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The application of laryngeal mask airway at difficulties
difficult airway is completed formal training of anesthesiologists had difficulty in mask ventilation or endotracheal intubation, or both have a clinical situations. ASA difficult airway guidelines to specifically 2013 laryngeal mask, as an important tool for dealing with difficult airway.
a laryngeal mask as air tools or intubation guided tool, can be used for cervical spondylosis, the use of neck collar, obstetrics, ankylosing spondylitis, sleep apnea, obesity, congenital diseases and reflux aspiration risk patients with a variety of difficult airway, Mallampitti and Cormack - classification Lehane grade has nothing to do with laryngeal mask in the ease of.
when not intubation, and not through the mask ventilation ( CICV） When placing a laryngeal mask ventilation in the first place, and through the laryngeal mask line endotracheal intubation.
in patients with difficult airway is expected, the anesthesiologist can consider to use a laryngeal mask airway management tools as; If must intubation, it can choose awake intubation or after induction of general anesthesia intubation: 1. If awake intubation failure, can consider to switch to anesthesiologists laryngeal mask airway management as a tool; Or oropharynx in laryngeal mask after anesthesia, used in laryngeal mask guided by flexible bronchoscopy mirror or bougie intubation; 2. If for the first time after induction of general anesthesia intubation failure, mask ventilation is good, it is not an emergency airway, can switch to other means of intubation, for example, using fiber mirror, light sticks, hard bronchoscope, visual laryngoscope intubation of tools such as, or in laryngeal mask guided by using bronchoscopy, bougie intubation or direct use of laryngeal mask airway management as a tool.
if the first line failure, mask ventilation intubation failure, can use laryngeal mask as an emergency ventilation tool. If a laryngeal mask airway is good, it is not an emergency airway, can switch to other modes of intubation. If a laryngeal mask airway failure, the consideration for emergency airway, should consider other emergency noninvasive airway ( Throat) Or emergency gen airway ( TTJV, through cricothyroid membrane, tracheotomy, retrograde tracheal intubation tube) 。
( A) By the intubation laryngeal mask line type endotracheal intubation
Fastrach laryngeal mask is the earliest type of intubation laryngeal mask, by a set of capsule ( The same as the classic laryngeal mask shape) , consistent with the anatomy of the radian, and with a guide handle hard vent ( Inside diameter of 13 mm) , epiglottis promotion fences and other parts. Compared with the classic laryngeal mask, Fastrach laryngeal mask ventilation tube more thick, short breather, vent the radian of oropharynx anatomical shape in advance the human body, even if the patients head kept midline laryngeal mask can also be placed in. Vent on the back with scale, can be used to determine the depth of cannula. Epiglottis ascension fences can prevent the epiglottis impreaaion nip into the ventilation tube, reduce the probability of endotracheal tube insert time blocked. Vent the remote have groove design, to keep the endotracheal tube in the middle position. Fastrach laryngeal mask is designed to match the special endotracheal tube, in order to improve the success rate of blind plug and reduce the damage. The endotracheal tube for silicone material steel wire reinforced pipe, tube soft, can be repeated use. Cant catheter tip is located in the middle of, can reduce the damage caused by intubation. Fastrach laryngeal mask can be used for blind tracheal intubation or trachea intubation guided by flexible bronchoscopy mirror.
Cookgas laryngeal mask is a classic laryngeal mask and Fastrach in fully absorbs the advantages of laryngeal mask, on the basis of design and production of new type intubation laryngeal mask. Deformation of the tube wall flexibility, ability is strong, can guide the blind agent and can be hard, mirror and FOB airway processing tools to complete the endotracheal intubation, and has a high success rate. With Fastrach laryngeal mask, Cookgas laryngeal mask intubation easier, blind agent endotracheal intubation success rate is higher.
I - Gel laryngeal mask can also be used for endotracheal intubation, FOB guidance, is a viable option.
( 2) Non intubation guided by a laryngeal mask airway intubation
there are literature reported using classic laryngeal mask, the Proseal laryngeal mask, Unique laryngeal mask and Ambu laryngeal mask and forceful laryngeal mask and other non intubation laryngeal mask guided tracheal intubation. But the following deficiencies: the ventilation pipe diameter can't through the coarser the endotracheal tube, blind intubation success rate low, difficult to determine the depth of the endotracheal tube.
non intubation laryngeal mask guidance intubation is feasible, but do not recommend the type of laryngeal mask intubation guided blind intubation, rubber bougie, in pig and Aintree catheter guided material can increase the success rate of intubation, with synthetic fiber with higher success rate of intubation.
( 3) Visual intubation laryngeal mask ( LMA - CTrach）
the laryngeal mask in Fastrach laryngeal mask intubation increased the video system, on the basis of the visual downward endotracheal intubation, high success rate of intubation, little injury, facilitate teaching, but this is no longer in production.
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