A Timmermann1, S Russo, U Natge, J Heuer, B M Graf. 1. Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität, Göttingen, Germany. atimmer@zari.de
Abstract
BACKGROUND: The Intubating LMA was designed to facilitate blind intubation and to provide ventilation between two intubation attempts. However, blind intubation can be associated with a risk of oesophageal penetration, therefore, a flexible bronchoscope is frequently used to assist tracheal intubation. This leads to increased burdens on materials and personal resources and prolongs intubation times. Hence the LMA CTrach laryngeal mask airway (CTrach) was developed with an integrated fibreoptic system which can be connected to a monitor for visualisation of the larynx during intubation. METHODS: We detail the initial experience gained with the practical handling of the CTrach and the application in 10 patients with difficult-to-manage airways. Laryngeal views were graduated in a CTrach-specific classification from grade I (clear view of the arytenoids, glottis and epiglottis) to grade IV (no part of the larynx can be identified). Adjusting manoeuvres were defined to improve the view of laryngeal structures. RESULTS: All patients could be successfully ventilated with the CTrach. Ventilation quality was rated adequate in nine and possible in one patient. The initial distribution of the laryngeal view between grades I-IV was 1/2/1/6 and after adjusting manoeuvres to improve the laryngeal view the grade distribution was 3/5/0/2. Intubation through the CTrach was successful in all patients, nine at first and one at the second attempt. CONCLUSION: In this small sample of patients with difficult-to-manage airways, the CTrach yielded high success rates for both ventilation and tracheal intubation. Adjusting manoeuvres can improve the laryngeal view further.
BACKGROUND: The Intubating LMA was designed to facilitate blind intubation and to provide ventilation between two intubation attempts. However, blind intubation can be associated with a risk of oesophageal penetration, therefore, a flexible bronchoscope is frequently used to assist tracheal intubation. This leads to increased burdens on materials and personal resources and prolongs intubation times. Hence the LMA CTrach laryngeal mask airway (CTrach) was developed with an integrated fibreoptic system which can be connected to a monitor for visualisation of the larynx during intubation. METHODS: We detail the initial experience gained with the practical handling of the CTrach and the application in 10 patients with difficult-to-manage airways. Laryngeal views were graduated in a CTrach-specific classification from grade I (clear view of the arytenoids, glottis and epiglottis) to grade IV (no part of the larynx can be identified). Adjusting manoeuvres were defined to improve the view of laryngeal structures. RESULTS: All patients could be successfully ventilated with the CTrach. Ventilation quality was rated adequate in nine and possible in one patient. The initial distribution of the laryngeal view between grades I-IV was 1/2/1/6 and after adjusting manoeuvres to improve the laryngeal view the grade distribution was 3/5/0/2. Intubation through the CTrach was successful in all patients, nine at first and one at the second attempt. CONCLUSION: In this small sample of patients with difficult-to-manage airways, the CTrach yielded high success rates for both ventilation and tracheal intubation. Adjusting manoeuvres can improve the laryngeal view further.