A study of laryngeal mask airway aided fiberoptic bronchoscopy-guided tracheal intubation in anticipated difficult airways patients

Abstract

Objective To estimate the clinical value of fiberoptic bronchoscopy(FOB)-guided tracheal intubation with laryngeal mask airway in anticipated difficult airways patients. Methods Twenty four ASA Ⅰ or Ⅱ patients scheduled for elective general anesthesia surgery with one or several difficult intubation criterion (thyromental distance<6 cm, 1.5 cm<interincisor distance<3 cm, head extension and neck movement limited <80 degree and Mallampati class Ⅲ or Ⅳ) were randomly allocated into 2 groups, 12 cases in each group. Patients in the LMA with FOB group (F group) underwent intubation with laryngeal mask airway with fiberoptic bronchoscope and patients in the direct laryngoscope group (L group) underwent direct intubation with laryngeal scope orally. If failed three times using direct laryngeal scope, intubate according to the F group method. Record patients airway assessment and the MAP and heart rate before(basement) and 3 min after intubation, the intubation time and the times of intubation successful. All the patients were followed up postoperatively for adverse effects like sore throat or hoarseness. Results Airway assessments of the patients in the two groups before intubation had no difference(P>0.05). Compared with the value of basement, the MAP and HR increased significantly in the patients of the L group(P 0.05). There is significant difference between L group and F group(P< 0.05). The first intubation attempt succeeded in 75% of the patients in the F group and the total success rate was 100%, though the success rate was only 25% at the first attempt in the L group and the total rate of success was 50% after three attempts. Six cases failed with direct laryngeal scope after three attempts, then two of them intubated successfully with FOB aided by LMA at the first attempt and four of them succeeded at the second time. The rate of success of first attempt and the total rate of three attempts in the F group were higher than the L group. There was significant difference between the two groups (P<0.05). The duration of intubation in the F group was shorter significantly than that in the L group [(81±9) s vs (161±26) s ](P<0.05). There were two cases in the F group who had mild sore throat. Six cases had moderate to severe sore throat and mild hoarseness and two cases had mild sore throat in the L group. Conclusions Laryngeal mask airway combining with fiberoptic bronchoscope intubation in anticipated difficult airways was effective to improve the success rate of intubation and reduce adverse effects of direct laryngoscope intubation postoperatively. It is worthy of clinical application. Key words: Difficult airway; Intubation, Intratracheal; Laryngeal mask; Fiberoptic bronchoscope