Unexpected resistance during tracheal tube insertion through the intubating laryngeal mask

Dimitriou, V.; Voyagis, G. S.; Douma, Amalia

doi:10.1046/j.1365-2346.1999.00492.x

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Proponents of tracheal transillumination claim this technique confers benefits over blind intubation by improving intubation success rates 24,47,85,87,90 . However, of three randomized trials, only one clearly demonstrated a significant improvement 87 .…”

Section: Discussionmentioning

confidence: 99%

“…Although recognised as a useful addition to the airway management armamentarium, blind intubation via the ILMA has been criticised for being a blind on blind technique 74,80 , associated with a risk of oesophageal intubation of 5% 80 . Two methods of visualization have been investigated: use of a bronchoscope 21,65,81,82 and tracheal transillumination, using either a light-wand [83][84][85][86][87] or flexible illuminated catheter 24,38,47,74,88,90 .…”

Section: Blind Versus Visualizing Techniques: Fibreoptics and Lightwandsmentioning

confidence: 99%

“…Three case reports 38,47,90 also describe possible advantages of tracheal transillumination. In one case, resistance to a blindly placed TT occurred, which would normally indicate incorrect placement; however, the presence of a midline glow at the level of the suprasternal notch suggested (correctly) intratracheal placement.…”

Section: Blind Versus Visualizing Techniques: Fibreoptics and Lightwandsmentioning

confidence: 99%

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Intubating Laryngeal Mask Airway

Caponas

2002

Anaesth Intensive Care

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The Intubating Laryngeal Mask Airway (ILMA) was introduced into clinical practice in 1997 following numerous clinical trials involving 1110 patients. The success rate of blind intubation via the device after two attempts is 88% in "routine" cases. Successful intubation in a variety of difficult airway scenarios, including awake intubation, has been described, with the overall success rate in the 377 patients reported being approximately 98%. The use of the ILMA by the novice operator has also been investigated with conflicting reports as to its suitability for emergency intubation in this setting. Blind versus visualized intubation techniques have also been investigated. These techniques may provide some benefits in improved safety and success rates, although the evidence is not definitive. The use of a visualizing technique is recommended, especially whilst experience with intubation via the ILMA is being gained. The risk of oesophageal intubation is reported as 5% and one death has been described secondary to the complications of oesophageal perforation during blind intubation. Morbidity described with the use of the ILMA includes sore throat, hoarse voice and epiglottic oedema. Haemodynamic changes associated with intubation via the ILMA are of minimal clinical consequence. The ILMA is a valuable adjunct to the airway management armamentarium, especially in cases of difficult airway management. Success with the device is more likely if the head of the patient is maintained in the neutral position, when the operator has practised at least 20 previous insertions and when the accompanying lubricated armoured tube is used.

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Section: Discussionmentioning

confidence: 99%

Section: Blind Versus Visualizing Techniques: Fibreoptics and Lightwandsmentioning

confidence: 99%

Section: Blind Versus Visualizing Techniques: Fibreoptics and Lightwandsmentioning

confidence: 99%

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Intubating Laryngeal Mask Airway

Caponas

2002

Anaesth Intensive Care

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“…525 Case reports also observed intubation success for unanticipated and emergency airway patients when combination techniques were used (Category B4-B evidence). [526][527][528][529][530][531][532][533][534][535][536] The literature is insufficient to evaluate which of the above devices are most effective when attempted first after failed intubation, nor is the literature sufficient to evaluate the most effective order of devices to be used for attempted intubation of an unanticipated or emergency difficult airway.…”

Section: Practice Guidelines For Difficult Airway Managementmentioning

confidence: 99%

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Apfelbaum¹,

Hagberg²,

Connis³

et al. 2021

Anesthesiology

593

547

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The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care, Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

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Comparison of fibreoptic‐guided intubation through ILMA versus intubation through LMA‐CTrach*

Sreevathsa¹,

Nathan²,

John

et al. 2008

Anaesthesia

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SummaryWe compared the time taken to intubate the trachea of a manikin by fibreoptic-guided intubation through an intubating laryngeal mask airway (ILMA-FOS) with intubation through a laryngeal mask airway CTrach (LMA-CTrach). Forty-two anaesthetists participated in this randomised crossover study. Although the insertion time was similar, the time taken to intubate the trachea was significantly shorter with the LMA-CTrach as compared with the ILMA-FOS, with a mean time (SD) for ILMA-FOS and CTrach 84 (32) and 53 (21) s, respectively (p < 0.001). The mean difference in the total time between the two techniques was 31 s, with a 95% confidence interval of 22 to 39 s. Thirty (71%) anaesthetists preferred LMA-CTrach as compared with ILMA-FOS (p = 0.008). We conclude that LMA-CTrach is a suitable alternative to fibreoptic-guided intubation through ILMA for the management of unanticipated failed intubation.

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Unexpected resistance during tracheal tube insertion through the intubating laryngeal mask

Cited by 5 publications

References 5 publications

Intubating Laryngeal Mask Airway

Intubating Laryngeal Mask Airway

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

Comparison of fibreoptic‐guided intubation through ILMA versus intubation through LMA‐CTrach*

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