The intubating laryngeal mask airway: Rocuronium improves endotracheal intubating conditions and success rate

2005 ◽  
Vol 17 (3) ◽  
pp. 163-166 ◽  
Author(s):  
Sunita G. Sastry ◽  
Harry J.M. Lemmens
Keyword(s):  
Laryngeal Mask Airway ◽  
Success Rate ◽  
Laryngeal Mask ◽  
Intubating Conditions ◽  
Intubating Laryngeal Mask Airway

Intubating Laryngeal Mask Airway

2002 ◽  
Vol 30 (5) ◽  
pp. 551-569 ◽  
Author(s):  
G. Caponas
Keyword(s):  
Laryngeal Mask Airway ◽  
Airway Management ◽  
Difficult Airway ◽  
Success Rate ◽  
Laryngeal Mask ◽  
Oesophageal Perforation ◽  
Clinical Consequence ◽  
Neutral Position ◽  
Valuable Adjunct ◽  
Intubating Laryngeal Mask Airway

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.

scholarly journals Comparison of Endotracheal Intubation Through I-gel and Intubating Laryngeal Mask Airway

2016 ◽  
Vol 10 (1) ◽  
pp. 18-24
Author(s):  
Bharat Choudhary ◽  
Rakesh Karnawat ◽  
Sadik Mohammed ◽  
Monika Gupta ◽  
Bharath Srinivasan ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Success Rate ◽  
Laryngeal Mask ◽  
Supraglottic Airway ◽  
Group I ◽  
Intubating Laryngeal Mask Airway ◽  
Supraglottic Airway Devices ◽  
Haemodynamic Changes ◽  
Airway Devices

Background: Supraglottic airway devices (SADs) are very useful airway adjunct in managing anticipated and unanticipated difficult airway and can be used as a ventilating aid and as a conduit for tracheal intubation. The new versions of SADs like i-gel and intubating laryngeal mask airway (ILMA), have advantage of hands-free airway maintenance without the need for tracheal intubation, they can be placed easily without direct visualization of the larynx, ensure predictable ventilation and can be used as conduit for tracheal intubation. Objective: To compare ease and success of placement of both SADs and ease and success of endotracheal (ET) intubation through both SADs. Method: Eighty patients of both sexes, aged between 18-60 years and belonging to ASA grade I and II undergoing surgical procedure under general anaesthesia (GA) were randomly divided into two group (i-gel and ILMA) of equal number. Following induction the allocated device was inserted and after confirming adequate ventilation, blind ET intubation was attempted through the device. First attempt and overall success rate of SAD insertion and ET intubation through SAD; time taken for SAD insertion and ET intubation through SAD; hemodynamic changes and postoperative complications were recorded and compared between groups. Result: Demographic profile, success rate of SAD insertion, haemodynamic changes and adverse effects were similar between groups (p>0.05).Overall time needed for successful SAD insertion was significantly shorter in group i-gel (22.52±5.64 sec) than group ILMA (31.15±5.52 sec) (p value <0.0001). Overall success rate of blind ET intubation was higher in group i-gel (75%) in comparison to group ILMA (65%). I-gel required significantly less time to achieve successful ET intubation than ILMA (26.30±11.35 sec vs. 33.53±13.13 sec)(p<0.0001). Conclusion: Both the SADs were proved to be useful alternative to conventional laryngoscope for ET intubation, although i-gel required lesser time and had better success rate of ET intubation as compared to ILMA.

Use of the Intubating Laryngeal Mask Airway

2000 ◽  
Vol 93 (2) ◽  
pp. 340-345 ◽  
Author(s):  
Janet M. van Vlymen ◽  
Margarita Coloma ◽  
W. Kendall Tongier ◽  
Paul F. White
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Success Rate ◽  
Study Drug ◽  
Laryngeal Mask ◽  
Controlled Study ◽  
High Dose ◽  
Success Rates ◽  
Double Blind ◽  
Intubating Laryngeal Mask Airway

