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Intubating laryngeal mask for fibreoptic intubation - particularly useful during neck stabilization

From the Department of Anesthesiology, Kansai Medical University, Osaka, Japan.

Address correspondence to: Takashi Asai MD PhD, Department of Anesthesiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi City, Osaka, 570-8507, Japan. Phone: 81-6-992-1001; Fax: 81-6-991-1301; E-mail: asait{at}takii.kmu.ac.jp

Purpose: To assess the ease of fibrescope-assisted tracheal intubation while the patient's head and neck were placed in the neutral or the manual in-line position, and to determine if the intubating laryngeal mask facilitated fibreoptic intubation in these positions.

Methods: In 84 patients, the patient's head and neck were placed in the neutral position (pillow placed under occiput), and in another 40 patients the head and neck were stabilized by the manual in-line method (no pillows under occiput). In both groups, after induction of anesthesia with 2.0 - 2.5 mg•kg^–1 propofol, 50 – -100 µg fentanyl and 1.0 mg·kg^–1 vecuronium, patients were allocated randomly into two groups: in Group C tracheal intubation was attempted using only a fibrescope, whereas in Group L fibreoptic intubation through the intubating laryngeal mask was attempted.

Results: In group C the success rate of fibreoptic tracheal intubation within two minutes was higher in the neutral position (31 of 42 patients (73%)) than in the manual in-line position (8 of 20 patients (40%)). In contrast, in group L the success rate was similar between the two positions. Tracheal intubation was easier in group L than in group C (P < 0.01 or 0.001) and the time for intubation was shorter in group L than in group C in both head and neck positions.

Conclusions: Fibreoptic tracheal intubation was more difficult in the manual in-line position than in the neutral position. The intubating laryngeal mask facilitated fibreoptic intubation in both positions.

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