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Use of the laryngeal tube in patients without teeth

2001; Elsevier BV; Volume: 51; Issue: 2 Linguagem: Inglês

10.1016/s0300-9572(01)00448-8

1873-1570

Takashi Asai, Akira Kawashima, Ikuhiro Hidaka, Shoji Kawachi,

Restraint-Related Deaths

A self-inflating bag and facemask are often used to ventilate the lungs during cardiopulmonary resuscitation. One major problem of this technique is that it may be difficult to obtain an air-tight seal around the mask, particularly in patients without teeth. We felt that the laryngeal tube (VBM, Medizintechnik, Germany) (Fig. 1) [1Asai T. Murao K. Shingu K. Efficacy of the laryngeal tube during intermittent positive pressure ventilation.Anaesthesia. 2000; 55: 1099-1102Crossref PubMed Scopus (92) Google Scholar, 2Dörge V. Ocker H. Wenzel V. Scinnucker P. The laryngeal tube: a new simple airway device.Anesth. Analg. 2000; 90: 1220-1222Crossref PubMed Scopus (147) Google Scholar, 3Agrò F. Cataldo R. Alfano A. Galli B. A new prototype for airway management in an emergency: the laryngeal tube.Resuscitation. 1999; 41: 284-286Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] would have a potential role in this circumstance. The laryngeal tube consists of an airway tube with a small balloon cuff attached at the tip (distal cuff) and a larger balloon cuff at the middle part of the tube (proximal cuff). When the device is inserted, it lies along the length of the tongue and the distal tip is positioned in the hypopharynx. The proximal cuff provides a seal by forming a plug in the upper pharynx and the distal cuff seals the oesophageal inlet. We used an improved laryngeal tube (Fig. 1), which differs from its prototype (used in previous reports [1Asai T. Murao K. Shingu K. Efficacy of the laryngeal tube during intermittent positive pressure ventilation.Anaesthesia. 2000; 55: 1099-1102Crossref PubMed Scopus (92) Google Scholar, 2Dörge V. Ocker H. Wenzel V. Scinnucker P. The laryngeal tube: a new simple airway device.Anesth. Analg. 2000; 90: 1220-1222Crossref PubMed Scopus (147) Google Scholar, 3Agrò F. Cataldo R. Alfano A. Galli B. A new prototype for airway management in an emergency: the laryngeal tube.Resuscitation. 1999; 41: 284-286Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar]) in several ways. The prototype had two pilot tubes to inflate two cuffs, whereas the current device has only one to inflate both cuffs. The tube is slightly longer now and there are three black lines (previously one) which indicate adequate depth. A soft silicone has been attached to the tip of the device (in the distal cuff) to minimize oropharyngeal injury and the integrity of the cuff has been improved [[4]Mandal N.G. Asai T. A new device has to be safe and reliable too.Anaesthesia. 2001; 56: 382Crossref PubMed Scopus (13) Google Scholar]. We used the laryngeal tube in five edentulous patients scheduled for elective surgery (Table 1). After induction of anesthesia and neuromuscular blockade, ventilation through a facemask was attempted. In all patients it was difficult to obtain an airtight seal, and ventilation was inadequate (little chest movement with no waveform of the end-tidal carbon dioxide [ET′CO2]) in three of them. A laryngeal tube (size 4 when the patient's height was 156 cm or greater; size 3 when the height was less than 156 cm) [[1]Asai T. Murao K. Shingu K. Efficacy of the laryngeal tube during intermittent positive pressure ventilation.Anaesthesia. 2000; 55: 1099-1102Crossref PubMed Scopus (92) Google Scholar] was inserted easily in all patients. After the cuffs had been inflated using an inflator (VBM, Germany) until the intracuff pressure reached 60 cmH2O [[1]Asai T. Murao K. Shingu K. Efficacy of the laryngeal tube during intermittent positive pressure ventilation.Anaesthesia. 2000; 55: 1099-1102Crossref PubMed Scopus (92) Google Scholar], it was always possible to ventilate the lungs adequately: the chest expanded well with a normal ET′CO2 waveforms during inflations. The minimum airway inflation pressure at which gas leaked around the device was 16 cmH2O, and in three patients gas did not leak around the device at the airway pressure of 30 cmH2O (Table 1). Therefore, we believe that the laryngeal tube has a potential role in the airway management during cardiopulmonary resuscitation, particularly in edentulous patients.Table 1Use of the laryngeal tube in five edentulous patientsSexAge (years)Height (cm)Weight (kg)Size of the laryngeal tubeLeak pressure (cmH2O)1Female83135383>302Female84137413183Female74156424164Male78163544>305Male67165564>30 Open table in a new tab