The impact of manual in‐line stabilisation on ventilation and visualisation of the glottis with the LMA CTrach™: a randomised crossover trial*

Abstract

SummaryThe LMA CTrach TM (CTrach) enables ventilation, glottis visualisation and tracheal intubation via a laryngeal mask conduit. The CTrach has been successfully used in patients with cervical spine pathology, but it is unclear if cervical spine immobilisation affects its ease of use. In this randomised crossover trial, the CTrach was used once with and once without manual in-line stabilisation of the cervical spine in every patient. With manual in-line stabilisation, the median [IQR] time to achieve ventilation was 22 [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The application of manual in-line stabilisation (MILS) in patients with cervical spine injuries can make laryngeal mask airway insertion and tracheal intubation more difficult [1,2]. Using an Intubating Laryngeal Mask Airway (ILMA) (The Laryngeal Mask Company, Singapore) together with a fibreoptic bronchoscope can improve the success rate of tracheal intubation during MILS as compared with using a Macintosh laryngoscope combined with a bougie [3]. The LMA CTrach TM system (The Laryngeal Mask Company) is a further development of the ILMA that incorporates fibreoptic channels in the laryngeal mask conduit, and has a detachable liquid crystal display viewer. It optimises laryngeal mask placement and tracheal intubation under direct vision. Provided the larynx can be fully visualised with the CTrach, the first attempt success rate of tracheal intubation is between 96-100% [4,5]. In a recent comparison, the first attempt success rate was 93% with the CTrach compared with 68% with the ILMA [6].The CTrach has been used successfully in patients with difficult airways due to anatomical variations, limited cervical spine mobility and obesity [7][8][9][10]. Although the CTrach is designed to be used with minimal neck movement, the impact of MILS on its use is presently unclear. In our practice, we had perceived some subjective difficulty in CTrach use when MILS was applied. Therefore we wished to evaluate the impact of MILS on the ease of achieving ventilation and glottis visualisation with the CTrach, in a randomised crossover trial. MethodsWe obtained institutional review board approval and written informed consent from 50 patients, aged 21-80 years, ASA I-III status, who were having elective surgery that required general anaesthesia and tracheal intubation. We excluded patients who had cervical spine

Tracheal intubation through laryngeal mask airway CTrach™ with polyvinyl chloride tube: Comparison between two orientations of the tracheal tube

“…It is similar to the intubating LMA (LMA Fastrach™) with an advantage of the ability to visualize in the viewer the passage of the tracheal tube through the glottis during intubation. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ] The main advantage of LMA CTrach™ is that with the help of the LMA CTrach™ viewer, the LMA CTrach™ outlet can be aligned in line with the laryngeal inlet that leads to high first intubation success rate. [ 2 3 4 ] Cost effectiveness and comparable success rates are the main reasons to choose polyvinyl chloride (PVC) tracheal tubes over the dedicated silicone tubes used with LMA Fastrach™.…”