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The intubating laryngeal mask airway in severe ankylosing spondylitis

[L'utilisation du masque laryngé d'intubation en cas de spondylarthrite ankylosante sévère]

Pao-Ping Lu, MD^*, Joseph Brimacombe, MB CHB FRCA MD, Angie C. Y. Ho, MD^*, Ming-Hwang Shyr, MD PhD^* and Hung-Pin Liu, MD^*

^* From the Department of Anesthesia, Chang Gung Memorial Hospital, Taoyuan Hsien, and
the Department of Anesthesia and Intensive Care, University of Queensland, Cairns Base Hospital, Cairns, Australia.

Dr. Joseph Brimacombe, Department of Anesthesia and Intensive Care, University of Queensland, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Phone: 61-7-40-506960; Fax: 61-7-40-506854; E-mail: jbrimacombe{at}austarnet.com.au

Purpose: To evaluate the use of inhalational induction followed by intubation through the intubating laryngeal mask (ILM) for patients with severe ankylosing spondylitis undergoing elective surgery who prefer airway management under anesthesia.

Methods: Nine patients undergoing a total of 11 procedures were enrolled in the study. Fentanyl 2 µg•kg^–1, midazolam 0.035 mg•kg^–1 and sevoflurane in oxygen 100% were used for induction. The ILM was inserted when the end-tidal sevoflurane concentration reached 3%. After an effective airway was established, atracurium 0.5 mg•kg^–1 was given. A polyvinyl chloride tube in the reversed position using a blind technique was used to intubate the trachea.

Results: The ILM provided an effective airway on 11/11 occasions at the first attempt. Intubation was successful at the first attempt on 7/11 occasions, at the second attempt on 2/11 and at the third attempt in 1/11. Intubation failed in one patient. The mean (range) minimal oxygen saturation was 99.4% (97–100%). There were no problems with ILM removal.

Conclusion: Inhalational induction followed by ILM insertion and blind intubation is a reasonable option in patients with severe ankylosing spondylitis undergoing elective surgery who prefer airway management under anesthesia.

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