1. Discussion 2 B
李又文

2. ANESTH ANALG 2001;92:1342-6 Hwan S. Joo, etc.
The Intubation Laryngeal Mask Airway after induction of General Anesthesia versus Awake Fiberoptic Intubation in patients with difficult airways
ANESTH ANALG
2001;92:1342-6
Hwan S. Joo, etc.

3. Abbreviations TI: Tracheal intubation
AFOI: Awake fiberoptic intubation
ILMA: Intubation laryngeal mask airway

4. AFOI

5. Intubation Laryngeal Mask Airway

8. AFOI
AFOI is the “gold standard” for p’t with suspected or proven difficult airways.
ASA “difficult airway algorithm” suggests difficult airways should be intubated awaked.
What should we do for patients who are not cooperative or those who refuse AFOI?

9. Disadvantages of AFOI Oxygen desaturation Tachycardia Hypertension
Life threatening AFOI requiring emergency surgical airway has been reported
55% incidence of patient discomfort

10. ILMA
ILMA allows confirmation of oxygenation and ventilation before tracheal intubation.
Normal airways:
99% ventilation success rate
97-99% TI success rate
Difficult airways:
Numerous case reports after failed laryngoscopy and failed FOB intubation

11. Hypothesis
Patients with difficult airways could be successfully and safely intubated after induction of anesthesia using ILMA
Patients would be more satisfied with TI after induction of anesthesia

12. Material and Method Prospective and randomized study ASA class I-III
Patient who required AFOI based on clinical predictors or history of prior difficult intubations
AFOI: 18 ILMA: 20

13. Including Multiple and failed laryngoscopies Cormack > Grade 3
Mallampati > Grade 3
Retrognathia
Thyromental distance < 6 cm
Limited c-spine movement

15. Excluding Unstable c-spine Morbid obesity (BMI>35)
History of difficult ventilation
At risk for aspiration of gastric contents
Mouth opening < 2.5 cm
Pathological abnormalities of the airway

16. Primary anesthesiologist: fully trained anesthesiologist
Study investigators experienced with both AFOI and ILMA(>50 cases of each)
Study investigators intervened when patient became hemodynamically unstable or primary anesthesiologist was unsuccessful after 20min using either method or if 4 TI attempt was required in the ILMA group.

17. ILMA group First: a single blind TI attempt
Second: FOB guidance without ILMA adaptation
Third: Reinsert the ILMA and with FOB guidance
Fourth: study investigator take over with and ILMA reinserted with FOB guide
Fifth: ILMA failure, awake patient for FOI

18. Results
Faster induction times in ILMA (672 ± 545s) than AFOI group (972 ± 331s)
AFOI group : all successfully intubated
ILMA group : all successfully ventilated;
50% blind TI ; 25% intubated with FOB guidance without changing ILMA; 15% changing ILMA with FOB guidance; 10% intubated by study investigator

19. Oxygenation
Minimum oxygen saturation was higher in ILMA at vs AFOI at 94.5
AFOI group : oxygen saturation decreased to 62% and 84% in two patients in the
ILMA: one patient decreased to 85%

20. Questionnaire Primary anesthesiologist :
More comfort with the method of AFOI
More experienced with AFOI
Predict higher patient satisfaction in ILMA group
Postoperative patients :
more satisfied with ILMA induction
no recall of TI in ILMA
no difference in sore throat and hoarseness

21. Conclusion
For calm and cooperative patient: no definite advantages other than patients comfort for using ILMA over AFOI
Patient who refuse AFOI or not cooperate may be candidates for TI with ILMA
Experience should be gained before attempting to use ILMA in patient with difficult airways

22. Thank you very much!