Awake intubation using the LMA-CTrach in patients with difficult airways

The Application of a SaCoVLMTM Visual Intubation Laryngeal Mask for the Management of Difficult Airways in Morbidly Obese Patients: Case Report

We report insertion of the SaCoVLM^TM in three awake morbidly obese patients (BMI 46. 7-52.1 kg/m²). The patients were given intravenous atropine and midazolam injections after entering the operating room and then inhaled an anesthetic with 2% lidocaine atomization. After SaCoVLM^TM insertion while patients were awake, when the vocal cords were visualized, controlled anesthetic induction commenced with spontaneous ventilation. The entire anesthesia induction and intubation process was completed under visualization, and no adverse events such as hypoxemia occurred. No patient had an unpleasant recall of the procedure. We conclude that the SaCoVLM^TM is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways.

Tracheal intubation through laryngeal mask airway CTrach™ with polyvinyl chloride tube: Comparison between two orientations of the tracheal tube

Background and Aims:

Higher success rate of intubation is observed with the reverse orientation of polyvinyl chloride (PVC) tracheal tube while intubating through laryngeal mask airway (LMA) Fastrach™. It is not clear whether the same is true during intubation through LMA CTrach™ visualizing the process of intubation. The primary aim of this study was to compare the influence of the PVC tracheal tube orientation on the success rate of intubation while intubating through LMA CTrach™.

Material and Methods:

One-hundred and fifty patients belonging to American Society of Anesthesiologists status I–II, undergoing elective surgery under general anesthesia were randomized to either group normal orientation or group reverse orientation. A maximum of 3 intubation attempts within a span of 3 min was allowed in each group before the change over to the other group. If intubation failed with the other orientation of the tube also, then intubation through LMA CTrach™ was abandoned and intubation done by direct laryngoscopy. The success of intubation, time, maneuvers, postoperative sore throat, and hoarseness were recorded.

Results:

Tracheal intubation through LMA CTrach™ with PVC tube was successful in 94.5% of patients in group normal orientation and in 98.6% of patients in group reverse orientation. The first attempt success rate was 75.3% and 86.3% in group normal and group reverse orientation, respectively. The incidence of a sore throat was higher in the group normal orientation than in the reverse orientation (31.8% and 26.5%, respectively).

Conclusions:

Overall success rate of intubation was comparable between the two groups. Though statistically insignificant, the first attempt success rate was higher in group reverse orientation.

Shikani optical stylet-guided intubation via the intubating laryngeal airway in patients with scar contracture of the face and neck

OBJECTIVE

To evaluate the feasibility of the Shikani Optical Stylet (SOS)-guided intubation through a new Intubating Laryngeal Airway (ILA) in anticipated difficult airways caused by scar contracture of the face and neck.

METHODS

Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea.

RESULTS

The ILA provided an effective airway in all patients. Intubation was successful at the first attempt on 22/33(66.7%) occasions and at the second attempt on 6/33 (18.2%). Intubation failed in 5 (15.1%) patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients' tracheas were finally intubated using a fibreoptic bronchoscope via the ILA.

CONCLUSIONS

The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.

The LMA CTrach™ in morbidly obese and lean patients undergoing gynecological procedures: a comparative study

PURPOSE

The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. The aim of this study was to compare the airway management quality in morbidly obese and lean patients with use of the LMA CTrach.

METHODS

After Ethics Committee approval, 60 adult patients (30 morbidly obese patients with body mass index >40 kg/m² and 30 lean patients with body mass index <30 kg/m²) scheduled to undergo gynecological surgery were enrolled in this prospective study. The induction of anesthesia was standardized using propofol, fentanyl, and rocuronium. Ventilation and intubation success rates, time taken to achieve successful ventilation, and intubation through the CTrach and airway complications were recorded.

RESULTS

The CTrach was successfully inserted and adequate ventilation through the CTrach was achieved in 59 patients (98%). Only 1 patient in the lean group was not able to ventilate through the CTrach. We were successful in endotracheal intubation, either under vision or blind, in 56 patients (93%). We were able to view the larynx in 51 patients (85%). Total intubation time was significantly longer in morbidly obese patients, 69 (311) s, than in lean patients, 33 (107) s [median (range)] (P < 0.001).

CONCLUSIONS

We concluded that the time to intubate the trachea in obese patients was significantly longer than in lean patients when the LMA CTrach was used.

[Use of the AirTraq device to manage difficult intubation in the awake patient]

OBJECTIVE

To assess successful intubation, hemodynamic and respiratory stability, and patient wellbeing during awake orotracheal intubation using the AirTraq device in patients anticipated to have difficult airways.

PATIENTS AND METHODS

Prospective observational study in patients who were candidates for awake intubation with the AirTraq device based on a score of 11 or more on the Arné test to predict a difficult airway. The 3 sets of variables assessed were intubation success, hemodynamic and respiratory stability, and subjective and objective measures of patient well-being.

RESULTS

Eleven patients were enrolled. Intubation was successful in 10 patients. Hemodynamic and respiratory stability was maintained in all cases. When well-being during intubation was subjectively assessed on a 10-point scale, the average score was 7.27 points on discharge from the recovery room and 7.45 points a month after the procedure. As objective reflections of well-being, nausea was reported by 5 patients, cough was recorded in 4 cases and agitation in 2.

CONCLUSIONS

The AirTraq can be used for awake intubation in cases of anticipated difficult airway when other approaches to intubation have failed or are not viable. Intubation is achieved successfully and hemodynamic and respiratory stability maintained. The device is well tolerated. An advantage of the AirTraq is that it allows the glottis to be visualized as the endotracheal tube is being inserted between the vocal cords so damage can be minimized.