Abstract
Purpose
To present a stepwise training method, first critiquing laryngeal mask (LM) insertion difficulty and malpositioning, then learning how to exchange an endotracheal tube (ETT) for a LM during emergence from anesthesia.
Methods
“Learning phase:” sixty adults were enrolled in a preliminary study in which ETT / LM exchange was not performed — only LM insertion difficulty and malpositioning in the presence of an oral ETT were evaluated. After induction of anesthesia and oral intubation, a classic LM size 4 was inserted using the standard recommended technique. Number of insertion attempts and fibreoptically determined malpositions were recorded. “ETT / LM exchange phase:” we performed airway exchange in 50 patients selected from our individual practices.
Results
“Learning phase:” the LM was satisfactorily positioned, on first attempt, in 95% of cases. With multiple insertion attempts it was possible to place the LM in all 60 intubated patients. Unsuccessful initial placement of the LM was always due to insufficient insertion depth (5%). When fully inserted into the hypopharynx, the epiglottis could be viewed fibreoptically in 13% of cases. “ETT / LM exchange phase:” the LM was inserted successfully in all 50 patients on first attempt. No complications occurred during any exchange.
Conclusion
We found it is easy to learn how to insert a LM in the presence of an oral ETT The most serious malposition, occurring in 5% of first attempts, was insufficient insertion depth. The only other malposition we encountered, fibreoptic visualization of the epiglottis, is not likely to result in complete airway obstruction following endotracheal extubation under anesthesia.
Résumé
Objectif
Présenter une méthode d’apprentissage progressif, comprenant d’abord la formulation de critiques sur les difficultés d’insertion et la malposition du masque laryngé (ML), puis l’apprentissage de l’échange d’un tube endotrachéal (TET) pour un ML pendant le retour à la conscience après l’anesthésie.
Méthode
“Phase d’apprentissage” : 60 adultes ont été recrutés pour une étude préliminaire au cours de laquelle l’échange TET / ML n’a pas été réalisé, mais où seulement la difficulté d’insertion et la malposition du ML, en présence d’un TET oral, ont été évaluées. Après l’induction de l’anesthésie et l’intubation orale, un ML typique de taille 4 a été inséré selon la technique standard recommandée. Le nombre d’essais nécessaires à l’insertion et de malpositions déterminées par fibroscopie a été noté. “Phase d’échange TET / ML” : l’échange a été réalisé chez 50 patients choisis parmi notre clientèle.
Résultats
“Phase d’apprentissage” : le ML a été mis en place de façon satisfaisante dans 95% des cas. Après de multiples essais, il a été possible d’insérer le ML chez les 60 patients intubés. Une malposition initiale du ML était toujours causée par une insertion insuffisamment profonde (5 %). Lorsque le ML était complètement inséré dans l’hypopharynx, on pouvait voir l’épiglotte par fibroscopie dans 13% des cas. “Phase d’échange TET / ML” : le Ml a été inséré avec succès chez les 50 patients au premier essai et aucune complication n’est survenue.
Conclusion
Nous avons constaté qu’il est facile d’apprendre à insérer un ML en présence d’un TET oral. La malposition la plus sérieuse, survenue dans 5 % des cas au premier essai, a été une insertion insuffisamment profonde. La seule autre malposition notée, la visualisation fibroscopique de l’épiglotte, ne risque pas de provoquer d’obstruction complète des voies aériennes à la suite de l’extubation endotrachéale sous anesthésie.
Article PDF
Similar content being viewed by others
References
Brimacombe JR, Brain AIJ, Berry AM. The Laryngeal Mask Airway: A Review and Practical Guide. Philadelphia: W.B. Saunders Company Ltd, 1997.
George SL, Blogg CE. Role of the LMA in tracheal extubation? (Letter). Br J Anaesth 1994; 72: 610.
Nair I, Bailey PM. Use of the laryngeal mask for airway maintenance following tracheal extubation (Letter). Anaesthesia 1995; 50: 174–5.
Costa E.Silva L, Brimacombe JR. Tracheal tube/laryngeal mask exchange for emergence (Letter). Anesthesiology 1996; 85: 218.
