Clinical Appraisal of Intubating Laryngeal Mask Airway (ILMA) for blind endotracheal intubation in the patients undergoing Spine or Orthopaedic Surgery under General Anaesthesia

Abstract

Background and Objective: The Intubating Laryngeal mask Airway (ILMA) is a new device designed to have better intubating characteristics than the standard LMA. The aim of our prospective study in a teaching hospital was to investigate the utility of ILMA for blind endotracheal intubation in patients undergoing spine or orthopaedic surgery under general anaesthesia. Methods: 75 American Society of Anaesthesiologists (ASA) physical status I and II adult patients were examined and ILMA was inserted as per the standard technique. The lubricated endotracheal tube was then passed through the ILMA. After confirmation of the successful endotracheal intubation, ILMA was removed as per the described technique. Ease of mask ventilation, time required for insertion of ILMA, number of attempts required for insertion of ILMA, time required to achieve intubation, number of attempts required for blind endotracheal intubation and haemodynamic parameters were recorded. Complications such as trauma, postoperative sore throat, lip or dental injury were looked for. Statistical analysis was done with the paired-t-test for haemodynamic parameters and percentages were calculated for the other parameters. Results: In spite of 32% of patients having restricted and nil neck movements, ILMA was inserted in 76% and 20% patients in first attempt and second attempt respectively. We could successfully intubate through ILMA in 96% patients with 58% in the first attempt. Haemodynamic parameters were clinically not significant. Conclusion: ILMA is a useful tool in patients with anticipated difficult airway especially in patients with cervical spine pathology. Blind endotracheal intubation through ILMA is easy. The paper was presented at the Maharashtra State Conference of Indian Society of Anaesthesiologists (MISACON 2004) in August 2004 and was awarded 3 prize in the teacher's category.