The Laryngeal Mask Airway Reliably Provides Rescue Ventilation in Cases of Unanticipated Difficult Tracheal Intubation Along with Difficult Mask Ventilation

Parmet, Jonathan L.; Colonna-Romano, Pietro; Horrow, Jan C.; Miller, Francis; Gonzales, Jerry M.; Rosenberg, Henry

doi:10.1097/00000539-199809000-00032

Cited by 102 publications

(71 citation statements)

References 23 publications

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Section: Discussionmentioning

confidence: 99%

“…[2][3][4] The laryngeal mask airway has since been shown to be mostly effective in providing rescue ventilation in the majority of CICV situations. 4,5 Currently, the incidence of CICV requiring emergency invasive infraglottic airway insertion may be lower than 2 in 10,000 patients. [2][3][4] According to the latest ASA practice guidelines for management of the difficult airway 6 and the Difficult Airway Society guidelines 7 for management of the unanticipated difficult intubation, in a cannot intubate, face mask ventilation-inadequate situation, insertion of laryngeal mask airway is the recommended step.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Currently, the incidence of CICV requiring emergency invasive infraglottic airway insertion may be lower than 2 in 10,000 patients. [2][3][4] According to the latest ASA practice guidelines for management of the difficult airway 6 and the Difficult Airway Society guidelines 7 for management of the unanticipated difficult intubation, in a cannot intubate, face mask ventilation-inadequate situation, insertion of laryngeal mask airway is the recommended step. 5 If a laryngeal mask airway does not restore ventilation/oxygenation, a CICV pathway is considered.…”

Section: Discussionmentioning

confidence: 99%

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Le masque laryngé prévient les fuites supraglottiques durant la ventilation via une cricothyrotomie sans ballonnet

Wong

Kumar

Prabhu

2007

Can J Anesth/J Can Anesth

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Purpose: A 'cannot intubate-cannot ventilate' situation requires emergency insertion of an infraglottic surgical airway. We present a case of postoperative macroglossia requiring emergency insertion of an uncuffed percutaneous cricothyroidotomy tube. The supraglottic leak was eliminated by the insertion of a laryngeal mask airway with an occluded 15-mm connector. Clinical features: A 49-yr-old man underwent clipping of a left posterior inferior cerebellar artery aneurysm and his tracheal tube was removed postoperatively. Two hours later, he became dyspneic and developed significant macroglossia. After application of topical anesthesia, direct laryngoscopy, oral fibreoptic bronchoscopy and laryngeal mask insertion were unsuccessful. The patient became progressively hypoxemic, pulseless electrical activity ensued, and cardiopulmonary resuscitation was initiated. An uncuffed percutaneous cricothyroidotomy tube was inserted. Oxygenation and hemodynamics were restored. As the cricothyroidotomy tube was uncuffed, there was a large supraglottic leak with manual ventilation. A laryngeal mask airway was inserted and the cuff was inflated. The 15-mm connector was occluded by a piece of tape. Subsequently, there was no further supraglottic leak with manual ventilation. He was taken to operating room and a surgical tracheotomy was performed. Conclusion: In a patient with postoperative macroglossia in a 'cannot intubate-cannot ventilate' situation, effective oxygenation was restored by insertion of an uncuffed cricothyroidotomy, but ventilation was affected by a substantial supraglottic leak. A new strategy using an inflated laryngeal mask airway with an occluded connector was utilized to successfully terminate the supraglottic leak, thereby restoring effective lung ventilation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Le masque laryngé prévient les fuites supraglottiques durant la ventilation via une cricothyrotomie sans ballonnet

Wong

Kumar

Prabhu

2007

Can J Anesth/J Can Anesth

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“…This despite its ease of use and affirmed efficacy as a salvage airway in the cannot intubate -cannot ventilate situation. 12 Optimum management of unanticipated airway difficulties requires the ability to rapidly recognize, acknowledge, correctly analyze and respond to the problem with technical facility. Errant or delayed decision-making in this process may lead down an irremediable path to morbidity and mortality.…”

Section: Complete Airway Obstruction I N This Issue Of the Journal Mmentioning

confidence: 99%

“…Par ailleurs, Hung a not~ que le recours h~tif ~ une technique de remplacement (stylet lumineux) dans des circonstances similaires est normalement r&ompens~ par une intubation endotrach6ale rapide dont les complications sont rares. 12 La gestion optimale des difficult~s d'intubation impr&ues exige la comp&ence ~ reconnaitre rapidement la situation, ~ l'analyser correctement et ~ y faire face avec une facilit~ d'ex&ution technique. Errer ou retarder la prise de d&ision dans les circonstances peut conduire irrfimfidiablement vers la morbiditfi et la mortalitY.…”

Section: Obstruction Complande Des Voies a Riennesunclassified

Obstruction complète des voies aériennes

Crosby

1999

Can J Anesth/J Can Anesth

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Determining When Quality Improvement Initiatives Should Be Considered Research

Casarett¹,

Karlawish²,

Sugarman³

2000

JAMA

214

141

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Quality improvement initiatives have become a major force in shaping health care. These initiatives are diverse but share a common goal of generating knowledge that will guide improvements in health care. Although quality improvement occupies an uncertain territory between clinical care and research, this difference is extremely important. If a quality improvement initiative is research, federal regulations require a variety of procedures that must be followed to protect the human subjects involved. Conversely, if the same initiative is not research, the regulations outlining these procedures are not applicable. This article proposes 2 criteria to determine whether a quality improvement initiative should be reviewed as research. Such an initiative should be reviewed and regulated as research if (1) the majority of patients involved are not expected to benefit directly from the knowledge to be gained or (2) if additional risks or burdens are imposed to make the results generalizable. Implementation of these criteria offers the possibility that the rights and interests of those who participate in quality improvement initiatives will be protected.

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The Laryngeal Mask Airway Reliably Provides Rescue Ventilation in Cases of Unanticipated Difficult Tracheal Intubation Along with Difficult Mask Ventilation

Cited by 102 publications

References 23 publications

Le masque laryngé prévient les fuites supraglottiques durant la ventilation via une cricothyrotomie sans ballonnet

Le masque laryngé prévient les fuites supraglottiques durant la ventilation via une cricothyrotomie sans ballonnet

Obstruction complète des voies aériennes

Determining When Quality Improvement Initiatives Should Be Considered Research

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