Doyle D John, Zura Andrew, Ramachandran Mangalakaraipudur, Lin Jia, Cywinski Jacek B, Parker Brian, Marks Theodore, Feldman Marc, Lorenz Robert R
Department of General Anesthesiology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
J Clin Anesth. 2007 Aug;19(5):367-9. doi: 10.1016/j.jclinane.2006.08.015.
We report a 22-year-old, 980-lb (445 kg) man with a body mass index of 163 kg/m(2), who needed intubation for tracheotomy surgery, as he was profoundly hypercarbic and reliant on a tight-fitting continuous positive airway pressure mask. Attempts at oral and nasal fiberoptic intubation during topical anesthesia were unsuccessful because of poor patient cooperation and epistaxis. Thus, after awake placement of a size 5 Laryngeal Mask Airway ProSeal LMA; (LMA North America, San Diego, CA), we induced anesthesia using sevoflurane. Then we placed an Aintree stylet (Cook Critical Care, Bloomington, IN) over a fiberoptic bronchoscope, and both were introduced through the LMA into the trachea. We then removed the fiberoptic bronchoscope followed by the LMA. A Parker size 7.5 endotracheal tube was then "railroaded" over the Aintree catheter into the trachea.
