Flexible lightwand-guided tracheal intubation with the intubating laryngeal mask Fastrach™ in adults after unpredicted failed laryngoscope-guided tracheal intubation

Dimitriou, Vasilios, Voyagis, Gregory S., and Brimacombe, Joseph R. (2002) Flexible lightwand-guided tracheal intubation with the intubating laryngeal mask Fastrach™ in adults after unpredicted failed laryngoscope-guided tracheal intubation. Anesthesiology, 96 (2). pp. 296-299.

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Abstract

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.

Item ID: 13455
Item Type: Article (Refereed Research - C1)
Keywords: tracheal intubation
ISSN: 1528-1175
Date Deposited: 21 Dec 2010 23:24
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110301 Anaesthesiology @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures @ 100%
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