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The LMA Fastrach^TM facilitates fibreoptic intubation in oral cancer patients

[Le ML Fastrach^TM facilite l’intubation fibroscopique dans les cas de cancer de la bouche]

Sushma Bhatnagar, MD^*, Seema Mishra, MD^*, Rajeev Ranjan Jha, MD^*, Amit K. Singhal, MD and Naresh Bhatnagar, PhD^*

^* From the Department of Anaesthesiology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences; and
the Department of Mechanical Engineering, Indian Institute of Technology, New Delhi, India.

Address correspondence to: Dr. Sushma Bhatnagar, 2, North Avenue, IIT-Hauz Khas, New Delhi-110016, India. E-mai: narbhat{at}hotmail.com; shumob{at}yahoo.com

Purpose: To compare ease of endotracheal intubation with the Intubating Laryngeal Mask Airway (ILMA) tracheal tube (TT; for LMA-Fastrach^TM) and regular PVC TT (Portex) for nasotracheal fibreoptic intubation in oral cancer patients with a difficult airway.

Methods: 40 patients of physical status ASA I–II with a history of previous oral cancer surgery and/or postoperative radiotherapy scheduled for oral cancer surgery were randomly allocated by sealed envelopes to undergo tracheal intubation with either the ILMA TT or a standard TT. Ease of nasal passage of the TT and ease of tracheal intubation over the fibrescope was assessed. Peak airway pressures were assessed intraoperatively and postoperatively for 12 hr.

Results: The use of the ILMA TT increased the ease of nasotracheal intubation by increasing the percentage of successful tube placements at the first attempt (80%) in comparison with standard TT (35%); (P < 0.05). Peak airway pressures were found to remain low with the ILMA TT. None of the patients experienced any airway related complications.

Conclusions: Use of a soft, flexible, nonkinking ILMA TT with a tapered tip design facilitates passage into the trachea over a fibreoptic bronchoscope and allows maintenance of lower airway pressures. The ILMA TT may be a useful adjunct for management of the difficult airway in oral cancer surgery.