.…”

“…Intubation success rates, intubation times and airway complications views and short optimal glottic view time with the DCI-VL, intubation success rates at the first attempt were not different. Poor views due to secretions or epiglottic structures were very common when using CT, and Liu et al (5) have argued that the failure in achieving an acceptable larynx view in a great number of patients compromises the clinical value of CT. Another reason for the poor quality of the initial laryngeal view with CT may be attributed to the position of the lens in the CT. Because the lens is very close to the laryngeal structures, the process of obtaining images can be easily disrupted by secretions and moisture (12). In addition, the possibility of epiglottic downfolding and obstruction by the arythenoids is increased with the LMA design of the CT. All of these reasons may increase the time to achieve a good view of the glottis with the CT.…”

“…In case of failure, we subsequently performed adjustment maneuvers to obtain an optimum view. Adjustment maneuvers included the "Chandy maneuver" (rotation of the device in the sagittal plane, using the handle to lift the cuff slightly away from the posterior pharyngeal wall), the forward maneuver (pushing the CT in deeper) and the "up-down maneuver" (partial withdrawal and reinsertion with the cuff inflated) (12). Three insertion attempts were allowed and more than three attempts were regarded as a failed insertion.…”