Use of the intubating laryngeal mask airway (LMA-Fastrach™) in patients with difficult airways.

Objective: To evaluate the success rate of intubation through the intubating laryngeal mask airway (LMA-Fastrach(TM)) in patients with predictive signs of difficult airway or after intubation failure. Study design: Open prospective study. Patients: The study included 33 adults, 21 with predictive signs of difficult airway and 12 after intubation failure. Methods: After induction of anaesthesia, the intubating LMA was inserted. Proper insertion was confirmed by easy bag ventilation and capnography. Intubation through the intubating LMA was then carried out with an armoured endotracheal tube. if intubation failed, a second attempt was carried out after a gentle manipulation of the intubating LMA. After two attempts, ii intubation remained impossible, fibrescopic intubation through the intubating LMA was carried out. In case of failure the usual tracheal intubation algorithms were used. Results: Tracheal intubation through the intubating LMA was successful in all patients, in 32 on the first attempt and in one on the second. Successful tracheal intubation was possible on the first attempt in 25 patients (76%), on the second in four (12%) and after fibrescopic intubation through the intubating LMA in the four remaining (12%). Conclusion: The results of this study confirm that tracheal intubation through the intubating LMA can be recommended in patients with a difficult airway, whether foreseen or not. (C)1999 Editions scientifiques et medicales Elsevier SAS.