Date: 15 Jan 2010

Awake intubation through an intubating laryngeal airway (ILATM) in a patient with Still’s disease

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To the Editor:

The intubating laryngeal airway (ILATM) (Mercury Medical, Clearwater, FL, USA) is a new supraglottic airway with an insertion technique and functionality very similar to the FastrachTM laryngeal mask airway (LMA-FastrachTM). We describe the use of the ILATM in fibreoptic-guided intubation in a patient with Still’s disease and an anticipated difficult airway. Written consent was obtained from the patient for publication of this article.

A 40-yr-old female patient (weight 55 kg, height 165 cm) with adult Still’s disease was scheduled for vitrectomy under general anesthesia. Previous cervical fusion resulted in cervical immobility, and the patient’s mouth opening was limited to 12 mm due to temporomandibular joint involvement. Standard monitors were applied and an intravenous infusion of glycopyrrolate 0.2 mg, midazolam 1 mg, and remifentanil was administered. Topical lidocaine 2-4% was atomized intraorally. A fully deflated size 3 LMA-FastrachTM could not be inserted between ...