The Upside-Down Intubating Laryngeal Mask Airway: A Technique for Cases of Fixed Flexed Neck Deformity

Abstract

When the neck is fixed in extreme flexion, access to the windpipe becomes very difficult. The intubating laryngeal mask airway (ILMA) appears unsuitable for guiding the breathing tube into the windpipe in such cases because of its rigid, preformed shape. However, the ILMA introduced upside down may provide the answer, even if the mouth opening is smaller than normal.

Anaesthetic Manageme Nt of a Post Burn Contracture Patient : A Case Report

“…2  History of inhalational injury may suggest tracheal stenosis which could hamper advancement of endotracheal tube.3…”

Cervical spine overflexion in a halo orthosis contributes to complete upper airway obstruction during awake bronchoscopic intubation: a case report

“…It is well known that LMAD insertion can be difficult in patients with fixed flexion of the cervical spine. [13][14][15] This has been attributed to the relatively acute angle between the oral and pharyngeal axes. 13 Nevertheless, it may be reasonable to attempt to insert a supraglottic airway to restore airway patency in an emergency before release of the halo.…”

Severe post-burn neck contracture release and skin graft harvest using tumescent local anaesthesia as the sole anesthetic technique

“…Commonly post-burn neck contracture release is performed under local anesthesia or total intravenous anesthesia followed by intubation of the patient. Alternative techniques include awake blind nasal intubation, fiberoptic intubation, and laryngeal mask airway [4]. Although awake blind nasal intubation is a reasonably good option, giving regional airway blocks would have been difficult because of scars.…”