Anaesthesia, 2005, 60, pages 817–830 Correspondence ......
4 European Union. Medical Device Directive (MDD) 93 ⁄ 42 ⁄ EEC. 5 Scott DHT. British Standards Institute report. ACTA Newsletter 2003; 17:5.
Use of the laryngeal tube after failed insertion of a laryngeal mask airway
The Laryngeal Tube (VBM, Medizin- technik, Germany) has a potential role during anaesthesia and cardiopulmon- ary resuscitation [1, 2]. It consists of an airway tube with a small balloon cuff attached at the tip and a larger Figure 3 Distal part of the laryngeal tube (left) and the laryngeal mask airway (right). balloon cuff at the middle part of the tube. We report successful use of the 100 mg and maintained with a target- distal part of the mask had wedged in laryngeal tube in three patients in controlled infusion. After no motor the narrowed pharynx. The distal whom insertion of the laryngeal mask response to jaw thrusting had been segment of the laryngeal tube is not airway had failed. An 18-year-old fit confirmed, insertion of a laryngeal tapered, and the width of the tube is and healthy woman (165 cm, 52 kg) mask airway was attempted, but it narrower than that of the laryngeal was scheduled for left oophorectomy. was impossible to advance it beyond mask airway (Fig. 3), and thus the After epidural catheterisation, general the back of the throat. In contrast, laryngeal tube might have passed anaesthesia was induced with propofol insertion of a laryngeal tube was easy. through the narrowed space. We 100 mg and deepened with sevoflura- The operation (40 min) proceeded suggest that, when insertion of the ne. After no motor response to thrust- without complications. laryngeal mask airway is difficult or ing the jaw forward had been A 72-year-old man (157 cm, 74 kg) impossible due to a narrowed pha- confirmed [3], the mouth was opened was scheduled for right total hip ar- rynx, insertion of the laryngeal tube to insert a laryngeal mask airway. throplasty. Preoperatively, difficult tra- may be attempted, before considering Enlarged tonsils were found. Because cheal intubation was predicted, because tracheal intubation. there was a gap between the tonsils the view of the oropharynx was limited T. Asai (approximately 1.5 cm), we felt that it (Mallampati score 3), the thyromental S. Matsumoto might be possible to insert the laryn- distance was 5 cm, there was a mild K. Shingu geal mask, but failed to advance the difficulty in thrusting the jaw forward Kansai Medical University device beyond the tonsils despite using and extending the neck, and snoring Osaka, 570–8507, Japan the insertion technique described in during sleep. After epidural catheterisa- E-mail: [email protected] the manufacturer’s instruction manual. tion, anaesthesia was induced with T. Noguchi Insertion of a flexible laryngeal mask propofol 150 mg. Insertion of a laryn- Kyushu Rosai Hospital (which should be easier to insert in geal mask failed twice. In contrast, a Fukuoka, 800–0296, Japan patients with enlarged tonsils) also laryngeal tube was easily inserted and K. Koga failed. Before tracheal intubation, we was used during anaesthesia of 140 min, University of Occupational and tried a laryngeal tube, which was without complications. Environmental Health easily inserted. The lungs were venti- The exact reason for successful Fukuoka, 807–8555, Japan lated through the laryngeal tube with- insertion of the laryngeal tube after out complications during the 80 min failed insertion of the laryngeal mask operation. airway in these cases is not known, Conflict of interest A 46-year-old woman (159 cm, but the success and failure might have None of the authors has received any 55 kg), with a history of Basedow’s been related to a difference in the financial support from the manufactur- disease at 20 years and tonsillectomy width of these two devices. The ers of the laryngeal mask airway or the at 34 years, was scheduled for left pharyngeal space was narrowed by laryngeal tube. oophorectomy. Preoperative examina- swollen tonsils in case 1, by a goitre tion indicated a goitre (with normal in case 2, and possibly by redundant References thyroid function) without deviation of tissues in the pharynx (which pro- 1 Asai T, Murao K, Shingu K. Efficacy of the trachea or difficulty in breathing. duced the snoring) in case 3. Insertion the laryngeal tube during intermittent After epidural catheterisation, general of the laryngeal mask airway might positive pressure ventilation. Anaesthesia anaesthesia was induced with propofol not have been possible because the 2000; 55: 1099–102.