Positive pressure ventilation during fibreoptic intubation: comparison of the laryngeal mask airway, intubating laryngeal mask and endoscopy mask techniques

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Presentation transcript:

Positive pressure ventilation during fibreoptic intubation: comparison of the laryngeal mask airway, intubating laryngeal mask and endoscopy mask techniques K. Aoyama, E. Yasunaga, I. Takenaka, T. Kadoya, T. Sata, A. Shigematsu British Journal of Anaesthesia Volume 88, Issue 2, Pages 246-254 (February 2002) DOI: 10.1093/bja/88.2.246 Copyright © 2002 British Journal of Anaesthesia Terms and Conditions

Fig 1 Fibreoptic intubation while maintaining positive pressure ventilation (PPV) and measurement of the tidal volumes with the laryngeal mask airway (LMA), intubating laryngeal mask (ILM) (a) or the Patil mask (b). (a) After insertion of an LMA or ILM, a 6.0 mm nasal RAE tracheal tube (TT) (LMA3/4 group), a 7.0 mm nasal RAE tracheal tube (LMA5 group) or an 8.0 mm special reinforced tracheal tube (ILM group) was inserted into the tube of the LMA or ILM. Fibreoptic intubation was performed while PPV was continued through the tracheal tube at a ventilation pressure of 20 cm H2O. The inspiratory and expiratory tidal volumes (Vi and Ve) during fibrescopy (SF stage) were measured with a pneumotachograph (VenTrak); the distal tip of the tracheal tube and the 4.0 mm outer diameter fibreoptic laryngoscope (FOL) were fixed at the LMA mask aperture bars or ILM epiglottic elevating bar during measurement. (b) After insertion of an Ovassapian intubating airway and placement of a Patil mask, fibreoptic intubation was performed while PPV was maintained through the Patil mask (Patil group). The side arm of the fibreoptic connector was blocked with tape. British Journal of Anaesthesia 2002 88, 246-254DOI: (10.1093/bja/88.2.246) Copyright © 2002 British Journal of Anaesthesia Terms and Conditions

Fig 2 Typical traces of tidal volumes during fibreoptic intubation through the size 4 laryngeal mask airway (LMA). The inspiratory volume (Vi) trace is upwards. After ventilation through the LMA (Sairway), a 6.0 mm nasal RAE tracheal tube was inserted into the LMA tube (TT insertion) and ventilation was performed through the tracheal tube (STT). A fibreoptic laryngoscope (FOL) was then introduced into the tracheal tube through the fibreoptic port (port open) and advanced into the trachea. The tracheal tube was inserted into the trachea over the FOL. During fibreoptic intubation (SFI) in this patient, tidal volumes were measured over six breaths because the time for intubation was 33 s, and six volumes were averaged to obtain the mean Ve (mean Ve=194 ml in this patient). At the SFI stage, leakage was noted after the tracheal tube cuff was passed below the mask aperture bars of the LMA (small arrow). Ventilation through the 6.0 mm RAE tracheal tube was adequate after the FOL had been removed (Safter). British Journal of Anaesthesia 2002 88, 246-254DOI: (10.1093/bja/88.2.246) Copyright © 2002 British Journal of Anaesthesia Terms and Conditions

Fig 3 Expiratory tidal volume in relation to patient's weight (mean and sd) at four stages during fibreoptic intubation in each group. The four stages (three in the Patil group) of ventilation were ventilation through each airway device (Sairway); ventilation through the tracheal tube passed into the tube of the laryngeal mask airway or intubating laryngeal mask (STT); ventilation during fibreoptic intubation (SFI); and ventilation through the tracheal tube placed in the trachea (Safter). Statistical differences are shown only for the SFI stage. *P<0.0001 compared with the LMA3/4 group; **P<0.0001 compared with the other groups. British Journal of Anaesthesia 2002 88, 246-254DOI: (10.1093/bja/88.2.246) Copyright © 2002 British Journal of Anaesthesia Terms and Conditions