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At least 19 recordsLinked to original sources
PubMed2002

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

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.

Adult↗
PubMed2001

Blind orotracheal intubation with the intubating laryngeal mask versus fibreoptic guided orotracheal intubation with the Ovassapian airway. A pilot study of awake patients.

In a randomized, prospective pilot study, we compared awake blind orotracheal intubation using the intubating laryngeal mask airway (blind-ILM) with awake fibreoptic-guided orotracheal intubation using an Ovassapian airway (FOS-OA). Fifty-four patients (ASA 1 to 3, aged 18 to 85 years) requiring awake intubation for elective surgery were randomly allocated by coin toss into two groups: 31 patients were intubated blindly through the ILM (blind-ILM) and 23 were intubated using fibreoptic guidance through the Ovassapian airway (FOS-OA). Sedation to a target clinical end-point (spontaneous eye-closing, but responsive to verbal command) was obtained with fentanyl/midazolam and a cricothyroid puncture was performed with 3 ml lignocaine 4%. The oropharynx was then topicalized until tolerance of a Guedel airway was achieved. The number of failed attempts (maximum of three allowed), overall success rates, the time from insertion of the airway to capnographic (blind-ILM) or fibreoptic (FOS-OA) confirmation of intubation or until three failed attempts, and cardiovascular responses before and during intubation, were recorded. The first time (blind-ILM, 25/31 [81%]; FOS-OA, 20/23 [87%], P = 0.6) and overall (blind-ILM, 26/31 [84%]; FOS-OA, 22/23 [96%], P = 0.2) intubation success rates were similar. The mean +/- SD time to intubation was shorter for the blind-ILM group (104 +/- 65 vs 158 +/- 115 sec, P = 0.05). There were no clinically significant differences in blood pressure or heart rate between groups. Compared with baseline values, there was no cardiovascular response to intubation in either group. We conclude that the blind-ILM and FOS-OA techniques have similar success rates and cardiovascular responses, but intubation is slightly quicker with the blind-ILM technique.

Adult↗
PubMed1997

Comparison between the Ovassapian intubating airway and the Berman intubating airway in fibreoptic intubation.

The most common indication for employing the fibreoptic technique for intubation is when a difficult intubation is anticipated. It may also be used when intubation unexpectedly proves difficult with a rigid laryngoscope in anaesthetized patients. However, failures with orotracheal fibreoptic intubation have been reported in up to 9.5% of cases, although only two possible equipment related causes of intubation difficulties have been identified. The Berman intubating airway and the Ovassapian intubation airway in fibreoptic orotracheal intubation have been compared in 65 patients. The study was randomized and for fibreoptic endoscopy each patient served as his or her own control. The results indicate that both airways can be used for orotracheal fibreoptic intubation in anaesthetized patients. The Berman airway offers easier visualization of the vocal cords than the Ovassapian airway, provided that the Berman airway is of an adequate size and positioned in the midline. Upon impingement of the intubation tube, completing the tracheal intubation is more difficult with the Berman airway than the Ovassapian airway.

Adult↗
PubMed2002

Detection and correction of accidental oesophageal intubation during flexible lightwand-guided intubation via the intubating laryngeal mask.

In the following two-part study, we determined the efficacy of observation of the light glow to detect correct placement of the tracheal tube after lightwand-guided tracheal intubation via the intubating laryngeal mask (ILM). We also determined the efficacy of a protocol to correct oesophageal intubation in this situation. In study 1, 80 ASA 1-3, anaesthetized, paralysed patients were randomly assigned to have a tracheal tube, preloaded with a flexible lightwand, placed into either the trachea (n=40) or oesophagus (n=40) under laryngoscope guidance. A blinded observer experienced with the lightwand technique determined whether oesophageal or tracheal intubation had occurred by observation of the light glow. In study 2, 1,000 patients, 400 of whom were included in a previous study, underwent flexible lightwand-guided intubation via the ILM. Placement of the tracheal tube in oesophagus or trachea was determined by observation of the glow and verified by capnography. Oesophageal intubation was corrected by adjusting the ILM position using a protocol comprising two adjusting manoeuvres. Observation, verification and correction were by experienced anaesthetists conducting the case. In study 1, oesophageal and tracheal intubation was correctly detected in 38/40 (95%) and 37/40 (92.5%) patients respectively. In study 2, oesophageal and tracheal intubation was correctly detected in 55/55 (100%) and 945/945 (100%) patients respectively. In 40/55 (73%) patients, tracheal intubation was successful at the second attempt and in 13/55 (24%) at the third or fourth attempt. In 2/55 (4%) patients, persistent oesophageal intubation occurred. The sensitivity, specificity and positive predictive value were 95%, 92.5% and 92.7% respectively in study 1, and were all 100% in study 2.

