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A long endotracheal tube to facilitate intubation via the Fastrach^TM laryngeal mask airway

Hiroyuki Kinoshita, MD, PhD^*, Katsutoshi Nakahata, MD, PhD^*, Hiroshi Iranami, MD, PhD, Shin Yamada, MD, Yasuo Hironaka, MD and Yoshio Hatano, MD, PhD^*

^* Wakayama Medical University;
Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan, E-mail: hkinoshi{at}pd5.so-net.ne.jp

To the Editor:

Although the laryngeal mask airway (LMA) is a definitive tool for fibreoptic endotracheal intubation, standard endotracheal tubes are limited by their short length when securing the position of the endotracheal cuff via this technique.^1–3 As a potential solution to this problem, we propose the use of a long endotracheal tube to secure intubation via the LMA.

The Institutional Review Board of the Japanese Red Cross Society Wakayama Medical Center approved publication of the personal health information from this case, and written informed consent was obtained from the patient. A long endotracheal tube made from polyvinyl chloride was prepared, and the quality of the tube was evaluated with the cooperation of Smiths Medical Japan Ltd. A 60-yr-old male patient, with a predicted difficult airway, was scheduled for the repair of a fractured clavicle. General anesthesia was induced with propofol 2 mg·kg^–1 and butorphanol 20 µg·kg^–1 iv, followed by the oral insertion of a #4 Fastrach^TM LMA. After establishing ventilation with the Fastrach^TM LMA using 3% sevoflurane in 100% oxygen with a fresh gas flow 6 L·min^–1 for three minutes, a long endotracheal tube (44 cm in length and 7.5 mm internal diameter, Figure) was advanced over a fibreoptic bronchoscope (Olympus^TM LF-DP, Tokyo, Japan; 3 mm outer diameter and 60 cm in length) into the ventilator lumen of Fastrach^TM. The long endotracheal tube was uneventfully advanced into the trachea, and thereafter the bronchoscope and Fastrach^TM LMA were simultaneously removed. During removal of Fastrach^TM, the anesthesiologist was capable of holding the middle portion of the long tube (about 23 cm from distal end of the tube, Figure) and pushing the proximal end of the tube so as to avoid unintentional extubation.

View larger version (120K): [in this window] [in a new window]   FIGURE During removal of the laryngeal mask airway from an adult patient, the operator is capable of holding 20 to 23 cm from the distal end of the tube to avoid unintentional extubation. The proximal portion of the endotracheal tube can be advanced easily while performing this procedure.

Footnotes

Accepted for publication October 10, 2005.

References

1 Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996; 84: 686–99.[Medline]

2 Ferson DZ, Rosenblatt WH, Johansen MJ, Osborn I, Ovassapian A. Use of the intubating LMA-Fastrach^TM in 254 patients with difficult-to-manage airways. Anesthesiology 2001; 95: 1175–81.[Medline]

3 Asai T, Latto IP, Vaughan RS. The distance between the grill of the laryngeal mask airway and the vocal cords. Is conventional intubation through the laryngeal mask safe? Anaesthesia 1993; 48: 667–9.[Medline]

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