Langeron O, Semjen F, Bourgain J L, Marsac A, Cros A M
Département d'Anesthésie-Réanimation, Centre Hospitalo-universitaire Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, Université Pierre et Marie Curie, France.
Anesthesiology. 2001 Jun;94(6):968-72. doi: 10.1097/00000542-200106000-00009.
The intubating laryngeal mask airway (ILMA; Fastrach; Laryngeal Mask Company, Henley-on-Thames, UK) may provide an alternative technique to fiberoptic intubation (FIB) to facilitate the management of the anticipated difficult airway. The authors therefore compared the effectiveness of the ILMA with FIB in patients with anticipated difficult intubation.
One hundred patients, with at least one difficult intubation criteria (Mallampati class III or IV, thyromental distance < 65 mm, interincisor distance < 35 mm) were enrolled (FIB group, n = 49; ILMA group, n = 51) in this prospective randomized study. Anesthesia was induced with propofol and maintained with alfentanil and propofol after an efficient mask ventilation has been demonstrated. The success of the technique (within three attempts), the number of attempts, duration of the successful attempt, and adverse events (oxygen saturation < 90%, bleeding) were recorded.
The rate of successful tracheal intubation with ILMA was 94% and comparable with FIB (92%). The number of attempts and the time to succeed were not significantly different between groups. In case of failure of the first technique, the alternative technique always succeeded. Failures in FIB group were related to oxygen desaturation (oxygen saturation < 90%) and bleeding, and to previous cervical radiotherapy in the ILMA group. Adverse events occurred significantly more frequently in FIB group than in ILMA group (18 vs. 0%, P < 0.05).
The authors obtained a high success rate and comparable duration of tracheal intubation with ILMA and FIB techniques. In patients with previous cervical radiotherapy, the use of ILMA cannot be recommended. Nevertheless, the use of the ILMA was associated with fewer adverse events.
气管插管型喉罩气道（ILMA；Fastrach；喉罩公司，英国泰晤士河畔亨利）可能为纤维支气管镜引导插管（FIB）提供一种替代技术，以利于处理预期的困难气道。因此，作者比较了ILMA与FIB在预期插管困难患者中的有效性。
在这项前瞻性随机研究中，纳入了100例至少符合一项困难插管标准（Mallampati分级III或IV级、甲颏距离<65mm、门齿间距离<35mm）的患者（FIB组，n = 49；ILMA组，n = 51）。在证实面罩通气有效后，用丙泊酚诱导麻醉，并用阿芬太尼和丙泊酚维持麻醉。记录技术成功率（三次尝试内）、尝试次数、成功尝试的持续时间以及不良事件（氧饱和度<90%、出血）。
ILMA气管插管成功率为94%，与FIB相当（92%）。两组间尝试次数和成功时间无显著差异。如果第一种技术失败，替代技术总能成功。FIB组的失败与氧饱和度降低（氧饱和度<90%）和出血有关，而ILMA组的失败与既往颈部放疗有关。FIB组不良事件的发生率显著高于ILMA组（18%对0%，P<0.05）。
作者用ILMA和FIB技术均获得了较高的成功率和相当的气管插管持续时间。对于既往有颈部放疗史的患者，不推荐使用ILMA。然而，使用ILMA的不良事件较少。
