Abstract
Purpose
We report two cases where the ProSeal™ laryngeal mask airway (PLMA) was successfully used as a rescue device, after failed tracheal intubation, during rapid sequence induction.
Clinical findings
The first case involved a 31-yr-old primigravida presenting for emergency Cesarean section for severe fetal distress. She had a grade 3 larynx and airway edema was observed during laryngoscopy. Attempts with a McCoy blade and gum elastic bougie failed to secure the airway. A size 4 PLMA was inserted with good airway control and surgery proceeded uneventfully. The second case involved a 51-yr-old man presenting for appendectomy. Following failed attempts at intubation, a size 5 PLMA was succesful in securing his airway and surgery proceeded uneventfully.
Conclusions
The correctly placed PLMA has potential advantages over the cLMA for airway rescue in the circumstance of failed emergency intubation in a patient with a potentially full stomach. In the two cases reported, the PLMA provided effective rescue of the airway.
Résumé
Objectif
Présenter deux cas où le masque laryngé ProSeal™ (MLP) a servi d’instrument de secours après l’échec de l’intubation endotrachéale pendant une induction à séquence rapide.
Éléments cliniques
Dans le premier cas, une primigeste de 31 ans est admise pour une césarienne d’urgence en raison d’une détresse foetale sévère. L’examen laryngoscopique révèle un larynx de grade 3 et un oedème des voies aériennes. Les tentatives d’intubation échouent avec la lame McCoy et une bougie d’intubation. Un MLP de taille 4 est inséré et permet un contrôle adéquat des voies aériennes et le bon déroulement de l’intervention chirurgicale. Le second cas implique un homme de 51 ans opéré pour une appendicectomie. Après l’échec de l’intubation, l’insertion réussie d’un MLP de taille 5 assure la protection des voies aériennes et une opération sans incident.
Conclusion
La bonne mise en place du MLP présente des avantages potentiels sur le ML classique pour protéger les voies aériennes en cas d’échec d’une intubation d’urgence chez un patient qui pourrait avoir l’estomac plein. Dans les deux cas présentés, le MLP a permis de rétablir efficacement la perméabilité des voies aériennes.
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References
Brain AI, Verghese C, Strube PJ. The LMA 'Proseal’ - a laryngeal mask with an oesophageal vent. Br J Anaesth 2000; 84:650–4.
Ovassapian A. Management of failed intubation in a septic patient (Letter). Br J Anaesth 2003; 91; 154–5.
Awan R, Nolan JP, Cook TM. Use of a ProSeal™ laryngeal mask airway for airway maintenance during emergency caesarean section after failed tracheal intubation. Br J Anaesth 2004; 92:144–6.
Baxter S, Brooks A, Cook T. Use of the Proseal LMA for maintenance after failed intubation during a modified rapid sequence induction. Anaesthesia 2003; 58:1132–3.
Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32:429–34.
Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42:487–90.
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39:1105–11.
Benumof JL, Dagg R, Benumof R. Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology 1997; 87:979–82.
Heier T, Feiner JR, Lin J, Brown R, Caldwell JE. Hemoglobin desaturation after succinylcholine-induced apnea. A study of the recovery of spontaneous ventilation in healthy volunteers. Anesthesiology 2001; 94:754–9.
Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996; 84:686–99.
Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth 1998; 45:757–76.
American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269–77.
Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59:675–94.
Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology 2000; 92:1229–36.
Cook TM, Nolan JP, Verghese C, et al. Randomized crossover comparison of the ProSeal™ with the classic laryngeal mask airway in unparalysed anaesthetized patients. Br J Anaesth 2002; 88:527–33.
Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a metaanalysis of the published literature. J Clin Anesth 1995; 7:297–305.
Devitt JH, Wenstone R, Noel AG, O’Donnell MP. The laryngeal mask airway and positive-pressure ventilation. Anesthesiology 1994; 80:550–5.
Evans NR, Gardner SV, James MF, et al. The ProSeal™ laryngeal mask: results of a descriptive trial with experience of 300 cases. Br J Anaesth 2002; 88:534–9.
Brimacombe J, Keller C, Fullekrug B, et al. A multicenter study comparing the ProSeal™ and Classic™ laryngeal mask airway in anesthetized, nonparalyzed patients. Anesthesiology 2002; 96:289–95.
Coulson A, Brimacombe J, Keller C, et al. A comparison of the ProSeal and classic laryngeal mask airways for airway management by inexperienced personnel after manikin-only training. Anaesth Intensive Care 2003; 31:286–9.
Stix MS, O’Connor CJ Jr. Maximum minute ventilation test for the ProSeal™ laryngeal mask airway. Anesth Analg 2002; 95:1782–7.
Koay CK. A case of aspiration with the Proseal LMA (Letter). Anaesth Intensive Care 2003; 31:123.
Asai T, Barclay K, Power I, Vaughan RS. Cricoid pressure impedes placement of the laryngeal mask airway. Br J Anaesth 1995; 74:521–5.
Harry RM, Nolan JP. The use of cricoid pressure with the intubating laryngeal mask. Anaesthesia 1999; 54:656–9.
Howath A, Brimacombe J, Keller C, Kihara S. Gum elastic bougie-guided placement of the ProSeal™ laryngeal mask (Letter). Can J Anesth 2002; 49:528–9.
Brimacombe J, Keller C, Judd DV. Gum elastic bougieguided insertion of the ProSeal™ laryngeal mask airway is superior to the digital and introducer tool techniques. Anesthesiology 2004; 100:25–9.
Yamamoto K, Tsubokawa T, Shibata K, Ohmura S, Nitta S, Kobayashi T. Predicting difficult intubation with indirect laryngoscopy. Anesthesiology 1997; 86:316–21.
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Cook, T.M., Brooks, T.S., Van der Westhuizen, J. et al. The Proseal™ LMA is a useful rescue device during failed rapid sequence intubation: two additional cases. Can J Anesth 52, 630–633 (2005). https://doi.org/10.1007/BF03015775
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DOI: https://doi.org/10.1007/BF03015775