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

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Abstract

Background

The authors determined the efficacy of using the intubating laryngeal mask airway FastrachTM (ILMTM) 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 ILMTM 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 ILMTM was performed with a flexible lightwand. The number of attempts at ILMTM placement, the number of adjusting maneuvers, the number of attempts at tracheal intubation via the ILMTM,and any episodes of hypoxia (oxygen saturation < 90%) were recorded.

Results

Forty-four of 11,621 patients (0.4%) met the inclusion criteria. ILMTM 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 ILMTM 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 ILMTM insertion (range, 52–82%), but none after ILMTM insertion. No patient developed hypoxia during or after intubation via the ILMTM.

Conclusion

The ILMTM 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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