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The LMA Fastrach™ facilitates fibreoptic intubation in oral cancer patients

Le ML Fastrach™ facilite l’intubation fibroscopique dans les cas de cancer de la bouche

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Abstract

Purpose

To compare ease of endotracheal intubation with the Intubating Laryngeal Mask Airway (ILMA) tracheal tube (TT; for LMA-Fastrach™) and regular PVC TT (Portex) for nasotracheal fibreoptic intubation in oral cancer patients with a difficult airway.

Methods

40 patients of physical status ASA I-II with a history of previous oral cancer surgery and/or postoperative radiotherapy scheduled for oral cancer surgery were randomly allocated by sealed envelopes to undergo tracheal intubation with either the ILMA TT or a standard TT. Ease of nasal passage of the TT and ease of tracheal intubation over the fibrescope was assessed. Peak airway pressures were assessed intraoperatively and postoperatively for 12 hr.

Results

The use of the ILMA TT increased the ease of nasotracheal intubation by increasing the percentage of successful tube placements at the first attempt (80%) in comparison with standard TT (35%); (P < 0.05). Peak airway pressures were found to remain low with the ILMA TT. None of the patients experienced any airway related complications.

Conclusions

Use of a soft, flexible, nonkinking ILMA TT with a tapered tip design facilitates passage into the trachea over a fibreoptic bronchoscope and allows maintenance of lower airway pressures. The ILMA TT may be a useful adjunct for management of the difficult airway in oral cancer surgery.

Résumé

Objectif

Comparer la facilité de l’intubation endotrachéale avec le tube endotrachéal (TE) du masque laryngé d’intubation (MLI, pour le ML Fastrach™) et le TE PVC (Portex) régulier pour l’intubation fibroscopique nasotrachéale quand l’intubation était difficile chez des patients atteints de cancer de la bouche.

Méthode

Quarante patients d’état physique ASA I-II opérés pour un cancer de la bouche et/ou ayant reçu une radiothérapie postopératoire ont été répartis au hasard pour être intubés avec le TE MLI ou le TE standard. La facilité de l’insertion nasale du TE et de l’intubation endotrachéale au-dessus du fibroscope a été évaluée. Les pressions maximales des voies aériennes ont été notées pendant et après l’opération, pendant 12 h.

Résultats

L’usage du TE MLI a augmenté la facilité de l’intubation nasotrachéale en haussant le pourcentage de mises en place réussies au premier essai (80 %) en comparaison du TE standard (35 %); (P < 0,05) dans les cas d’intubation de grade I. Les pressions maximales des voies aériennes sont demeurées faibles avec le TE MLI. Il n’y a pas eu de complications reliées aux voies respiratoires.

Conclusion

L’usage d’un TE MLI mou, flexible et armé, muni d’une pointe effilée, facilite le passage dans la trachée au-dessus du fibroscope bronchique et permet de maintenir de basses pressions dans les voies respiratoires. Le TE MLI peut être un accessoire utile dans les cas d’accès difficile aux voies aériennes en chirurgie de cancer buccal.

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Author information

Correspondence to Sushma Bhatnagar or Seema Mishra or Rajeev Ranjan Jha or Amit K. Singhal or Naresh Bhatnagar.

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Bhatnagar, S., Mishra, S., Ranjan Jha, R. et al. The LMA Fastrach™ facilitates fibreoptic intubation in oral cancer patients. Can J Anesth 52, 641–645 (2005). https://doi.org/10.1007/BF03015777

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Keywords

  • Oral Cancer
  • Tracheal Intubation
  • Tracheal Tube
  • Difficult Airway
  • Nasotracheal Intubation