Abstract
Purpose
To report successful awake insertion of the intubating laryngeal mask (Fastrach™) and subsequent tracheal intubation through it, in a patient with predicted difficult tracheal intubation, due to limited mouth opening, and difficult ventilation through a facemask, due to a large mass at the corner of the mouth.
Clinical Features
A 53-yr-old woman with a large post-gangrenous mass on the right cheek to the angle of the mouth was scheduled for its resection. The right side of her face was damaged by a bomb attack followed by cancrum oris 50 yr ago. The distance between the incisors during maximum mouth opening was 2 cm and that between the gums on the right side < 1 cm. After preoxygenation and 50 μg fentanyl and 30 mg propofoliv, propofol was infused at 2 mg·kg−1·hr−1. Lidocaine, 8%, was sprayed on the oropharynx. A #4 intubating laryngeal mask was inserted with a little difficulty. A fibrescope was passed through a 7.5-mm ID RAE tracheal tube, and the combination was easily passed through the laryngeal mask into the trachea. General ansthesia was then induced. Finally, the intubating laryngeal mask was removed, while the RAE tube was being stabilized using an uncuffed 6.0-mm ID tracheal tube.
Conclusion
Awake tracheal intubation through the intubating laryngeal mask is a useful technique in patients with limited mouth opening in whom ventilation via a facemask is expected to be difficult.
Résumé
Objectif
Décrire l’insertion vigile réussie du masque laryngé (Fastrach™) et l’intubation endotrachéale subséquente au travers de ce masque chez une patiente dont l’intubation s’annonçait difficile à cause d’une ouverture limitée de la bouche et d’une ventilation compliquée par masque étant donné une importante masse au coin de la bouche.
Éléments cliniques
Une femme de 53 ans a été admise pour la résection d’une importante masse postgangréneuse à la joue droite, au coin de la bouche. Il y a 50 ans, elle avait subi une stomatite gangréneuse à la suite d’une blessure au côté droit du visage lors d’un bombardement. À l’ouverture maximale de la bouche, la distance entre les incisives était de 2 cm, mais < I cm entre les gencives du côté droit. Après la préoxygénation et l’administration de 50 μg de fentanyl et de 30 mg de propofoliv, on a fourni une perfusion de propofol à 2 mg·kg−1hr−1. On a pulvérisé ensuite de la lidocaïne 8 % sur l’oropharynx. Un masque laryngé n∘ 4 a été inséré avec un peu de difficulté, Un fibroscope a été placé dans une canule trachéale de RAE d’un DI de 7,5 mm, puis le tout dans le masque laryngé qu’on a facilement introduit dans la trachée. On a ensuite induit l’anesthésie générale. Finalement, on a retiré le masque laryngé et stabilisé le tube de RAE à l’aide d’un tube endotrachéal sans ballonnet d’un DI de 6,0 mm.
Conclusion
L’emploi du masque laryngé pour l’intubation endotrachéale vigile s’est révélée utile pour les patients chez qui l’ouverture de la bouche est limitée et la ventilation par masque s’annonce difficile.
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Asai, T., Matsumoto, H. & Shingu, K. Awake tracheal intubation through the intubating laryngeal mask. Can J Anesth 46, 182–184 (1999). https://doi.org/10.1007/BF03012555
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DOI: https://doi.org/10.1007/BF03012555