Adolescent↗
PubMed2004

Comparison of the Williams Airway Intubator and Ovassapian Fibreoptic Intubating Airway for fibreoptic orotracheal intubation.

A randomised study was carried out in 60 anaesthetised patients with no evidence of airway difficulties, to compare the Williams Airway Intubator and the Ovassapian Fibreoptic Intubating Airway for bronchoscopic view and ease of railroading a tracheal tube during fibreoptic orotracheal intubation. The Williams Airway Intubator provided a better view of the glottis (41 (68.3%) unobstructed views) than the Ovassapian Fibreoptic Intubating Airway (15 (25%) unobstructed views; p < 0.0001) and a shorter time was needed to complete bronchoscopy (median (95% CI) difference 4 s (1-7); p = 0.01). Four (6.7%) bronchoscopies failed using the Williams Airway Intubator compared with 26 (43.3%) using the Ovassapian Fibreoptic Intubating Airway (p < 0.0001). Both airways provided similar intubating conditions when the glottis was visible.

Adolescent↗
PubMed1998

Large goitre causing difficult intubation and failure to intubate using the intubating laryngeal mask airway: lessons for next time.

A 63-yr-old woman was anaesthetized for sub-total thyroidectomy. The thyroid gland was large, deviating the trachea to the right and causing 30% tracheal narrowing at the level of the suprasternal notch. Mask ventilation was easy but laryngoscopy was Cormack and Lehane grade 3. Despite being able to see the tip of the epiglottis, tracheal intubation was impossible. An intubating laryngeal mask was inserted and although the airway was clear and ventilation easy, it was not possible to intubate the trachea either blindly or with the fibreoptic bronchoscope. Tracheal intubation was eventually achieved using a 6.5-mm cuffed oral tracheal tube via a size 4 laryngeal mask under fibreoptic control. We describe the case in detail and discuss the use of the intubating laryngeal mask, its potential limitations and how to optimize its use in similar circumstances.

Contraindications↗
PubMed2002

[Intubation in a patient with lingual tonsil hypertrophy using an intubating laryngeal mask airway in combination with fiberoptic intubation].

A 66-yr-old man was scheduled for colon resection under general anesthesia. There were no findings suggesting difficulty of airway management. After induction of anesthesia, manual ventilation via a facemask was suboptimal, but increased fresh gas flow improved it. At direct laryngoscopy after achieving muscular relaxation, the arytenoids and epiglottis could not be seen even by an expert anesthesiologist. Intubating laryngeal mask airway (ILMA) was inserted to patient's larynx and ventilation could be continued. Tracheal intubation through ILMA was impossible because of hard resistance for inserting the endotracheal tube. Fiberoptic bronchoscopy revealed that the hypertrophied lingual tonsil obstructed the aperture of ILMA. Several attempts were made for intubation using fiberoptic tracheal intubation technique through ILMA and finally the patient's trachea was intubated without any bleeding or swelling of laryngeal tissues. The effectiveness of ILMA for the patient with lingual tonsil hypertrophy is still unknown, but the insertion of ILMA might be considered for safe airway management in combination with a fiberscope.

Aged↗
PubMed2006

Comparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients.

Sixty patients with no clinical indicators of a difficult airway were selected to undergo a fibreoptic assessment after induction of general anaesthesia using both the Berman Intubating Airway and the Williams Airway Intubator. The bronchoscopic view and ease of railroading a tracheal tube during fibreoptic orotracheal intubation were studied. The bronchoscopic views obtained by the Berman Airway and the Williams Airway were significantly different (p < 0.008, test of symmetry). The estimated odds ratio of obtaining an obstructed path was 3.06 times higher for the Berman than the Williams Airway. However, if the glottis could be reached with the bronchoscope, there was no significant difference in the degree of ease of intubation between the two airways.

Adolescent↗
PubMed1998

[The importance of the laryngeal mask in the difficult intubation and early experience with the intubating laryngeal mask airway--ILMA--Fastrach].

