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

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

From the Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA.

Address correspondence to: Dr. Adrian Matioc, VA Medical Center, Department of Anesthesiology, 2500 Overlook Terrace, Madison, Wisconsin 53705, USA. Phone: 608-280-7006; Fax: 608-280-7098; E-mail: aamatioc{at}facstaff.wisc.edu

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^TM (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.

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