The laryngeal mask airway as an adjunct to extubation on the intensive care unit

Glaisyer, Hilary; Parry, M G; Lee, J.; Bailey, Paul

doi:10.1111/j.1365-2044.1996.tb15076.x

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…Several authors have suggested that the use of the laryngeal mask after tracheal extubation may minimise the stress response while providing a patent airway during emergence from anaesthesia [3,4,19]. They inserted the laryngeal mask after tracheal extubation; however, there is a small theoretical risk of losing a patent airway if it is not possible to insert the laryngeal mask after the tracheal tube has been removed.…”

Section: Discussionmentioning

confidence: 99%

Respiratory complications associated with tracheal extubationTiming of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia

et al. 1998

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SummarySixty patients were randomly allocated to one of three groups and the incidences of respiratory complications which occurred during emergence from anaesthesia were compared under the following three circumstances: tracheal extubation after the patient had regained consciousness (awake group); tracheal extubation while the patient was still anaesthetised (anaesthetised group); and the use of the laryngeal mask during emergence from anaesthesia (mask group). In the mask group, the laryngeal mask was inserted under deep anaesthesia before tracheal extubation and the lungs were ventilated through the laryngeal mask after tracheal extubation. In the awake group, straining (bucking) occurred in 18 patients and desaturation (arterial oxygen haemoglobin saturation`95%) in two patients. In the anaesthetised group, airway obstruction occurred in 17 patients and desaturation in one of these patients. In the mask group, ventilation through the laryngeal mask was temporarily difficult immediately after tracheal extubation in one patient and coughing occurred before removal of the mask in three patients. No respiratory complications occurred in two patients in the awake group, three patients in the anaesthetised group and 16 patients in the mask group. The incidence of respiratory complications during recovery from anaesthesia was significantly lower in the mask group than in the other two groups (pooled) (p``0.001). Therefore, the use of the laryngeal mask after tracheal extubation decreases the incidence of respiratory complications during recovery from anaesthesia.

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Section: Discussionmentioning

confidence: 99%

Respiratory complications associated with tracheal extubationTiming of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia

et al. 1998

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“…Nair and Bailey, Costa e Silva and Brimacombe and Glaisyer et al . [ 9 10 11 ] had suggested that the use of the laryngeal mask after tracheal extubation may minimize the stress response while providing a patent airway during emergence from anesthesia. They inserted the laryngeal mask after extubation; however, there is a small theoretical risk of losing a patent airway, if it is not possible to insert the laryngeal mask after the tracheal tube has been removed.…”

Section: Discussionmentioning

confidence: 99%

Respiratory and hemodynamic outcomes following exchange extubation with laryngeal mask airway as compared to traditional awake extubation

et al. 2016

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Background:Traditional awake extubation leads to respiratory complications and hemodynamic response which are detrimental in neurosurgery, ENT surgery and patients with comorbidities.Aims:The primary objective was to compare the respiratory complications and hemodynamic stress response between traditional awake extubation of a endotracheal tube (ETT) and that following exchange extubation of ETT by using a laryngeal mask airway (LMA).Settings and Design:This prospective randomized study was conducted in a Tertiary Care Centre in 60 American Society of Anesthesiologists I and II patients coming for general surgery.Materials and Methods:Patients were randomized by permuted blocks into traditional awake extubation group and exchange extubation group. At the end of surgery in traditional group, awake extubation of ETT was done. In exchange group, 0.3 mg/kg propofol was administered, and the ETT was exchanged for a LMA. Awake extubation of LMA was then performed. Respiratory complications such as bucking, coughing, desaturation and the need for airway maneuvers and hemodynamic response were noted in both groups.Analysis Tools:Chi-square test, independent sample t- and paired t-tests were used as applicable.Results:Incidence of respiratory complication was 93.3% in traditional extubation while it was only 36.7% in exchange extubation group (P < 0.001). Hemodynamic response measured immediately at extubation in terms of heart rate, systolic blood pressure (BP), diastolic BP, mean arterial pressure, and rate pressure product were all significantly lesser in exchange group when compared to traditional extubation.Conclusion:Exchange extubation with LMA decreases respiratory complications and hemodynamic stress response when compared to traditional awake extubation.

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“…We should consider thyroidectomy a possible cause of extubation failure and manage it accordingly. Authors recommend following Bailey's manoeuvre13 14 by adding intubating laryngeal mask airway (LMA) or air-Q simultaneously with ETT followed by an extubation trial, or by keeping the tube exchanger inside the trachea after extubation for the meantime in these post-thyroidectomy patients, to look for bilateral vocal cord movement by flexible FOB under sedation, and then taking a decision accordingly 15. Among non-invasive methods, laryngeal ultrasound is an emerging modality that can also be utilised to assess the vocal cords 16…”

Section: Discussionmentioning

confidence: 99%

Head injury patient with bilateral vocal cord paralysis: a mistake and a lesson learnt

et al. 2015

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Bilateral recurrent nerve palsy along with head injury is a rare clinical possibility and can be potentially fatal if not properly diagnosed. We report a case of a head injury patient with intact Glasgow Coma Scale requiring immediate re-intubation and tracheostomy after extubation failure as a result of stridor and severe dyspnoea with paradoxical respiratory pattern, possibly because of undiagnosed significant surgical history.

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The laryngeal mask airway as an adjunct to extubation on the intensive care unit

Cited by 7 publications

References 5 publications

Respiratory complications associated with tracheal extubationTiming of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia

Respiratory complications associated with tracheal extubationTiming of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia

Respiratory and hemodynamic outcomes following exchange extubation with laryngeal mask airway as compared to traditional awake extubation

Head injury patient with bilateral vocal cord paralysis: a mistake and a lesson learnt

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