UNLABELLED: The conventional laryngeal mask airway ("Standard" laryngeal mask airway SLMA is of outstanding importance in the management of the difficult airway. The intubating laryngeal mask airway (ILMA, commercial name Fastrach) has become available recently. First results indicate that the excellent ventilation characteristics of SLMA are maintained, but in addition blind intubation is successful in more than 90% of patients with normal anatomy as well as with difficult intubation. PURPOSE: We present the use of ILMA, compare the potential of the two laryngeal mask types in difficult intubation by own results, present the results of a first symposium on the ILMA held at Jersey in December 1996, the role of the SLMA in difficult intubation as proposed by the American and the French Societies of Anaesthesiology, as well as an outlook on possible uses of the ILMA in the light of the available results. METHODS: The SLMA was prospectively used between 1992 and 1997 for 66 operations in 55 patients with difficult intubation (laryngoscopic view Cormack grade IV, n = 24; grade III, n = 35; grade < III, n = 7). 48 operations were performed after resection of a facial carcinoma, 14 on patients without carcinoma who could not be intubated conventionally, 5 on patients with periglottic pathology, and on 50 normals. The ILMA was used on 150 patients between 11/1996 and 11/1997, 106 had normal anatomy, 33 were difficult to intubate (Cormack grade IV, n = 12; grade III, n = 21), 24 had a reduced mouth opening of < or = 2.5 cm awake, 14 of these also were difficult to intubate. RESULTS: Ventilation was superior to a face mask (FM): (SLMA: ventilation not sufficient (SaO2 < 90% > 30 sec) with a FM in 22 operations compared to 5 with a SLMA; ILMA: ventilation not sufficient with a FM in 7 operations compared to 3 with an ILMA). Blind intubation through a SLMA had a success rate of 50% and 34% in 50 normals and in 32 operations with difficult intubation after a mean of 2.6 intubation attempts each. The success rate per intubation attempt for the SLMA was 22% in normals and 13% in difficult intubation. Through an ILMA, blind intubation was successful in 92% of normals, 5 of them with immobile spine, in 91% in patients with difficult intubation, and in 83% in patients with reduced mouth opening. The success rate per intubation attempt was 60% in normals, 46% in difficult intubation, and 46% in reduced mouth opening, with a success rate for the first intubation attempt of 57%. This compares favourably with results presented at the Jersey symposium in 554 patients. CONCLUSION: The ILMA maintains the superb ventilation potential of a SLMA in difficult intubation but doubles the success rate of blind intubation irrespective of anatomical difficulties, with a 50% success rate during the first intubation attempt. Possible uses of the ILMA may be in difficult intubation situations including immobile spine, in cannot ventilate--cannot intubate situations comparable to a SLMA with an improved chance of successful intubation, and perhaps as a device for ventilation and intubation for untrained people. The use of the ILMA can be trained during everyday practice. Expert assessment of successful endotracheal tube position is mandatory.

Facial Neoplasms↗
PubMed2000

Tracheal intubation with the Macintosh laryngoscope versus intubating laryngeal mask airway in adults with normal airways.

We tested the hypothesis that haemodynamic changes to intubation and postoperative pharyngolaryngeal morbidity are similar for blind intubating laryngeal mask (ILM)-guided compared with laryngoscope-guided tracheal intubation in adults with normal airways. We also compared intubation success rates and airway complications. One-hundred and fifty paralysed, anaesthetized adult patients undergoing elective surgery were randomly assigned to one of three equal-sized groups: 1. blind intubation via the ILM using a straight, silicone tube; 2. intubation with a Macintosh laryngoscope using a straight silicone tube and 3. intubation with a Macintosh laryngoscope using a polyvinyl chloride tube (controls). A standard sequence of adjusting manoeuvres was followed if intubation was difficult. The number of adjusting manoeuvres and intubation attempts, time to intubation, intubation success rate (first attempt and within 3 min), haemodynamic changes (pre-induction, post-induction, post-intubation), oesophageal intubation, mucosal trauma (blood detected), hypoxia (SpO2 < 95%) and postoperative pharyngolaryngeal morbidity (double-blinded) were documented. Time to successful intubation was longer (57 vs 35 s), and more intubation attempts were required in the ILM group (P < 0.0001). The intubation success rate was 100% (all first attempt) for the laryngoscope groups and 94% (56% first attempt) for the ILM group. There were no significant differences in heart rate or blood pressure among groups. Oesophageal intubation (26 v 0%) and mucosal trauma (19 v 2%) were more common in the ILM group. Hypoxia and postoperative pharyngolaryngeal morbidity were similar among groups. Blind intubation through the ILM offers no advantages over the Macintosh laryngoscope for adult patients requiring intubation for elective surgery with normal airways, but it is a feasible alternative.

