What determines the success rate of tracheal intubation via intubating laryngeal mask airway (ILMA) in normal patients?

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.

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Use of the Intubating Laryngeal Mask Airway

Anesthesiology ◽

10.1097/00000542-200008000-00010 ◽

2000 ◽

Vol 93 (2) ◽

pp. 340-345 ◽

Cited By ~ 20

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.

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Hemodynamic changes occurring with tracheal intubation by direct laryngoscopy compared with intubating laryngeal mask airway in adults: A randomized comparison trial

Egyptian Journal of Anaesthesia ◽

10.1016/j.egja.2012.11.003 ◽

2013 ◽

Vol 29 (2) ◽

pp. 103-107 ◽

Cited By ~ 5

Author(s):

Masoomeh Tabari ◽

Mohammad Alipour ◽

Mahdi Ahmadi

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Direct Laryngoscopy ◽

Laryngeal Mask ◽

Hemodynamic Changes ◽

Intubating Laryngeal Mask Airway ◽

Comparison Trial

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Comparison of the Intubating Laryngeal Mask Airway with the Fiberoptic Intubation in Anticipated Difficult Airway Management

Anesthesiology ◽

10.1097/00000542-200106000-00009 ◽

2001 ◽

Vol 94 (6) ◽

pp. 968-972 ◽

Cited By ~ 98

Author(s):

Olivier Langeron ◽

François Semjen ◽

Jean-Louis Bourgain ◽

Alain Marsac ◽

Anne-Marie Cros

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Adverse Events ◽

Oxygen Saturation ◽

Difficult Airway ◽

Difficult Intubation ◽

Laryngeal Mask ◽

Fiberoptic Intubation ◽

Alternative Technique ◽

Intubating Laryngeal Mask Airway

Background The intubating laryngeal mask airway (ILMA; Fastrach; Laryngeal Mask Company, Henley-on-Thames, UK) may provide an alternative technique to fiberoptic intubation (FIB) to facilitate the management of the anticipated difficult airway. The authors therefore compared the effectiveness of the ILMA with FIB in patients with anticipated difficult intubation. Methods One hundred patients, with at least one difficult intubation criteria (Mallampati class III or IV, thyromental distance < 65 mm, interincisor distance < 35 mm) were enrolled (FIB group, n = 49; ILMA group, n = 51) in this prospective randomized study. Anesthesia was induced with propofol and maintained with alfentanil and propofol after an efficient mask ventilation has been demonstrated. The success of the technique (within three attempts), the number of attempts, duration of the successful attempt, and adverse events (oxygen saturation < 90%, bleeding) were recorded. Results The rate of successful tracheal intubation with ILMA was 94% and comparable with FIB (92%). The number of attempts and the time to succeed were not significantly different between groups. In case of failure of the first technique, the alternative technique always succeeded. Failures in FIB group were related to oxygen desaturation (oxygen saturation < 90%) and bleeding, and to previous cervical radiotherapy in the ILMA group. Adverse events occurred significantly more frequently in FIB group than in ILMA group (18 vs. 0%, P < 0.05). Conclusion The authors obtained a high success rate and comparable duration of tracheal intubation with ILMA and FIB techniques. In patients with previous cervical radiotherapy, the use of ILMA cannot be recommended. Nevertheless, the use of the ILMA was associated with fewer adverse events.

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Tracheal intubation in patients immobilized by a rigid collar: a comparison of GlideScope and an intubating laryngeal mask airway*

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1506-49 ◽

2016 ◽

Vol 46 ◽

pp. 1617-1623 ◽

Cited By ~ 1

Author(s):

Semih ÖZDİL ◽

Zehra İpek ARSLAN AYDIN ◽

Zehra Nur BAYKARA ◽

Kamil TOKER ◽

Zeynep Mine SOLAK

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Laryngeal Mask ◽

Intubating Laryngeal Mask Airway

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TRACHEAL INTUBATION DURING MANUAL INLINE STABILISATION: COMPARISON OF INTUBATING LARYNGEAL MASK AIRWAY™ VERSUS TRACHLIGHT®

10.36106/ijar/4308961 ◽

2021 ◽

pp. 60-62

Author(s):

Manjunath Prabhu ◽

Shwethapriya Rao ◽

Arushi Gupta

Keyword(s):

Cervical Spine ◽

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Laryngeal Mask ◽

P Value ◽

Stabilization Method ◽

Intubating Laryngeal Mask Airway ◽

Effective Ventilation ◽

Unstable Cervical Spine ◽

Spine Movement

Introduction: Airway management with unstable cervical spine is a major challenge to anesthetist. Conventional direct laryngoscopy causes substantial movement of cervical spine and can cause neurological decit. Newer devices like Intubating Laryngeal Mask Airway(ILMA) and Trachlight avoid cervical spine movement. To compare rate of successful tracheal Aim: intubation with Intubating Laryngeal Mask Airway™ with Trachlight® in anaesthetised and paralysed adults with manual in line stabilization Method and Materials: 50 patients were included in the study and allocated in two groups. In the ILMA group ,patients were ventilated and then intubated through the ILma. IN the Trachlight group, patients were intubated using trachlight. Success rate , time taken for intubation and post operative sore throat and hoarseness of voice were compared between the two groups. Results: In the ILMA group,21 patients could be adequately ventilated in the rst attempt and 4 in second attempt. 12 patients could be successfully intubated. 9 patients could be intubated in the rst attempt and 3 patients in second attempt. In the Trachlight , 24 patients could be intubated in the rst attempt and one patient in second attempt. Intubation time was 14.08 ± 2.23 seconds in the ILMA group whereas in Trachlight group it was 26.48 ± 9.13 seconds(p value of <0.0001) In healthy anaesthetized,paralysed adults with manual in line stabiliz Conclusion: ation Trachlight assistance at tracheal intubation provides high rst attempt success.ILMA is an effective ventilation device, but an unacceptably high failure rate at blind tracheal intubation.

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Intubating Laryngeal Mask Airway Allows Tracheal Intubation When the Cervical Spine is Immobilized by a Rigid Collar

Indian Journal of Anaesthesia and Analgesia ◽

10.21088/ijaa.2349.8471.2215.4 ◽

2015 ◽

Vol 2 (2) ◽

pp. 87-94

Author(s):

S. Gvalani ◽

◽

D. Pahwa ◽

Keyword(s):

Cervical Spine ◽

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Laryngeal Mask ◽

Intubating Laryngeal Mask Airway

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Intubating Laryngeal Mask Airway

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000503 ◽

2002 ◽

Vol 30 (5) ◽

pp. 551-569 ◽

Cited By ~ 45

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.

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