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BJA Advance Access published online on July 28, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei201
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted June 14, 2005

Case Report

Use of a ProSealTM laryngeal mask airway and a Ravussin cricothyroidotomy needle in the management of laryngeal and subglottic stenosis causing upper airway obstruction

T. M. Cook 1* {dagger}, M. Asif 1, R. Sim 2, and J. Waldron 2

1 Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK
2 Department of Otorhinolaryngology, Royal United Hospital, Combe Park, Bath BA1 3NG, UK

* To whom correspondence should be addressed.
T. M. Cook, E-mail: timcook{at}ukgateway.net


  Abstract

We report the successful use of a ProSealTM laryngeal mask airway (PLMA) as a dedicated airway to allow fibre-optic inspection and passage through a tightly stenosed glottic and subglottic lesion, before fibre-optic-guided transtracheal placement of a Ravussin needle and jet ventilation. The described technique avoided both tracheostomy and the potential of ‘seeding’ the tumour by passage of the needle through the mass. The PLMA may be a useful ‘dedicated airway’ and has several advantages over the classic LMA®{ddagger} and intubating LMA when used for this purpose. These include improved airway seal and reduced risk of aspiration. Four other cases of use of the PLMA as a dedicated airway during management of difficult airways are discussed.

Keywords: complications, difficult airway, tracheal stenosis; equipment, laryngeal mask airway, proseal.

{dagger}Declaration of interest. Dr Tim Cook has received honoraria for lecturing for Intavent Orthofix and the LMA Company, both distributors of the ProSealTM and other laryngeal mask airways.

{ddagger}LMA® is the property of Intavent Ltd.


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The management of laryngeal and subglottic stenosis.
Br. J. Anaesth., June 1, 2006; 96(6): 803 - 803.
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Use of a ProSeal laryngeal mask airway and a Ravussin cricothyroidotomy needle in the management of
James H Low, et al.
British Journal of Anaesthesia, 11 Oct 2005 [Full text]
When discussion lead to optimal management
Davide Cattano
British Journal of Anaesthesia, 21 Feb 2006 [Full text]
Use of a ProSealTM laryngeal mask airway and a Ravussin cricothyroidotomy needle in the management o
Tim M Cook
British Journal of Anaesthesia, 1 Mar 2006 [Full text]

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