Intubating Laryngeal Mask Airway

Abstract

The Intubating Laryngeal Mask Airway (ILMA) was introduced into clinical practice in 1997 following numerous clinical trials involving 1110 patients. The success rate of blind intubation via the device after two attempts is 88% in "routine" cases. Successful intubation in a variety of difficult airway scenarios, including awake intubation, has been described, with the overall success rate in the 377 patients reported being approximately 98%. The use of the ILMA by the novice operator has also been investigated with conflicting reports as to its suitability for emergency intubation in this setting. Blind versus visualized intubation techniques have also been investigated. These techniques may provide some benefits in improved safety and success rates, although the evidence is not definitive. The use of a visualizing technique is recommended, especially whilst experience with intubation via the ILMA is being gained. The risk of oesophageal intubation is reported as 5% and one death has been described secondary to the complications of oesophageal perforation during blind intubation. Morbidity described with the use of the ILMA includes sore throat, hoarse voice and epiglottic oedema. Haemodynamic changes associated with intubation via the ILMA are of minimal clinical consequence. The ILMA is a valuable adjunct to the airway management armamentarium, especially in cases of difficult airway management. Success with the device is more likely if the head of the patient is maintained in the neutral position, when the operator has practised at least 20 previous insertions and when the accompanying lubricated armoured tube is used.

Repeated attempts improve tracheal tube insertion time using the intubating laryngeal airway in a mannequin

“…2). The sequence of steps of tracheal tube intubation and subsequent removal of the ILA using the stabilizer is identical to the methodology used for the Intubating LMA [1,3].…”

“…Airway (Intubating LMA; LMA-Fastrach; LMA North America, Inc.), permit blind or endoscope-guided tracheal intubation [1][2][3][4]. In unanticipated difficult airway situations, tracheal intubation through a LMA or Intubating LMA has been recommended as an alternative tracheal tube intubation strategy by the recent ASA Difficult Airway Guidelines and Difficult Airway Society guidelines [5,6].…”

Methoden des Atemwegsmanagements in der pr�klinischen Notfallmedizin

“…Über ihren Nutzen in der Notfallmedizin und im Rahmen der schwierigen Intubation existieren zahlreiche Übersichtsarbeiten und Fallberichte [26,99].…”

“…Anders als bei der konventionellen Intubation scheint eine Relaxation die Erfolgsrate nicht zu erhöhen [26,28,62,66,99]. Nachteilig ist der hohe Anschaffungspreis.…”

“…Wie die üb-rigen Larynxmasken positioniert sich auch die ILMA beim Blocken. Einer Metaanalyse zufolge ist die blinde endotracheale Intubation nach einer variablen Anzahl an Versuchen in bis zu 97% der Fälle erfolgreich[26]. Ösophageale Fehllagen des blind über die ILMA eingeführ-ten Tubus wurden mit einer Inzidenz von 5% angegeben.…”