discussion 2
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Discussion 2. B8501061 李又文. 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. Abbreviations. TI: Tracheal intubation - PowerPoint PPT PresentationTRANSCRIPT
Discussion 2B8501061
李又文
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.
Abbreviations TI: Tracheal intubation AFOI: Awake fiberoptic intubation ILMA: Intubation laryngeal mask airway
AFOI
Intubation Laryngeal Mask Airway
AFOI AFOI is the “gold standard” for p’t with suspecte
d or proven difficult airways. ASA “difficult airway algorithm” suggests difficult
airways should be intubated awaked. What should we do for patients who are not coo
perative or those who refuse AFOI?
Disadvantages of AFOI Oxygen desaturation Tachycardia Hypertension Life threatening AFOI requiring emergency surgi
cal airway has been reported 55% incidence of patient discomfort
ILMA ILMA allows confirmation of oxygenation and ve
ntilation before tracheal intubation. Normal airways: 99% ventilation success rate 97-99% TI success rate Difficult airways: Numerous case reports after failed laryngosco
py and failed FOB intubation
Hypothesis Patients with difficult airways could be succ
essfully and safely intubated after induction of anesthesia using ILMA
Patients would be more satisfied with TI after induction of anesthesia
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
Including Multiple and failed laryngoscopies Cormack > Grade 3 Mallampati > Grade 3 Retrognathia Thyromental distance < 6 cm Limited c-spine movement
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
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.
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
Results Faster induction times in ILMA (672 ± 545
s) than AFOI group (972 ± 331s) AFOI group : all successfully intubated ILMA group : all successfully ventilated; 50% blind TI ; 25% intubated with FOB gui
dance without changing ILMA; 15% changing ILMA with FOB guidance; 10% intubated by study investigator
Oxygenation Minimum oxygen saturation was higher in I
LMA at 97.5 vs AFOI at 94.5 AFOI group : oxygen saturation decreased t
o 62% and 84% in two patients in the ILMA: one patient decreased to 85%
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
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
Thank you very much!