Use of a Laryngeal Mask in a Patient with an Unstable Neck

Abstract

In Response: Dr. Kiyama made a useful suggestion that, in the patient with an unstable neck, the trachea could have been intubated through the laryngeal mask (leaving both the endotracheal tube and laryngeal mask in place during the operation), and at the end of surgery, the endotracheal tube could have been removed easily with the laryngeal mask in place. There were two reasons why we did not do so in our patient [1]. First, we used the intubating laryngeal mask for tracheal intubation but removed the mask afterward, because the device has a rigid metal tube that might produce unduly pressures on a fragile cervical spine if the device is left in place for a prolonged period [2]. Second, as in our previous report [3], the presence of the cuff of the laryngeal mask might have interfered with surgery (anterior fixation of the cervical spine). The presence of an endotracheal tube should not impede placement of the laryngeal mask [4]; stabilization of the head and neck does not markedly decrease the success rate of ventilation through the laryngeal mask (although placement may be more difficult) [5,6]. However, we have found that placement may often fail in both circumstances if the mask is placed without using the correct method as described by the inventor (unpublished observation). Therefore, we believe that any technique, such as one we report [1], should be applied to the actual patient only by people who have gained enough skill through proper training. Takashi Asai, MD, PhD Koh Shingu, MD Department of Anesthesiology; Kansai Medical University; Moriguchi City, Osaka, Japan