Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-24T12:48:58.875Z Has data issue: false hasContentIssue false
  • English
  • Français

The laryngeal tube for difficult airway management: a prospective investigation in patients with pharyngeal and laryngeal tumours

Published online by Cambridge University Press:  26 August 2005

M. Winterhalter ,
K. Kirchhoff ,
W. Gröschel ,
E. Lüllwitz ,
R. Heermann ,
L. Hoy ,
J. Heine ,
C. Hagberg  and
S. Piepenbrock
M. Winterhalter
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
K. Kirchhoff
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
W. Gröschel
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
E. Lüllwitz
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
R. Heermann
Affiliation:
Hannover Medical School, Department of ENT, Hannover, Germany
L. Hoy
Affiliation:
Hannover Medical School, Department of Biometry, Hannover, Germany
J. Heine
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
C. Hagberg
Affiliation:
University of Texas-Houston Medical School, Department of Anesthesiology, Houston, TX, USA
S. Piepenbrock
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
Get access

Extract

Summary

Background and objective: Since the introduction of the laryngeal mask into clinical practice, various additional supraglottic ventilatory devices have been developed. Although it has been demonstrated that the laryngeal tube is an effective airway device during positive pressure ventilation no clinical study has been performed thus far regarding its use in patients with predicted ventilation and intubation difficulties. Methods: The aim of this study was to prospectively evaluate the use of the laryngeal tube for temporary oxygenation and ventilation in adult patients with supraglottic airway tumours scheduled to undergo a pharyngeal–laryngeal oesophagoscopy and bronchoscopy under general anaesthesia. In addition to our standard airway management with face mask ventilation and rigid bronchoscopy, all patients were temporarily ventilated with an laryngeal tube. Also, in patients requiring laryngeal biopsies, endotracheal intubation was performed with a 6.0 mm microlaryngeal tracheal tube. Minute ventilation volumes, tidal volumes, ventilation pressures, end-expiratory CO2 concentration, oxygen saturation and arterial blood gas samples were measured. Results: From 54 enrolled patients only patients with relevant tumour masses were evaluated (n = 23). Mask ventilation was performed without difficulty in 15 of 23 patients. Mechanical ventilation with the laryngeal tube was possible in 22 of 23 patients with an audible leak present in three. Conventional endotracheal intubation was successfully performed in 19 of 23 patients. During face mask ventilation, minute volume, tidal volume, ventilation pressure, end-tidal CO2, oxygen saturation and arterial PO2 were significantly lower and PCO2 significantly higher (P < 0.05, paired t-test). No statistically significant differences were noted between the laryngeal tube and the microlaryngeal tracheal tube. Conclusions: The possibility of difficult ventilation and intubation must always be considered in patients with supraglottic airway tumours. In these cases, the laryngeal tube can be considered for routine airway management and may be useful in the ‘cannot-intubate’ situation although difficulties should be anticipated in patients with previous irradiation, specifically of the throat area.

Keywords

RESPIRATORY MECHANICS, airway, airflowLARYNGEAL MASKS, laryngeal tube airwayMONITORING PHYSIOLOGIC, ventilationSURGERY, endoscopicOTORHINOLARYNGOLOGIC NEOPLASMS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 9 , September 2005 , pp. 678 - 682
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Dörges V, Hartmut O, Wnzel V, Schmucker P. The laryngeal tube: a new simple airway device. Anesth Analg 2000; 90: 1220–1222.Google Scholar
Agro F, Cataldo R, Alfano A, Galli B. A new prototype for airway management in an emergency: the laryngeal tube. Resuscitation 1999; 41: 284–286.Google Scholar
Genzwuerker H, Hilker T, Hohner E, Kuhnert-Frey B. The laryngeal tube: a new adjunct for airway management. Prehosp Emerg Care 2000; 4: 168–172.Google Scholar
Ocker H, Wenzel V, Schmucker P, Steinfath M, Dorges V. A comparison of the laryngeal tube with the laryngeal mask airway during routine surgical procedures. Anesth Analg 2002; 95: 1094–1097.Google Scholar
Mallampati SR, Gatt SP, Guigino LD et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429–434.Google Scholar
Samsoon GLT, Young JRB. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487–490.Google Scholar
Parmet JL, Colonna-Romano P, Horrow JC, Miller F, Gonzales J, Rosenberg H. The laryngeal mask airway reliably provides rescue ventilation in cases of unanticipated difficult tracheal intubation along with difficult mask ventilation. Anesth Analg 1998; 87: 661–665.Google Scholar
International Liaison Committee on Resuscitation/European Resuscitation Council. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care Part 6, Section 3: adjuncts for oxygenation, ventilation, and airway control. Resuscitation 2000; 46: 115–125.
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: 1269–1277.
Hrska F, Hofbauer R, Staudinger T, Schellongowski P, Frass M. The importance of the esophageal–tracheal-double lumen tube for clinical use and emergencies. AINS 2002; 37: 378–385.Google Scholar
Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996; 84: 686–699.Google Scholar
Donlon J. Anesthesia for eye, ear, nose and throat surgery. In: Miller RD, ed. Anesthesia, 5th edn. Philadelphia: Churchill Livingstone, 2000: 2173–2198.
Rumball CJ, Mc Donald D. The PTL, combitube, laryngeal mask and oral airway: a randomised prehospital comparative study of ventilatory device effectiveness in 470 cases for cardiorespiratory arrest. Prehosp Emerg Care 1997; 1: 1–10.Google Scholar
Tanigawa K, Shigematsu A. Choice for airway devices for 12020 cases of nontraumatic cardiac arrest in Japan. Prehosp Emerg Care 1998; 2: 96–100.Google Scholar
Devitt JH, Wenstone R, Noel AG, O'Donnnell MP. The laryngeal mask airway and positive pressure ventilation. Anesthesiology 1994; 80: 550–555.Google Scholar
Asai T, Murao K, Shingu K. Effiacy of the laryngeal tube during intermittent positive pressure ventilation. Anaesthesia 2000; 55: 1099–1102.Google Scholar
Brimacombe J, Keller C, Brimacombe LA. Comparison of the laryngeal mask airway proseal and the laryngeal tube airway in paralysed anesthetized adult patients undergoing pressure-controlled ventilation. Anesth Analg 2002; 95: 770–776.Google Scholar
Brain AI. The LMA proseal – a laryngeal mask with an oesophageal vent. Br J Anesth 2000; 84: 650–654.Google Scholar
Genzwuerker HV, Roth V, Schmeck J. Comparing laryngeal mask airway proseal and laryngeal tube. Anesth Analg 2003; 96: 1535.Google Scholar