Airway Management in Hypoxemic Patient using Modified Intubating Laryngeal Mask Airway Technique

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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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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Intubating Laryngeal Mask Airway in Morbidly Obese and Lean Patients

Anesthesiology ◽

10.1097/00000542-200506000-00008 ◽

2005 ◽

Vol 102 (6) ◽

pp. 1106-1109 ◽

Cited By ~ 63

Author(s):

Xavier Combes ◽

Stéphane Sauvat ◽

Bertrand Leroux ◽

Marc Dumerat ◽

Emanuel Sherrer ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Airway Management ◽

Airway Device ◽

Laryngeal Mask ◽

Morbidly Obese ◽

Obese Patients ◽

Healthy Weight ◽

Management Quality ◽

Intubating Laryngeal Mask Airway

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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