J Dent Anesth Pain Med.  2015 Sep;15(3):167-171.

Difficult intubation using intubating laryngeal mask airway in conjunction with a fiber optic bronchoscope

• Kim JS
• Seo DK
• Lee CJ
• Jung HS
• Kim SS

Abstract

When anesthesiologists encounter conditions in which intubation is not possible using a conventional direct laryngoscope, they can consider using other available techniques and devices such as fiber optic bronchoscope (FOB)-guided intubation, a laryngeal mask airway (LMA), intubating LMA (ILMA), a light wand, and the Combitube. FOB-guided intubation is frequently utilized in predicted difficult airway cases and is generally performed when the patient is awake to enable easier access to the trachea. An LMA can be introduced to ventilate the patient with relative ease, while an ILMA can be used for definite endotracheal intubation. However, occasionally, an endotracheal tube (ETT) cannot pass through the larynx, despite successful introduction of a FOB into the trachea and placement of an ILMA by the anesthesiologist. Therefore, we initially introduced an ILMA for emergent ventilation, followed by successful insertion of an ETT under FOB guidance. In this report, we describe three cases of difficult intubation using a FOB and ILMA combination approach.

Keyword

Bronchoscope; Intubation; LMA

MeSH Terms

Bronchoscopes*
Humans
Intubation*
Intubation, Intratracheal
Laryngeal Masks*
Laryngoscopes
Larynx
Nerve Fibers, Myelinated*
Trachea
Ventilation

Reference

1. Langeron O, Semjen F, Bourgain JL, Marsac A, Cros AM. Comparison of the intubating laryngeal mask airway with the fiberoptic intubation in anticipated difficult airway management. Anesthesiology. 2001; 94:968–972.

2. Brain AI, Verghese C, Addy EV, Kapila A. The intubating laryngeal mask I: development of a new device for intubation of the trachea. Br J Anaesth. 1997; 79:699–703.

3. Baskett PJ, Parr MJ, Nolan JP. The intubating laryngeal mask. Results of a multicentre trial with experience of 500 cases. Anaesthesia. 1998; 53:1174–1179.

4. Cros AM, Maigrot F, Esteben D. Fastrach laryngeal mask and difficult intubation. Ann Fr Anesth Reanim. 1999; 18:1041–1046.

5. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2013; 118:251–270.

6. Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: A one-year study of 610 tracheal intubations. Ann Emerg Med. 1998; 31:325–332.

7. Brain AI, Verghese C, Addy EV, Kapila A, Brimacombe J. The intubating laryngeal mask. II: a preliminary clinical report of a new means of intubating the trachea. Br J Anaesth. 1997; 79:704–709.

8. Ferson DZ, Rosenblatt WH, Johansen MJ, Osborn I, Ovassapian A. Use of the intubating LMA-Fastrach in 254 patients with difficult to manage airways. Anesthesiology. 2001; 95:1175–1181.

9. Nolan JP, Deakin CD, Soar J, Böttiger BW, Smith G. European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation. 2005; 67:S39–S86.

10. Branthwaite MA. An unexpected complication of the intubating laryngeal mask. Anaesthesia. 1999; 54:166–167.

11. Kundra P, Sujata N, Ravishankar M. Conventional tracheal tubes for intubation through the intubating laryngeal mask airway. Anesth Analg. 2005; 100:284–288.

12. Asai T, Shingu K. Difficulty in advancing a tracheal tube over a fibreoptic bronchoscope: incidence, causes and solutions. Br J Anaesth. 2004; 92:870–881.

13. Keller C, Brimacombe J. Pharyngeal mucosal pressures, airway sealing pressures, and fiberoptic position with the intubating versus the standard laryngeal mask airway. Anesthesiology. 1999; 90:1001–1006.

14. Cattano D, Chaudhry R, Callender R, Killoran P, Hagberg C. Recent trends in airway management: we are not ready to give up fiberoptic endoscopy. F1000Res. 2014; 3:114.