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Canadian Journal of Anesthesia

, Volume 51, Issue 10, pp 1018–1021 | Cite as

Use of the Laryngeal Tube™ in two unexpected difficult airway situations: lingual tonsillar hyperplasia and morbid obesity

  • Adrian A. Matioc
  • John Olson
Cardiothoracic Anesthesia, Respiration and Airway

Abstract

Purpose

The 2003 ASA Practice Guidelines for Management of the Difficult Airway suggest the early use of the Laryngeal Mask Airway and Combitube as rescue airway devices in the cannot ventilate-cannot intubate situation, switching the focus from laryngoscopy and intubation to ventilation and oxygenation. The Practice Guidelines are not intended as standards but as recommendations. Multiple new alternative airway devices were described in the last ten years. The Laryngeal Tube™ (LT) is a new Food and Drug Administration approved supraglottic airway device. The device is in use in Europe since 1999 and in the United States since 2002.

Clinical features

We report two cases in which the LT was used to solve two unexpected difficult airway situations. The first case (“cannot intubate-inadequate mask ventilation”) involved an undiagnosed lingual tonsillar hyperplasia and the LT provided the means to ventilate and administer the anesthetic. In the second case (“cannot ventilate-cannot intubate”) we report the successful use of the LT to rescue the airway in a morbidly obese patient. In both cases an endotracheal tube was ultimately inserted using an awake fibreoptic technique with the patient in the sitting position.

Conclusions

In these clinical situations of unexpected difficult airway with significant periglottic obstruction the LT provided adequate ventilation after the first insertion. The LT may complement the laryngeal mask airway in difficult airway management. Further research is needed to define the role of the LT in the management of difficult airways.

Keywords

Continuous Positive Airway Pressure Laryngeal Mask Airway Difficult Airway Airway Device Laryngeal Mask Airway ProSeal 
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.

L’usage du Laryngeal Tube™ dans deux situations d’intubation difficile inattendue : hyperplasie des amygdales linguales et obésité morbide

Résumé

Objectif

Les ASA Practice Guidelines for Management of the Difficult Airway de 2003 suggèrent l’utilisation précoce du masque laryngé et du Combitube comme instruments de secours quand on ne peut ni ventiler, ni intuber, insistant maintenant sur la ventilation et l’oxygénation plutôt que sur la laryngoscope et l’intubation. Les directives cliniques ne sont pas des normes, mais bien des recommandations. Beaucoup d’autres instruments d’intubation ont été présentés au cours de la dernière décennie. Le Laryngeal Tube™ (LT), pour l’intubation supraglottique, est approuvé par la Food and Drug Administration américaine. On l’utilise en Europe depuis 1999 et aux États-Unis depuis 2002.

Éléments cliniques

Nous présentons deux cas où le LT a permis de solutionner deux situations problématiques d’intubation. Le premier cas («intubation impossibleventilation au masque inadéquate») comportait une hyperplasie des amygdales linguales non diagnostiquée alors que le LT a permis de ventiler et d’administrer l’anesthésie. Dans le second cas («ventilation impossibleintubation impossible»), nous signalons l’usage réussi du LT pour assurer la perméabilité des voies aériennes chez une patient atteint d’obésité morbide. Dans les deux cas, un tube endotrachéal a été finalement inséré en utilisant une technique fibroscopique vigile avec le patient en position assise.

Conclusion

Dans les situations cliniques présentées, de difficulté d’intubation inattendue avec obstruction périglottique significative, le LT a permis de fournir une ventilation adéquate après la première insertion. Le LT peut servir de complément au masque laryngé pour la maîtrise des voies aériennes. D’autres recherches seront nécessaires pour définir le rôle du LT dans le contrôle des voies aériennes.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of WisconsinMadisonUSA

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