Adult↗
PubMed2001

Tracheal intubation through the intubating laryngeal mask in patients with unstable necks.

BACKGROUND: In patients with unstable necks, the neck should be stabilized during induction of anaesthesia, but this may make tracheal intubation difficult. Awake intubation may produce straining, which could be detrimental to the unstable neck. METHODS: We studied 20 patients with unstable necks to examine the efficacy of insertion of the intubating laryngeal mask under conscious sedation (to minimize the possibility of losing a patent airway and to facilitate fibrescope-aided intubation) followed by tracheal intubation through the laryngeal mask after induction of anaesthesia (to reduce stress response to intubation). After the patient had been sedated with midazolam (up to 5 mg) and fentanyl (up to 100 microg), the intubating laryngeal mask was inserted. General anaesthesia was then induced with sevoflurane and tracheal intubation attempted. RESULTS: In all patients, tracheal intubation through the laryngeal mask succeeded without airway obstruction. Neither insertion of the mask under conscious sedation nor tracheal intubation after induction of anaesthesia caused straining, and only two patients moved upper extremities at intubation. Insertion of the laryngeal mask did not significantly alter blood pressure or heart rate. Tracheal intubation significantly increased blood pressure and heart rate, but the increase was considered to be small. CONCLUSIONS: In the patient with an unstable neck with a low risk of pulmonary aspiration, insertion of the intubating laryngeal mask while the patient is sedated may minimize difficulty in obtaining a patent airway before tracheal intubation and may facilitate a fibrescope-aided tracheal intubation; subsequent induction of anaesthesia before tracheal intubation may minimize stress response to intubation.

Adult↗
PubMed1998

The intubating laryngeal mask. Clinical appraisal of ventilation and blind tracheal intubation in 110 patients.

This study assesses the efficacy of the intubating laryngeal mask as a ventilation device and blind intubation guide. Following induction of anaesthesia with propofol, the device was successfully inserted at the first attempt in 110/110 (100%) patients. Placement took less than 10 s in all patients. Size selection was based on nose-chin distance. Adequate ventilation was achieved in 104/110 (95%) patients. Blind tracheal intubation using an 8-mm internal diameter straight silicone cuffed tracheal tube was attempted 3 min after the administration of vecuronium. Passage of a lighted stylet through the intubating laryngeal mask was used to determine the position of the intubating laryngeal mask cuff before blind intubation. If resistance was felt during intubation, a sequence of adjusting manoeuvres was used, based on the depth at which resistance occurred. Tracheal intubation was possible in 104/104 (100%) patients. In 42 (40%) patients, no resistance was encountered and the trachea was intubated at the first attempt. Sixty-two (60%) patients required one adjusting manoeuvre. The mean (range) time taken to successful intubation, i.e. the time from disconnection of the intubating laryngeal mask from the breathing system to successful tracheal intubation, was 79 (12-315) s. Six patients with potential or known intubation problems were included in the study. The tracheas of all six patients were successfully intubated. We conclude that the intubating laryngeal mask is an effective ventilation device and intubation guide with potential for use in patients who may present difficulty in tracheal intubation.

Adult↗
PubMed2000

A comparison of blind and lightwand-guided tracheal intubation through the intubating laryngeal mask.

We have tested the hypothesis that intubation success rates, haemodynamic changes, airway complications and postoperative pharyngolaryngeal morbidity differ between blind and lightwand-guided intubation through the intubating laryngeal mask airway. One hundred and twenty paralysed anasthetised adult patients (ASA I-II, no known or predicted difficult airways) were assigned in a random manner to one of two equal-sized groups. In the blind group, patients were intubated blindly through the intubating laryngeal mask airway. In the lightwand group, patients were intubated through the intubating laryngeal mask airway assisted by transillumination of the neck with a lightwand. A standard sequence of adjusting manoeuvres was followed if resistance occurred during intubation or if transillumination was incorrect. The number of adjusting manoeuvres, time to intubation, intubation success rates, haemodynamic changes (pre-induction, pre-intubation, postintubation), oesophageal intubation, mucosal trauma (blood detected), hypoxia (oxygen saturation < 95%) and postoperative pharyngolaryngeal morbidity (double-blinded) were documented. Overall intubation success was similar (blind, 93%; lightwand, 100%), but time to successful intubation was significantly shorter (67 vs. 46 s, p = 0. 027) and the number of adjusting manoeuvres was significantly fewer (p = 0.024) in the lightwand group. There were no significant differences in blood pressure or heart rate between the groups at any time. Oesophageal intubation occurred more frequently in the blind group (18 vs. 0%, p = 0.002). The incidence and severity of mucosal injury, sore throat and hoarseness were similar between the groups. We conclude that lightwand-guided intubation through the intubating laryngeal mask is superior to the blind technique.