Glaisyer HR, Parry M, Lee J, Bailey PM. The laryngeal mask airway as an adjunct to extubation on the intensive care unit (Letter). Anaesthesia 1996; 51: 1187–8.
Bailey PM. ENT Anesthesia and the LMA.In: Brain AIJ, Braun U, Bailey PM, Verghese C, Brimacombe J (Eds). The Laryngeal Mask Airway. Presented at the 11th World Congress of Anesthesiologists, Sydney: Australia, 1996.
Dob DP, Shannon CN, Bailey PM. Efficacy and safety of the laryngeal mask airway vs. Guedel airway following tracheal extubation. Can J Anesth 1999; 46: 179–81.
Asai T. Use of the laryngeal mask after tracheal extubation (Letter). Can J Anesth 1999; 46: 997.
Dob DP, Bailey PM. Use of the laryngeal mask after tracheal extubation (Reply). Can J Anesth 1999; 46: 998.
Asai T. Use of the laryngeal mask during emergence from anaesthesia (Letter). Eur J Anaesth 1998; 15: 379–80.
Koga K, Asai T, Vaughn RS, Latto IP. Respiratory complications associated with tracheal Extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia. Anaesthesia 1998; 53: 540–4.
Asai T, Shingu K. Use of the laryngeal mask during emergence from anesthesia in a patient with an unstable neck (Letter). Anesth Analg 1999; 88: 469–70.
Asai T, Shingu K. Capnography for safe use of the laryngeal mask during emergence from anesthesia (Letter). Anesth Analg 1999; 89: 1589.
Kim ES, Bishop MJ. Cough during emergence from isoflurane anesthesia. Anesth Analg 1998; 87: 1170–4.
Brain AIJ, Denman WT, Goudsouzian NG. LMA-Classic™ and LMA-Flexible™ Instruction Manual. San Diego: The Laryngeal Mask Company Ltd, 1999.
Brimacombe J. Analysis of 1500 Laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia. Anaesthesia 1996; 51: 76–80.
Asai T: Difficulty in insertion of the laryngeal mask.In: Latto IP, Vaughn RS (Eds.). Dfficulties in Tracheal Intubation, 2nd ed., Philadelphia: W.B. Saunders Company Ltd, 1997: 197–214.
Ovassapian A, Mesnick PS: The laryngeal mask airway.In: Ovassapian A. (Ed.). Fiberoptic Endoscopy and the Difficult Airway, 2nd ed., Philadelphia: Lippincott-Raven Publishers, 1996; 231–46.
Hartley M, Vaughn RS. Problems associated with tracheal extubation. Br J Anaesth 1993; 71: 561–8.
Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation. Anesth Analg 1995; 80: 149–72.
Asai T, Koga K, Vaughn RS. Respiratory complications associated with tracheal intubation and extubation. Br J Anaesth 1998; 80: 767–75.
Ovassapian A, Dykes MHM, Golmon ME: A training programme for fibreoptic nasotracheal intubation. Use of model and live patients. Anaesthesia 1983; 38: 795–8.
Brain AIJ, Brimacombe JR, Berry AM, Verghese C. Reflux during positive pressure ventilation via the laryngeal mask airway? (Letter). Br J Anaesth 1995; 74: 489.
Brain AIJ. Studies on the laryngeal mask: first, learn the art (Letter). Anaesthesia 1991; 46: 417–8.
Brain AIJ. Laryngeal mask misplacement-causes, consequences and solutions (Letter). Anaesthesia 1992; 47: 531–2.
Author information
Authors and Affiliations
Corresponding author
Additional information
Funding: Departmental (no purchases necessary; use and sterilization of laryngeal mask airways and fibrescopes) and Institutional (administrative, forms).
Rights and permissions
About this article
Cite this article
Stix, M.S., Borromeo, C.J., Sciortino, G.J. et al. Learning to exchange an endotracheal tube for a laryngeal mask prior to emergence. Can J Anesth 48, 795–799 (2001). https://doi.org/10.1007/BF03016697
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03016697