Intubating Laryngeal Mask Airway in Morbidly Obese and Lean Patients

Background The intubating laryngeal mask airway (ILMA) was designed using the characteristics of healthy-weight subjects but was shown to be an effective airway device in morbidly obese patients. The authors compared airway management quality in morbidly obese and lean patients with use of the ILMA. Methods Fifty morbidly obese and 50 lean patients (mean body mass indexes, 42 and 27 kg/m, respectively) were enrolled in this prospective study. After induction of general anesthesia, characteristics of airway management were judged on safety and efficiency parameters, including success rate at ventilation and intubation and airway management quality criteria, such as the number of patients who required adjustment maneuvers, the number of failed tracheal intubation attempts, the total duration of airway management, and an overall difficulty visual analog scale score. Results The ILMA was successfully inserted and adequate ventilation through the ILMA was achieved in all 100 patients. The success rates of tracheal intubation through the ILMA were similar in obese and lean patients (96% and 94%, respectively). The numbers of failed blind tracheal access attempts and patients who required airway-adjustment maneuvers were significantly reduced in obese patients as compared with lean patients. Four obese patients experienced transient episodes of oxygen desaturation (oxygen saturation < 90%) before adequate bag ventilation was established with the ILMA. Conclusion The authors confirmed that the ILMA was an efficient airway device for airway management of both lean and obese patients. In the conditions of this study, the authors observed that airway management with the ILMA was simpler in obese patients as compared with lean patients.

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Tracheal intubation in morbidly obese patients: a comparison of the Intubating Laryngeal Mask Airway™ and Laryngeal Mask Airway CTrach™*

Anaesthesia ◽

10.1111/j.1365-2044.2011.06991.x ◽

2012 ◽

Vol 67 (3) ◽

pp. 261-265 ◽

Cited By ~ 12

Author(s):

Z. I. Arslan ◽

D. Özdamar ◽

T. S. Yildiz ◽

Z. M. Solak ◽

K. Toker

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Laryngeal Mask ◽

Morbidly Obese ◽

Obese Patients ◽

Intubating Laryngeal Mask Airway

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Airway Management during Spaceflight

Anesthesiology ◽

10.1097/00000542-200005000-00010 ◽

2000 ◽

Vol 92 (5) ◽

pp. 1237-1241 ◽

Cited By ~ 22

Author(s):

Christian Keller ◽

Joseph Brimacombe ◽

Marzia Giampalmo ◽

Axel Kleinsasser ◽

Alex Loeckinger ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Airway Management ◽

Simulated Microgravity ◽

Life Support ◽

Laryngeal Mask ◽

Scale Model ◽

Experimental Conditions ◽

Oropharyngeal Airway ◽

Intubating Laryngeal Mask Airway

Background The authors compared airway management in normogravity and simulated microgravity with and without restraints for laryngoscope-guided tracheal intubation, the cuffed oropharyngeal airway, the standard laryngeal mask airway, and the intubating laryngeal mask airway. Methods Four trained anesthesiologist-divers participated in the study. Simulated microgravity during spaceflight was obtained using a submerged, full-scale model of the International Space Station Life Support Module and neutrally buoyant equipment and personnel. Customized, full-torso manikins were used for performing airway management. Each anesthesiologist-diver attempted airway management on 10 occasions with each device in three experimental conditions: (1) with the manikin at the poolside (poolside); (2) with the submerged manikin floating free (free-floating); and (3) with the submerged manikin fixed to the floor using a restraint (restrained). Airway management failure was defined as failed insertion after three attempts or inadequate device placement after insertion. Results For the laryngoscope-guided tracheal intubation, airway management failure occurred more frequently in the free-floating (85%) condition than the restrained (8%) and poolside (0%) conditions (both, P < 0.001). Airway management failure was similar among conditions for the cuffed oropharyngeal airway (poolside, 10%; free-floating, 15%; restrained, 15%), laryngeal mask airway (poolside, 0%; free-floating, 3%; restrained, 0%), and intubating laryngeal mask airway (poolside, 5%; free-floating, 5%; restrained, 10%). Airway management failure for the laryngoscope-guided tracheal intubation was usually caused by failed insertion (> 90%), and for the cuffed oropharyngeal airway, laryngeal mask airway, and intubating laryngeal mask airway, it was always a result of inadequate placement. Conclusion The emphasis placed on the use of restraints for conventional tracheal intubation in microgravity is appropriate. Extratracheal airway devices may be useful when restraints cannot be applied or intubation is difficult.

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Flexible Lightwand–guided Tracheal Intubation with the Intubating Laryngeal Mask Fastrach TMin Adults after Unpredicted Failed Laryngoscope-guided Tracheal Intubation

Anesthesiology ◽

10.1097/00000542-200202000-00012 ◽

2002 ◽

Vol 96 (2) ◽

pp. 296-299 ◽

Cited By ~ 27

Author(s):

Vasilios Dimitriou ◽

Gregory S. Voyagis ◽

Joseph R. Brimacombe

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Median Number ◽

Airway Device ◽

Laryngeal Mask ◽

Successful Intubation ◽

Inclusion Criteria ◽

The Third ◽

Intubating Laryngeal Mask Airway ◽

Ventilatory Device

Background The authors determined the efficacy of using the intubating laryngeal mask airway Fastrach (ILM) as a ventilatory device and aid to flexible lightwand-guided tracheal intubation in patients with unpredicted failed laryngoscope-guided tracheal intubation when managed by experienced anesthetists. Methods During a 27-month period, 16 experienced anesthetists agreed to use the ILM as an airway device and airway intubator in patients (aged > 18 yr) with predicted normal airways who were subsequently found to be difficult to intubate (three failed attempts at laryngoscopy). Intubation via the ILM was performed with a flexible lightwand. The number of attempts at ILM placement, the number of adjusting maneuvers, the number of attempts at tracheal intubation via the ILM,and any episodes of hypoxia (oxygen saturation < 90%) were recorded. Results Forty-four of 11,621 patients (0.4%) met the inclusion criteria. ILM insertion and ventilation was successful at the first attempt in 40 of 44 patients (91%) and at the second attempt in 4 of 44 (9%). Flexible lightwand-guided tracheal intubation via the ILM was successful in 38 of 44 patients (86%) at the first attempt, 3 of 44 (7%) at the second attempt, 2 of 44 (5%) at the third to fifth attempts, and failed in 1 of 44 (2%). The median number of adjusting maneuvers before successful intubation was 1 (range, 0-4). Hypoxia occurred in 5 patients before ILM insertion (range, 52-82%), but none after ILM insertion. No patient developed hypoxia during or after intubation via the ILM. Conclusion The ILM is an effective ventilatory device and aid to flexible lightwand-guided tracheal intubation in adult patients with predicted normal airways in whom laryngoscope-guided tracheal intubation subsequently fails when managed by experienced anesthetists.

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