Blind intubation via the laryngeal mask: a word of caution

Correspondence: Blind intubation through the air‐Q laryngeal mask in children – A word of caution

“…Because of the near orthogonal orientation of the epiglottis in relation to the laryngeal axis in infants and small children, fiberoptic visualization through appropriately inserted laryngeal masks often reveals the epiglottis apposed to the airway tube of the laryngeal mask (2). A flexible fiberoptic scope allows us to improve the alignment of the laryngeal mask before attempts at intubation, improving success and minimizing trauma.…”

Continuous ventilation technique for laryngeal mask airway (LMATM) removal after fiberoptic intubation in children

“…Thus, the technique is not dependent on fiberoptic intubation and can be used also with blind tracheal intubation through the LMA in children, although in children fiberoptic‐guided intubation through the LMA is preferred. (25,26). It must be pointed out that with the proposed technique the outer diameter of the connection part may become critically large within the LMA No.…”

Alternative Ventilation Strategies: Laryngeal Masks

“…The included studies were classified into eight levels of evidence by study design and methodology following a modification of the system described by the American Heart Association and International Liaison Committee on Resusci- Abouleish [42], Auden [43], Carenzi [44], Cortez [45], Ellis [46], Hansen [47], Hinton [48], Johr [49], Lesmes [50], Lonnqvist [51], Lopez-Gil [11], Markakis [52], Mecklem [53], Oliva [54], Park [55], Puebla [56], Shank [57], Theroux [58], Trevisanuto [59],…”

“…Observational studies describing laryngeal masks used with neonates to administer anesthesia, to facilitate endotracheal intubation, or to facilitate diagnostic bronchoscopy were assigned to level of evidence 7 (extrapolation) regardless of methodology. In total, our search identified 48 relevant studies, including one Cochrane systematic review [15], one small randomized controlled trial [16], two nonrandomized cohort studies [2,17], three large uncontrolled case series [18][19][20], three mechanical or animal models [21][22][23], and multiple smaller case series or individual case reports for neonatal resuscitation [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and other nonresuscitation purposes [11,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]…”

“…Sixteen case reports describe a total of 18 neonatal patients in whom a laryngeal mask was used as a lifesaving rescue airway during resuscitation when facemask ventilation and endotracheal intubation had been unsuccessful [24][25][26][27][28][29][30][31][32]34,[36][37][38][39][40][41]. Several additional reports describe the laryngeal mask used to guide intubation when direct laryngoscopy was unsuccessful [30,36,43,46,47,58,[61][62][63]. The ETT either was advanced blindly into the larynx through the mask or was advanced over a fiberoptic bronchoscope that had been placed through the mask.…”