Awake intubation using an intubating laryngeal mask airway in a parturient with spina bifida

Degler, Shawn M.; Dowling, Rachel D.; Sucherman, Daniel R.; Leighton, Barbara L.

doi:10.1016/j.ijoa.2004.07.010

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…[39][40][41] Hence, the FT-LMA can be utilized when awake techniques are necessitated or when access to FOB is limited and an awake technique is necessary.…”

Section: Indications For Placementmentioning

confidence: 99%

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Gerstein

Braude

Hung

et al. 2010

Can J Anesth/J Can Anesth

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Purpose To provide an evidence-based overview and update on the use of the Fastrach TM Intubating Laryngeal Mask AirwayÒ (FT-LMA) when used within operative and non-operative settings. Principal findings The FT-LMA is available in three sizes to provide ventilation and the ability to pass an endotracheal tube (ETT) into the trachea blindly, semi-blindly, or with indirect visualization for patients over 30 kg. The Chandy maneuver is recommended routinely; the first maneuver optimizes ventilation, and the second maneuver increases success at endotracheal intubation (ETI). The manufacturer's reinforced tube or a pre-warmed or reversed standard ETT may be utilized. Insertion and ventilation are successful in almost all patients. Blind ETI is highly successful; adjuncts are generally not necessary. The FT-LMA has a proven role in the airway management of anticipated difficult operating room (OR) intubations, unanticipated OR intubations, cervical spine injuries, and limited airway access situations. Literature in the pre-hospital and emergency department settings is limited but favourable. The FT-LMA has compared favourably with fibreoptic intubation, the LMA-Classic TM , the laryngeal tube, and the CobraPLA TM . Initially, the more expensive LMA CTrach TM appeared to be more successful, but overall it is not. The FT-LMA airway seal pressures are excellent; serious complications are uncommon, and the FT-LMA figures prominently in most difficult airway guidelines. Conclusions The FT-LMA has proven to be a useful difficult airway device both within and outside of the operating room. Effective ventilation is established in nearly all cases, and blind ETI is possible in the vast majority of cases if the optimal techniques described are used. Serious complications are uncommon. Constatations principales Le FT-LMA est disponible en trois tailles pour permettre la ventilation et le passage d'une sonde endotrache´ale (SET) dans la trache´e de façon aveugle, semi-aveugle ou avec visualisation directe chez les patients pesant plus de 30 kg. La manoeuvre de Chandy est recommande´e de façon routinie`re; la premie`re manoeuvre optimise la ventilation, et la seconde augmente le succe`s lors d'une intubation endotrache´ale (IET). La sonde arme´e du fabricant ou une SET standard pre´chauffe´e ou inverse´e peut eˆtre utilise´e. L'insertion et la ventilation re´ussissent chez presque tous les patients. L'IET en aveugle a un taux de re´ussite e´leve´; en re`gle ge´ne´rale, les accessoires ne sont pas ne´cessaires. Le FT-LMA joue un rôle e´prouve´dans la prise en charge des voies ae´riennes lors d'intubations anticipe´es comme difficiles dans la salle d'ope´ration (SOP), d'intubations impre´vues en SOP, de le´sions de la colonne cervicale et dans les situations oul 'acce`s aux voies ae´riennes est limite´. La litte´rature portant sur son utilisation dans des contextes pre´-hospitaliers et dans le de´partement des urgences est restreinte mais favorable. Le FT-LMA a e´te´favorablement compare´al 'intubation par fibroscopie, au LMA...

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“…[39][40][41] Hence, the FT-LMA can be utilized when awake techniques are necessitated or when access to FOB is limited and an awake technique is necessary.…”

Section: Indications For Placementmentioning

confidence: 99%

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Gerstein

Braude

Hung

et al. 2010

Can J Anesth/J Can Anesth

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“…We have included 136 reports, both full publications and abstracts, covering 158 cases (see also Supporting Information, Appendices S1–S6) . Case reports largely fall into two groups: those describing equipment, or a technique, for provision of general anaesthesia; or those identifying a woman who had predicted airway difficulty, who was managed with regional analgesia or anaesthesia with the aim of avoiding of general anaesthesia.…”

Section: Resultsmentioning

confidence: 99%

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

2020

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We reviewed the literature on management of general and regional anaesthesia in pregnant women with anticipated airway difficulty. We identified 138 publications comprising 158 cases; these either described equipment or techniques for the provision of general anaesthesia, or the management of women with regional analgesia or anaesthesia, with the aim of avoiding general anaesthesia. Most of the former group described women requiring caesarean section alone, or in combination with other surgery, which was sometimes airwayrelated. Management techniques were largely similar to those in non-obstetric patients requiring surgery who have airway difficulties, although suggested differences related to physiological changes of pregnancy and avoidance of nasal intubation. In the reports discussing regional anaesthesia, consideration was often given to the possible requirement for urgent out-of-hours anaesthetic intervention, and the predicted difficulty of management of general anaesthesia should it be required. In a number of reported cases, multidisciplinary planning led to the conclusion that elective caesarean section should be performed in order to avoid emergency airway management. Based on this literature review, we advise antenatal planning that includes: assessment of the patient's clinical characteristics; consideration of the equipment and personnel available to provide safe airway management out-of-hours; and elective caesarean section should these be lacking. If general anaesthesia is required, a risk assessment must be made as to the probability of safe airway management after the induction of anaesthesia, and awake tracheal intubation should be used if this cannot be assured. Decision aids are provided to illustrate these points. Online appendices include a comprehensive compendium of case reports on the management of a number of rare syndromes and airway conditions.

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“…[ 16 17 ] More case reports described successful uses of LMA in CDs when tracheal intubation or facemask ventilation was impossible. [ 4 5 6 7 8 9 10 ] Three large-sample studies also successfully reported their experience of using different types of the LMAs in more than 4700 parturients and reported no cases of aspiration but one case of regurgitation, although it should be noted that low-risk patients were selected in these studies. Patients who had a potentially difficult airway, BMI ≥35 kg/m 2 , or gastroesophageal reflux were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 2 3 ] Many reports have shown successful or even lifesaving use of the LMA in providing ventilation and oxygenation when tracheal intubation has failed, including the “cannot intubate, cannot ventilate” situation during obstetrical anesthetic practice. [ 4 5 6 7 8 9 10 ]…”

Section: Introductionmentioning

confidence: 99%

Laryngeal Mask Airway for Cesarean Delivery

Geng

Wang

2017

Chinese Medical Journal

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Background:The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA).Methods:We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups.Results:During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups.Conclusions:Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.

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Awake intubation using an intubating laryngeal mask airway in a parturient with spina bifida

Cited by 8 publications

References 9 publications

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

The FastrachTM Intubating Laryngeal Mask Airway®: an overview and update

Anticipated difficult airway during obstetric general anaesthesia: narrative literature review and management recommendations.

Laryngeal Mask Airway for Cesarean Delivery

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