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The laryngeal tube for difficult airway management: a prospective investigation in patients with pharyngeal and laryngeal tumours

Published online by Cambridge University Press:  26 August 2005

M. Winterhalter ,
K. Kirchhoff ,
W. Gröschel ,
E. Lüllwitz ,
R. Heermann ,
L. Hoy ,
J. Heine ,
C. Hagberg  and
S. Piepenbrock
M. Winterhalter
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
K. Kirchhoff
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
W. Gröschel
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
E. Lüllwitz
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
R. Heermann
Affiliation:
Hannover Medical School, Department of ENT, Hannover, Germany
L. Hoy
Affiliation:
Hannover Medical School, Department of Biometry, Hannover, Germany
J. Heine
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
C. Hagberg
Affiliation:
University of Texas-Houston Medical School, Department of Anesthesiology, Houston, TX, USA
S. Piepenbrock
Affiliation:
Hannover Medical School, Department of Anesthesiology, Hannover, Germany
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Summary

Background and objective: Since the introduction of the laryngeal mask into clinical practice, various additional supraglottic ventilatory devices have been developed. Although it has been demonstrated that the laryngeal tube is an effective airway device during positive pressure ventilation no clinical study has been performed thus far regarding its use in patients with predicted ventilation and intubation difficulties. Methods: The aim of this study was to prospectively evaluate the use of the laryngeal tube for temporary oxygenation and ventilation in adult patients with supraglottic airway tumours scheduled to undergo a pharyngeal–laryngeal oesophagoscopy and bronchoscopy under general anaesthesia. In addition to our standard airway management with face mask ventilation and rigid bronchoscopy, all patients were temporarily ventilated with an laryngeal tube. Also, in patients requiring laryngeal biopsies, endotracheal intubation was performed with a 6.0 mm microlaryngeal tracheal tube. Minute ventilation volumes, tidal volumes, ventilation pressures, end-expiratory CO2 concentration, oxygen saturation and arterial blood gas samples were measured. Results: From 54 enrolled patients only patients with relevant tumour masses were evaluated (n = 23). Mask ventilation was performed without difficulty in 15 of 23 patients. Mechanical ventilation with the laryngeal tube was possible in 22 of 23 patients with an audible leak present in three. Conventional endotracheal intubation was successfully performed in 19 of 23 patients. During face mask ventilation, minute volume, tidal volume, ventilation pressure, end-tidal CO2, oxygen saturation and arterial PO2 were significantly lower and PCO2 significantly higher (P < 0.05, paired t-test). No statistically significant differences were noted between the laryngeal tube and the microlaryngeal tracheal tube. Conclusions: The possibility of difficult ventilation and intubation must always be considered in patients with supraglottic airway tumours. In these cases, the laryngeal tube can be considered for routine airway management and may be useful in the ‘cannot-intubate’ situation although difficulties should be anticipated in patients with previous irradiation, specifically of the throat area.

Keywords

RESPIRATORY MECHANICS, airway, airflowLARYNGEAL MASKS, laryngeal tube airwayMONITORING PHYSIOLOGIC, ventilationSURGERY, endoscopicOTORHINOLARYNGOLOGIC NEOPLASMS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 9 , September 2005 , pp. 678 - 682
Copyright
© 2005 European Society of Anaesthesiology

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