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BJA Advance Access originally published online on October 12, 2007
British Journal of Anaesthesia 2007 99(6):912-915; doi:10.1093/bja/aem274
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Intubating laryngeal mask as a ventilatory device during percutaneous dilatational tracheostomy: a descriptive study

U. Linstedt1,*, F. Möller2, N. Grote2, M. Zenz2 and A. Prengel3

1 Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Diako Hospital, Flensburg, Academic Teaching Hospital of the University of Kiel, Germany
2 Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Knappschaftskrankenhaus Bochum—Langendreer, Ruhr University, Bochum, Germany
3 Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Virngrund Clinic, Ellwangen, Germany

* Corresponding author: Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Diakonissenkrankenhaus, Marienhölzungsweg 2, 24393 Flensburg, Germany. E-mail: linstedtul{at}diako.de

Background: We use an intubating laryngeal mask (ILM) in preference to an endotracheal tube (ETT) as the ventilatory device during percutaneous dilatational tracheostomy (PDT) to overcome potential problems such as difficult ventilation, accidental extubation, damage of the ETT or of the bronchoscope, and need for additional assistant to secure the airway. We report our experience with this method.

Methods: In this prospective observational study, PDT was performed using the ILM in 86 patients. The insertion of the ILM, the quality of ventilation, and the view of the tracheal puncture site were rated as: ‘very good’, ‘good’, ‘difficult’, and ‘not possible with ILM’.

Results: The bronchoscope was not damaged during any case, and all PDTs were performed by two physicians, without the need for an additional assistant. PDTs with ILM were successful in 95% of the patients (n=82). The ratings were ‘very good’ or ‘good’ in 80% of cases with regards to ventilation, in 90% for identification of relevant structures and tracheal puncture site, and in 85% for the view inside the trachea during PDT. Tracheal re-intubation was required for inadequate ventilation with ILM in four patients.

Conclusions: The advantages of this procedure were lack of damage to the bronchoscope, the need for two instead of three persons to perform the PDT, and the excellent view inside the trachea. We recommend the ILM as a standard device for ventilation during bronchoscope-guided PDT.

Keywords: airway, patency; complications, airway obstruction; equipment, laryngeal mask, intubating; equipment, tracheostomy, percutaneous; surgery, tracheotomy


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This article has been cited by other articles:


Home page
 Br J AnaesthHome page
P. V. Dimitrov, C. Verghese, G. M. Haslam, S. Laver, J. P. Nolan, K. Gupta, T. M. Cook, U. Linstedt, F. Moller, N. Grote, et al.
Intubating laryngeal mask as a ventilatory device
Br. J. Anaesth., April 1, 2008; 100(4): 561 - 564.
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E-letters:

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Use of the ProSeal LMA during percutaneous dilatational tracheostomy
George M Haslam, et al.
British Journal of Anaesthesia, 10 Jan 2008 [Full text]
Intubating laryngeal mask (ILMA) as a ventilatory device
Peter V Dimitrov, et al.
British Journal of Anaesthesia, 22 Jan 2008 [Full text]
Laryngeal mask airway during percutaneous dilatational tracheostomy
Ulf Linstedt
British Journal of Anaesthesia, 1 Feb 2008 [Full text]

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