Adult↗
PubMed2005

The intubating laryngeal mask airway: rocuronium improves endotracheal intubating conditions and success rate.

STUDY OBJECTIVE: To assess intubating conditions without neuromuscular blocking drugs, to determine the relation between the dose of rocuronium and the probability of achieving excellent or at least good (good or excellent) intubating conditions with the intubating laryngeal mask airway (ILMA), and finally, to determine the relationship between rocuronium use and the success rate of endotracheal intubation. DESIGN: Prospective, randomized, double-blinded, placebo-controlled study. SETTING: University-affiliated medical center. PATIENTS: Sixty American Society of Anesthesiologists physical status I and II patients undergoing elective surgery. INTERVENTIONS: Anesthesia was induced with propofol 2.5 mg/kg and fentanyl 1 microg/kg. One minute after loss of consciousness, patients received rocuronium 0.2 mg/kg or saline. In the rocuronium group, if intubating conditions were scored as poor, rocuronium dose in the next patient was increased by 0.05 mg/kg. If intubating conditions were scored as good, no change was made, but if conditions were scored as excellent, the dose was decreased by 0.05 mg/kg. One minute after rocuronium or saline administration, an ILMA was used to intubate the trachea. If intubation was unsuccessful, a second attempt was made using the ILMA. MEASUREMENTS: We recorded intubating conditions and the success rate of tracheal intubation. MAIN RESULTS: Without rocuronium, the probability of achieving at least good intubating conditions with the ILMA was 30%. A rocuronium dose of 0.2 mg/kg resulted in a probability of 80% to achieve at least good intubating conditions. Rocuronium significantly increased the success rate of the second intubation attempt. CONCLUSION: To achieve good or excellent intubating conditions with the ILMA, a rocuronium dose lower than the standard intubating dose of 0.6 mg/kg can be used. Neuromuscular blockade increases the success rate of intubation if a second attempt is necessary.

Adult↗
PubMed1995

Lightwand intubation: II--Clinical trial of a new lightwand for tracheal intubation in patients with difficult airways.

Lightwands have been used to assist in the tracheal intubation of patients with difficult airways for many years. A new lightwand (Trachlight) with a brighter light source and a flexible stylet permits both oral and nasal intubation under ambient light. This study reports the effectiveness of the Trachlight in tracheal intubation in patients with difficult airways. Two groups of patients were studied: Group 1--patients with a documented history of difficult intubation or anticipated difficult airways; Group 2--anaesthetized patients with an unanticipated failed laryngoscopic intubation. In Group 1, the tracheas were intubated using the Trachlight with patients either awake or under general anaesthesia. In Group 2, tracheas were intubated under general anaesthesia using the Trachlight. The time-to-intubation, number of attempts, failures, and complications during intubation for all patients were recorded. Two hundred and sixty-five patients were studied with 206 patients in Group 1, and 59 in Group 2. In most patients, the tracheas were intubated orally (183 versus 23 nasal) during general anaesthesia (202 versus 4 awake) in Group 1. Intubation was successful in all but two of the patients with a mean (+/- SD) time-to-intubation of 25.7 +/- 20.1 sec (range 4 to 120 sec). The tracheas of these two patients were intubated successfully using a fibreoptic bronchoscope. Orotracheal intubation was successful in all patients in Group 2 using the Trachlight with a mean (+/- SD) time-to-intubation of 19.7 +/- 13.5 sec. Apart from minor mucosal bleeding (mostly from nasal intubation), no serious complications were observed in any of the study patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Comparison of times to achieve tracheal intubation with three techniques using the laryngeal or intubating laryngeal mask airway.

