Abstract
Purpose
To present a case where the Aintree intubation catheter® (AIC) was used in conjunction with the Laryngeal Mask Airway® (LMA) and a fibreoptic bronchoscope (FOB) in a patient with an unexpected difficult airway.
Clinical features
A 38-yr-old 90 kg man scheduled for nasal endoscopy with ethmoidectomy under general anesthesia was found, unexpectedly, to be difficult to intubate using both a Macintosh laryngoscope (#4 blade) and a GlideScope® video laryngoscope despite having an airway examination that was unremarkable except for slightly decreased mouth opening and a large tongue. Intubation was achieved by inserting a size 5 disposable LMA into the upper airway, introducing a FOB into an AIC inserting the FOB/AIC assembly into the trachea via the LMA, removing the LMA, and then passing a regular size (7.5 mm) endotracheal tube into the trachea over the AIC.
Conclusion
In this patient, the AIC provided an effective alternative to other methods for intubating through a regular LMA.
Résumé
Objectif
Présenter un cas où le Aintree intubation catheter® (AIC) a été utilisé en conjonction avec le Laryngeal Mask Airway® (LMA) et un fibroscope bronchique (FOB) dans un cas d’intubation difficile imprévue.
Éléments cliniques
Un homme de 38 ans, pesant 90 kg, devant subir une endoscopie nasale et une ethmoïdectomie sous anesthésie générale a été, de façon inattendue, difficile à intuber avec un laryngoscope Macintosh (lame 4) et un vidéo-laryngoscope GlideScope® malgré un examen des voies aériennes qui était sans particularité sauf pour une ouverture de la bouche légèrement réduite et une grosse langue. L’intubation a été réalisée en insérant un MLA jetable de taille 5 dans les voies aériennes supérieures, en introduisant une FOB dans un AIC et en insérant ce FOB/AIC rassemblé dans la trachée au travers du LMA, puis en enlevant le MLA et en passant ensuite un tube endotrachéal de taille régulière (7,5 mm) dans la trachée au-dessus de l’AIC.
Conclusion
Chez le patient présenté, l’AIC a été utilisé en remplacement d’autres méthodes d’intubation au travers d’un LMA régulier.
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References
American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway. An updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology 2003; 98: 1269–77.
Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth 1998; 45:757–76.
Kidd JF, Dyson A, Latto IP. Successful difficult intubation. Use of the gum elastic bougie. Anaesthesia 1988;43:437–8.
Rosenblatt WH, Wagner PJ, Ovassapian A, Kain ZN. Practice patterns in managing the difficult airway by anesthesiologists in the United States. Anesth Analg 1998; 87:153–7.
Brimacombe JR, Brain AI, Berry AM. The Laryngeal Mask Airway: a Review and Practical Guide. London: WB Saunders; 1997.
Patil VU, Sopchak AM, Thomas PS. Use of a dental mirror as an aid to tracheal intubation in an infant (Letter). Anesthesiology 1993; 78:619–20.
Cooper RM. Use of a new videolaryngoscope (GlideScope®) in the management of a difficult airway. Can J Anesth 2003; 50:611–3.
Agro F, Barzoi G, Montecchia F. Tracheal intubation using a Macintosh laryngoscope or a GlideScope® in 15 patients with cervical spine immobilization (Letter). Br J Anaesth 2003; 90:705–6.
Doyle DJ, Zura A, Ramachandran M. Videolaryngoscopy in the management of the difficult airway (Letter). Can J Anesth 2004; 51:95.
Atherton DP, O’Sullivan E, Lowe D, Charters P. A ventilationexchange bougie for fibreoptic intubations with the laryngeal mask airway. Anaesthesia 1996; 51:1123–6.
Logan S, Charters P. Laryngeal mask and fibreoptic tracheal intubation (Letter). Anaesthesia 1994; 49:543–4.
Hawkins M O’Sullivan E, Charters P. Fibreoptic intubation using the cuffed oropharyngeal airway and Aintree intubation catheter. Anaesthesia 1998; 53:891–4.
Hasan MA, Black AE. A new technique for fibreoptic intubation in children. Anaesthesia 1994; 49:1031–3.
Heath ML, Allagain J. Intubation through the laryngeal mask. A technique for unexpected difficult intubation. Anaesthesia 1991; 46:545–8.
Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996; 84:686–99.
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Support was provided solely from institutional and/or departmental sources. The authors have no financial relationship with any of the manufacturers of any of the devices described in this case report.
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Zura, A., Doyle, D.J. & Orlandi, M. Use of the Aintree intubation catheter® in a patient with an unexpected difficult airway. Can J Anesth 52, 646–649 (2005). https://doi.org/10.1007/BF03015778
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DOI: https://doi.org/10.1007/BF03015778