Background The intubating laryngeal mask airway (ILMA) is designed to facilitate blind tracheal intubation. The effect of a muscle relaxant on the ability to perform tracheal intubation through the ILMA device has not been previously evaluated. This randomized, double-blind, placebo-controlled study was designed to evaluate rocuronium, 0.2 or 0.4 mg/kg administered intravenously, on the success rate and incidence of complications associated with ILMA-assisted tracheal intubation. Methods A total of 75 healthy patients were induced with propofol 2 mg/kg and fentanyl 1 microg/kg intravenously. After insertion of the ILMA device, patients were administered either saline, rocuronium 0.2 mg/kg, or rocuronium 0.4 mg/kg in a total volume of 5 ml. At 90 s after administration of the study drug, tracheal intubation was attempted using a disposable polyvinyl tube. If unsuccessful, a reusable silicone tube was tried. In addition to recording the time and number of attempts required to secure the airway, the incidence of complications during placement of the tracheal tube and removal of the ILMA were noted. Results Tracheal intubation was successful in 76-96% of the patients. The overall success rates and times required to secure the airway were similar in all three treatment groups. The high-dose rocuronium group experienced less patient movement (8 vs. 28 and 48%) and coughing (12 vs. 20 and 52%) than the low-dose rocuronium and saline groups, respectively. Use of rocuronium was also associated with a dose-related decrease in the requirement for supplemental bolus doses of propofol during intubation and removal of the ILMA device. Conclusions Use of rocuronium did not significantly improve the success rate in performing tracheal intubation through the ILMA. However, it produced dose-related decreases in coughing and movement after tracheal intubation and reduced difficulties associated with removal of the ILMA device.

Evaluation of Paramedic Utilization of the Intubating Laryngeal Mask Airway in High-Fidelity Simulated Critical Care Scenarios

2013 ◽  
Vol 28 (6) ◽  
pp. 630-631 ◽  
Author(s):  
Donald Byars ◽  
Bruce Lo ◽  
Jeff Yates
Keyword(s):  
Critical Care ◽  
Laryngeal Mask Airway ◽  
Difficult Airway ◽  
Success Rate ◽  
Airway Device ◽  
Prehospital Setting ◽  
Laryngeal Mask ◽  
Intubating Laryngeal Mask Airway ◽  
One Year ◽  
High Degree

AbstractIntroductionSuccessful oxygenation and ventilation can mean the difference between life and death in the prehospital setting. While airway challenges can be numerous within the confines of the emergency department, there are many additional confounding difficulties in the prehospital setting, which include limited access to equipment, poor lighting, extreme environments, limited personnel to assist, no immediate backup, and limited rescue airway options. The concept of an easy, reliable, and rapidly deployable alternative rescue airway device is critical, especially when considering the addition of rapid sequence intubation protocols in the prehospital setting.HypothesisThe primary objective of this study was to ascertain whether paramedics can be trained to deploy this alternative airway device with an acceptable success rate in a simulated critical care airway scenario. The secondary objective was to determine whether the previously-trained paramedics were able to retain their ability to deploy the device successfully at one year.MethodsThis was a prospective, observational, single-group, descriptive cohort, educational trial. Forty paramedics were trained in the use of the Intubating Laryngeal Mask Airway (I-LMA) in a simulation medicine curriculum culminating in a simulated critical care difficult airway scenario requiring urgent oxygenation and ventilation after failed traditional endotracheal intubation. An emergency medicine physician proctor determined successful airway management. Repeat testing was then performed at approximately one year out, challenging the medics to intubate a mannequin using the I-LMA during an unrelated training session.ResultsOf the 40 paramedics who underwent complete simulation training, 39 were able to intubate and ventilate the simulated difficult airway using the I-LMA during the critical care scenario. This yields a success rate of 97.5% (95% CI, 87.1%-99.4%). At approximately one year out, 35 out of 35 medics were able to intubate the mannequin using the I-LMA, resulting in a success rate of 100% (95% CI, 91.4%-100%).ConclusionsIn this study, paramedics were able to deploy the I-LMA with a high degree of success in a simulated difficult airway, with a high degree of skill retention at one year out.ByarsD, LoB, YatesJ. Evaluation of paramedic utilization of the Intubating Laryngeal Mask Airway in high-fidelity simulated critical care scenarios. Prehosp Disaster Med.2013;28(6):1-2.

Sign in / Sign up

Export Citation Format

Share Document