Flexible Lightwand–guided Tracheal Intubation with the Intubating Laryngeal Mask Fastrach  TMin Adults after Unpredicted Failed Laryngoscope-guided Tracheal Intubation

Background The authors determined the efficacy of using the intubating laryngeal mask airway Fastrach (ILM) as a ventilatory device and aid to flexible lightwand-guided tracheal intubation in patients with unpredicted failed laryngoscope-guided tracheal intubation when managed by experienced anesthetists. Methods During a 27-month period, 16 experienced anesthetists agreed to use the ILM as an airway device and airway intubator in patients (aged > 18 yr) with predicted normal airways who were subsequently found to be difficult to intubate (three failed attempts at laryngoscopy). Intubation via the ILM was performed with a flexible lightwand. The number of attempts at ILM placement, the number of adjusting maneuvers, the number of attempts at tracheal intubation via the ILM,and any episodes of hypoxia (oxygen saturation < 90%) were recorded. Results Forty-four of 11,621 patients (0.4%) met the inclusion criteria. ILM insertion and ventilation was successful at the first attempt in 40 of 44 patients (91%) and at the second attempt in 4 of 44 (9%). Flexible lightwand-guided tracheal intubation via the ILM was successful in 38 of 44 patients (86%) at the first attempt, 3 of 44 (7%) at the second attempt, 2 of 44 (5%) at the third to fifth attempts, and failed in 1 of 44 (2%). The median number of adjusting maneuvers before successful intubation was 1 (range, 0-4). Hypoxia occurred in 5 patients before ILM insertion (range, 52-82%), but none after ILM insertion. No patient developed hypoxia during or after intubation via the ILM. Conclusion The ILM is an effective ventilatory device and aid to flexible lightwand-guided tracheal intubation in adult patients with predicted normal airways in whom laryngoscope-guided tracheal intubation subsequently fails when managed by experienced anesthetists.