ABSTRACT
BACKGROUND AND AIMS: LMA CTrachTM, a new intubating conduit, has a thicker shaft compared to that of the intubating laryngeal mask airway (ILMA) due to the embedded optical fibres of the system. This causes difficulty during insertion despite normal mouth opening. Utility of two manoeuvres to overcome this was evaluated. METHODS: From our experience with LMA CTrachTM we found that two manoeuvres can be helpful to facilitate the insertion of LMA (a) dorsal and downward pressure over the shaft at the point where it hinges against the incisors while continuing the one handed rotational insertion of LMA (b) Lateral insertion of the LMA till the cuff is inside the oral cavity and then rotation of the LMA by 90° and then complete the insertion. A retrospective analysis of 200 insertions of LMA CTrachTM was done to evaluate the utility of these manoeuvres. RESULTS: Out of 200 insertions, 15 were found to be difficult. Manoeuvre "a" was applied in 13 cases to facilitate the insertion and manoeuvre "b" was applied in 2 cases where insertion was not possible despite manoeuvre "a'. Insertion was successful in these cases after the application of the described manoeuvres. CONCLUSION: The two manoeuvres described above can be useful when LMA CTrachTM insertion into the oral cavity is obstructed by the incisor teeth.
ABSTRACT
BACKGROUND AND AIMS: Higher success rate of intubation is observed with the reverse orientation of polyvinyl chloride (PVC) tracheal tube while intubating through laryngeal mask airway (LMA) Fastrach™. It is not clear whether the same is true during intubation through LMA CTrach™ visualizing the process of intubation. The primary aim of this study was to compare the influence of the PVC tracheal tube orientation on the success rate of intubation while intubating through LMA CTrach™. MATERIAL AND METHODS: One-hundred and fifty patients belonging to American Society of Anesthesiologists status I-II, undergoing elective surgery under general anesthesia were randomized to either group normal orientation or group reverse orientation. A maximum of 3 intubation attempts within a span of 3 min was allowed in each group before the change over to the other group. If intubation failed with the other orientation of the tube also, then intubation through LMA CTrach™ was abandoned and intubation done by direct laryngoscopy. The success of intubation, time, maneuvers, postoperative sore throat, and hoarseness were recorded. RESULTS: Tracheal intubation through LMA CTrach™ with PVC tube was successful in 94.5% of patients in group normal orientation and in 98.6% of patients in group reverse orientation. The first attempt success rate was 75.3% and 86.3% in group normal and group reverse orientation, respectively. The incidence of a sore throat was higher in the group normal orientation than in the reverse orientation (31.8% and 26.5%, respectively). CONCLUSIONS: Overall success rate of intubation was comparable between the two groups. Though statistically insignificant, the first attempt success rate was higher in group reverse orientation.
