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Heuer J. F. 1, Crozier T. A. 1, Braun U. 1, Neumann P. 2, Hilgers R. 3, Quintel M. 1, Timmermann A. 1,4
1 Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Göttingen, Germany;
2 Department of Anesthesiology, Evangelisches Krankenhaus, Göttingen-Weende, Germany;
3 Department of Medical, Statistics, University of Göttingen Medical School, Göttingen, Germany;
4 Department of Anesthesiology, Helios Klinikum Emil von Behring, Berlin, Germany
BACKGROUND: Blind insertion of endotracheal tubes through the intubating laryngeal mask airway (ILMA) is unsuccessful in almost 50% of cases on the first attempt, with an overall success rate of approximately 90%. We used a portable fiber optic device (Foley Airway Stylet Tool® FAST) to detect the reasons for failed intubations and tested its use in facilitating endotracheal tube placement.
METHODS:Thirty patients without anticipated intubation difficulties participated in the study. The fiber optic device was fastened with its tip at the end of the endotracheal tube, and both instruments were advanced through the previously inserted ILMA past the lifting bar. The view was scored in the following manner: I, full view of laryngeal inlet; II, partial vocal cords, arytenoids, epiglottis; III, epiglottis; IV, no laryngeal structures identifiable. The ILMA was adjusted for the best obtainable view, which was scored, and the endotracheal tube was inserted.
RESULTS: The initial laryngeal view was I in four patients, II in eighteen patients, III in one patient and IV in seven patients. The best view after corrective maneuvers was I in twenty-seven patients, II in two patients and IV in one patient. First attempt tracheal intubations were successful in twenty-seven (90%) patients; two patients required a second attempt.
CONCLUSION: A grade II view or worse indicated misalignment of the ILMA with the glottis. An endotracheal tube inserted blindly through the misaligned ILMA will impinge on and potentially damage laryngeal structures. The use of a portable fiber optic device can help reduce the failure rate of endotracheal intubations by utilizing ILMA in emergent situations.