We compared the times to intubate the trachea using three techniques in 60 healthy patients with normal airways: (i) fibreoptic intubation with a 6.0-mm reinforced tracheal tube through a standard laryngeal mask airway (laryngeal mask-fibreoptic group); (ii) fibreoptic intubation with a dedicated 7.0-mm silicone tracheal tube through the intubating laryngeal mask airway (intubating laryngeal mask-fibreoptic group); (iii) blind intubation with the dedicated 7.0-mm silicone tracheal tube through the intubating laryngeal mask airway (intubating laryngeal mask-blind group). Mean (SD) total intubation times were significantly shorter in the intubating laryngeal mask-blind group (49 (20) s) than in either of the other two groups (intubating laryngeal mask-fibreoptic 74 (21) s; laryngeal mask-fibreoptic group 75 (36) s; p < 0.001). However, intubation at the first attempt was less successful with the intubating laryngeal mask-blind technique (15/20 (75%)) than in the other two groups (intubating laryngeal mask-fibreoptic 19/20 (95%) and laryngeal mask-fibreoptic 16/20 (80%)) although these differences were not statistically significant. We conclude that in this patient group, all three techniques yield acceptable results. If there is a choice of techniques available, the intubating laryngeal mask-blind technique would result in the shortest intubation time.

Anesthesia, Dental↗
PubMed1994

Neuromuscular blockade-assisted oral intubation versus nasotracheal intubation in the prehospital care of injured patients.

STUDY OBJECTIVE: To compare nasotracheal intubation (NTI) to neuromuscular blockade-assisted oral intubation (NMB-assisted oral intubation) in the prehospital care of injured patients. DESIGN: Prospective, randomized study conducted over 21 months. SETTING: A university hospital-sponsored helicopter service. PARTICIPANTS: Consecutive adult (more than 12 years old) injured patients at the accident scene with an initial Glasgow Coma Scale of 8 or less in whom the airway was not managed immediately by unrelaxed oral intubation or cricothyrotomy. Subjects were randomized by 24-hour time blocks into NTI or NMB-assisted oral intubation treatment groups. Forty-four were entered into the NTI group (39 randomized, two crossed over to NMB-assisted oral intubation), and 33 were entered into the NMB-assisted oral intubation group (38 randomized, seven crossed over to NTI). INTERVENTIONS: NMB-assisted oral intubation (succinylcholine 1.5 mg/kg IV) or NTI was carried out according to standard protocols. RESULTS: The success rate for NTI was 79.5% (35 of 44) and was similar to that of NMB-assisted oral intubation, 75.8% (25 of 33; chi 2 = .16; P = .69). There were no significant differences between the NTI and the NMB-assisted oral intubation groups with regard to sex, age, outcome, and Glasgow Coma Scale. For those patients in whom the initial technique was successful, NTI was significantly quicker than NMB-assisted oral intubation (mean time of NTI, 2.9 minutes; mean time of NMB-assisted oral intubation, 5.9 minutes; Mann-Whitney U, 168.0; P < .01). CONCLUSION: In the prehospital management of severely injured patients, there is no significant difference between NMB-assisted oral intubation and NTI in the rate at which endotracheal intubation is achieved. However, practitioners may prefer NTI because it requires significantly less time to perform than NMB-assisted oral intubation.

Adult↗
PubMed2004

The intubating laryngeal mask airway facilitates tracheal intubation in the lateral position.

UNLABELLED: Although the difficulty of tracheal intubation in the lateral position has not been systematically evaluated, airway loss during surgery in a laterally positioned patient may have hazardous consequences. We explored whether the intubating laryngeal mask airway (ILMA) facilitates tracheal intubation in patients with normal airway anatomy, i.e., Mallampati grade or=5 cm, positioned in the lateral position. We evaluated whether this technique can be used as a rescue when the airway is lost during the middle of surgery in laterally positioned patients with respect to success rate and intubation time. Anesthesia was induced with propofol, fentanyl, and vecuronium in 50 patients undergoing spine surgery for lumbar disk herniation (Lateral) and 50 undergoing other surgical procedures (Supine). Patients having disk surgery (Lateral) were positioned on their right or left sides before induction of general anesthesia, and intubation was performed in that position. Patients in the control group (Supine) were anesthetized in supine position, and intubation was performed in that position. Intubation was performed blindly via an ILMA in both groups. The time required for intubation and number and types of adjusting maneuvers used were recorded. Data were compared by the Mann-Whitney U test, Fisher's exact test, chi(2) test, or unpaired Student's t-test, as appropriate. Data presented as mean (SD). Demographic and airway measures were similar in the two groups, except for mouth opening, which was slightly wider in patients in the lateral position: 5.1 (0.9) versus 4.6 (0.7) cm. The time required for intubation was similar in each group ( approximately 25 s), as was intubation success (96%). We conclude that blind intubation via an ILMA offers a frequent success rate and a clinically acceptable intubation time (<1 min) even in the lateral position. IMPLICATIONS: Blind intubation via the intubating laryngeal mask airway (ILMA) offers frequent success and a clinically acceptable intubation time even in patients in the lateral position.

Adolescent↗