An Experience with Intubating Laryngeal Mask Airway for Difficult Airway Management: Report on 38 Cases
Somboon Thienthong MD*, Duenpen Horatanarung MD*, Malinee Wongswadiwat MD*, Polpun Boonmak MD*, Thitima Chinachoti MD**, Suthannee Simajareuk BSc*
Affiliation : * Department of Anesthesiology, Faculty of Medicine, Khon Kaen University ** Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University
A retrospective study was performed on 38 patients (23 males and 15 females) in whom the intubating
laryngeal mask airway (ILMA) was used for airway management at Srinagarind and Siriraj Hospital in
2003. The patients’ age and weight ranged between 12 and 75 years and 40 and 94 kg, respectively. Difficult
tracheal intubation was suspected before starting general anesthesia in 17 patients, whereas it was found
difficult after induction of general anesthesia in 21.
The ILMA was successfully placed in all patients with airway patency classified as ‘good’ and
‘acceptable’ in 36 patients (94.7%), and ‘poor’ in two. Oxygen saturation during intubation was maintained
above 95 percent in all patients. Tracheal intubation through the ILMA was successful in 34 patients (89.5%),
which was described as ‘easy’ in 27 of 34 patients (79.4%). In the remaining 7, 2-5 attempts were required for
successful tracheal intubation. The types of endotracheal tubes used were: 1) the pre-formed silicone tube in
55.9 percent, 2) the pre-formed flexible tube in 41.2 percent; and, 3) the standard polyvinyl tube in 2.9
percent. In the four patients with failed tracheal intubation through the ILMA, three were successfully
intubated with conventional laryngoscopy and one with gum elastic bougie. There were no serious
complications following the use of the ILMA in these patients. The ILMA proved a safe, very useful and easy
to use device with a high success rate for difficult airway management.
Keywords : Intubating laryngeal mask airway, Difficult airway management, Endotracheal tube
