The intubating laryngeal maskClinical appraisal of ventilation and blind tracheal intubation in 110 patients

Abstract

SummaryThis study assesses the efficacy of the intubating laryngeal mask as a ventilation device and blind intubation guide. Following induction of anaesthesia with propofol, the device was successfully inserted at the first attempt in 110/110 (100%) patients. Placement took less than 10 s in all patients. Size selection was based on nose-chin distance. Adequate ventilation was achieved in 104/110 (95%) patients. Blind tracheal intubation using an 8-mm internal diameter straight silicone cuffed tracheal tube was attempted 3 min after the administration of vecuronium. Passage of a lighted stylet through the intubating laryngeal mask was used to determine the position of the intubating laryngeal mask cuff before blind intubation. If resistance was felt during intubation, a sequence of adjusting manoeuvres was used, based on the depth at which resistance occurred. Tracheal intubation was possible in 104/104 (100%) patients. In 42 (40%) patients, no resistance was encountered and the trachea was intubated at the first attempt. Sixty-two (60%) patients required one adjusting manoeuvre. The mean (range) time taken to successful intubation, i.e. the time from disconnection of the intubating laryngeal mask from the breathing system to successful tracheal intubation, was 79 (12-315) s. Six patients with potential or known intubation problems were included in the study. The tracheas of all six patients were successfully intubated. We conclude that the intubating laryngeal mask is an effective ventilation device and intubation guide with potential for use in patients who may present difficulty in tracheal intubation.

Comparison of the air-Q ILA™ and the LMA-Fastrach™ in airway management during general anaesthesia

“…This result is consistent with other studies which varied between 89.5-100%. [15][16][17][18] Ease of tracheal intubation using the LMAFastrach ™ was significantly superior to using the air-Q ™ ILA in terms of cricoid manipulation requirement, ease of passage, number of attempts required, and eventual success rate.…”

“…[8][9][10][11][12][13][14] Reported success rates of tracheal intubation using the LMA-Fastrach ™ have varied between 89.5-100%. [15][16][17][18] Intubation using the intubating laryngeal mask airway has been associated with lesser adverse cardiovascular responses, compared to conventional intubation with direct laryngoscopy. Fewer incidents of injury to teeth and lips were reported as the laryngoscope was not required.…”

Difficult Airway Society guidelines for management of the unanticipated difficult intubation

“…ILMA TM for secondary tracheal intubation: Numerous reports have confirmed the effectiveness of the ILMA TM for both ventilation and blind intubation in patients without airway difficulties [89,[91][92][93][94][95][96][97][98]]. The overall intubation success rate in 1100 patients in these studies was 95.7% [90].…”

Intubating laryngeal mask for fibreoptic intubation — particularly useful during neck stabilization

“…1,13 Previous studies have reported that, when tracheal intubation was attempted blindly through the intubating laryngeal mask the success rate was high (93-100%). 8,9,14 However, this blind intubation may fail in 50-60% of patients at the first attempt 8,9,14 and might damage the larynx and surrounding tissues, such as impingement of the epiglottis into the laryngeal inlet 15 or perforation of a esophageal pouch. 16 Therefore, caution is required for the blind technique, 17 particularly when there is resistance during the advancement of a tracheal tube or when ventilation via the mask is suboptimal.…”