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Awake tracheal intubation through the intubating laryngeal mask

  • Takashi Asai
  • Hideo Matsumoto
  • Koh Shingu
Brief Clinical Reports

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.

Keywords

Tracheal Intubation Tracheal Tube Laryngeal Mask Airway Difficult Airway Difficult Tracheal Intubation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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.

References

  1. 1.
    Brimacombe JR, Brain AIJ, Berry AM. The laryngeal Mask Airway. Instruction manual, 3rd ed. Berkshire: Intavent-Orthofix, 1996.Google Scholar
  2. 2.
    Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996; 84: 686–99.PubMedCrossRefGoogle Scholar
  3. 3.
    Asai T, Latto P. Role of the laryngeal mask in patients with difficult tracheal intubation and difficult ventilation.In: Latto IP, Vaughan RS (Eds.). Difficulties in Tracheal Intubation, 2nd ed. London: W.B. Saunders Company Ltd, 1997: 177–96.Google Scholar
  4. 4.
    Maltby JR, Loken RG, Beriault MT, Archer DP. Laryngeal mask airway with mouth opening less than 20 mm. Can J Anaesth 1995; 42: 1140–2.PubMedGoogle Scholar
  5. 5.
    Chadd GD, Ackers JWL, Bailey PM. Difficult intubation aided by the laryngeal mask airway (Letter). Anaesthesia 1989; 44: 1015.PubMedCrossRefGoogle Scholar
  6. 6.
    Gimud O, Bourgain JL, Marandas P, Billard V. Limits of laryngeal mask airway in patients after cervical or oral radiotherapy. Can J Anaesth 1997; 44: 1237–41.CrossRefGoogle Scholar
  7. 7.
    Brain AIJ, Verghese C, Addy EV, Kapila A, Brimacombe J. The intubating laryngeaJ mask. II: a preliminary clinical report of a new means of intubating the trachea. Br J Anaesth 1997; 79: 704–9.PubMedGoogle Scholar
  8. 8.
    Joo H, Rose K. Fastrach—a new intubating laryngeal mask airway: successful use in patients with difficult airways. Can J Anaesth 1998; 45: 253–6.PubMedGoogle Scholar
  9. 9.
    Ovassapian A. Management of the difficult airway.In: Ovassapian A (Ed.). Fiberoptic Endoscopy and Difficult Airway. New York: Raven Press, 1996: 201–30.Google Scholar
  10. 10.
    Koga, K, Asai T, Latto IP, Vaughan RS. Effect of the size of a tracheal tube and the efficacy of the use of the laryngeal mask for fibrescope-aided tracheal intubation. Anaesthesia 1997; 52: 131–5.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  1. 1.Department of AnaesthesiologyKansai Medical UniversityOsakaJapan

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