Case Reports
Use of the intubating laryngeal mask airway to facilitate awake orotracheal intubation in patients with cervical spine disorders

https://doi.org/10.1016/S0952-8180(99)00052-5Get rights and content

Abstract

Airway management in patients with unstable cervical spines remains a challenge for anesthesia providers. Because neurologic evaluations may be required following tracheal intubation and positioning for the surgical procedure, an awake intubation technique is desirable in this patient population. In this report, we describe the use of an intubating laryngeal mask airway (ILMA) to facilitate awake tracheal intubation in two patients with cervical spine disorders. After topical local analgesia, the ILMA was inserted easily, and a tracheal tube was passed through the glottic opening without complications. Thus, the ILMA may be an acceptable alternative to the fiberoptic bronchoscope for awake tracheal intubation.

Introduction

The intubating laryngeal mask airway (ILMA) (LMA-Fastrach™, LMA North America, Inc., San Diego, CA) represents a further improvement on the capabilities of the original LMA for facilitating tracheal intubation,1, 2 especially in patients with difficult airways or unstable cervical spines.3, 4, 5, 6 In contrast to the airway tube of the conventional LMA, the lumen of the ILMA is wider and constructed of stainless steel that is covered with a rubberized material, which allows it to maintain its anatomic shape.1 As a result of its larger internal diameter and hinged epiglottic elevating bar (“glottic flap”), the ILMA facilitates passage of a bronchoscope or tracheal tube. One of the major advantages of the ILMA over conventional intubation devices lies in its ability to facilitate intubation in patients with little or no manipulation of the patient’s head or cervical spine.1, 6, 7

Recent reports have described the use of the ILMA in patients with difficult airways.3, 4, 5, 6 However, in this report we describe the use of the ILMA for performing an awake orotracheal intubation in two patients with cervical spine disorders.

Section snippets

Case 1

A 28-year-old, 64-kg, 172-cm woman was a restrained passenger involved in a rollover motor vehicle accident in which she sustained a fracture of the odontoid process at the C2 level, She was flown to Parkland Memorial Hospital for a surgical stabilization procedure. The patient was awake and alert; oriented to person, time, and place; and neurologically intact. She had a Mallampati class I airway in the supine position; otherwise she was healthy with no other underlying diseases. The surgical

Discussion

Blind nasotracheal intubation, fiberoptic orotracheal intubation, and orotracheal intubation by direct laryngoscopy with manual in-line stabilization of the head and neck are well-established techniques for managing patients with cervical spine dysfunction,8, 9, 10, 11, 12, 13, 14 but the techniques are not without complications. With blind nasotracheal intubation, it is common for nasal intubation to cause mild-to-moderate nasal bleeding. More serious complications include sinusitis,

References (16)

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