Airway Management - Case Reports and Feedback - Dr. Lorraine Foley-Pateno, MD

Lorraine Foley-Pateno, MD
A-1497
2003

Use of FAST (Foley Flexible Airway Stylet) Fiberoptic Scope through the Intubating Laryngeal Mask Airway Lorraine J. Foley, M.D.
Winchester Anesthesia Associates, Winchester Hospital, Tufts School of Medicine, Winchester, Massachusetts, United States. Introduction: The incidence of unanticipated difficult airway/intubation ranges from 1-3% (1). When patient cannot be intubated by conventional direct laryngoscopy, other airway adjunct are used (2). One alternative is the Intubating Laryngeal Mask Airway (ILMA). It is designed to provide ventilation and superior conduit for blind or fiberoptic bronchoscope (FOB) guided tracheal intubation. The success rate for blind intubation via ILMA on 1st attempt has been reported 50-75%, and 3.5% failure after 5th attempt (3,4,5). With FOB, 100% success rate for intubation is reported but this requires 2 person familiar with equipment,increased time to intubation and consuming cleaning care.

FAST scope (Clarius Medical, Minn) was designed as a simple flexible fiberoptic scope to help visualize intubating through ILMA as 1 person technique with minimal cleaning. The objective of this study is to describe the technique, time to intubate, and success rate of FAST scope.

Method: Single center prospective non-blinded trial in patients (pts) undergoing surgery requiring general anesthesia with endotracheal tube (ETT). With approval from Ethnic Committee and written informed consent, pts ASA 1-3, ages 18-80, male or female requiring general anesthesia with ETT were enrolled. Those who refused, h/o reflux,GERD or full stomach were excluded. Standard monitors ECG, pulse oximeter and blood pressure were applied. Pts were preoxygenated, propofol induction and narcotics given. ILMA placed, adequate ventilation obtained, muscle relaxant given. ETT placed on FAST scope and placed through ILMA. While looking through scope, ILMA was manipulated by it's steel handle till vocal cords (vc) visualized. ETT with FAST passed through vc into tracheal. FAST removed and ETCO2 confirmed.

Results: Total 15 patients. 11 elective, and 4 difficult intubations, ILMA and FAST was used as rescue were entered. Time to intubate with 11/11 elective <30secs and 4 difficult intubations rescues ranged 3-20mins. ILMA ventialtion successful 1st attempt 13/15(87%), and 2/15 (15%) 2nd attempt. Placement of ETT with FAST scope, full view of vc was seen in 7/15(47%) on lst pass, and ETT placed easily. VC were partially visualized 8/15(53%) and 1, 2, or3 manipulations of ILMA for full view of vc were 5/8(62.5%), 2/8(25%), or 1/8 2.5%) respectively were needed. ETT placement was 100%.

Conclusion: Small preliminary study shows successful 100% intubation can occur with one person technique of FAST scope via manipulation of ILMA. Advantages of FAST is one person technique, requiring easy set up, cleaning, and portability

References: 1.Anesth Analg 81:254-8, 1995 2.Critical Care Clinics 16:429-44,2000 3. Anesthesiology,95:1175-81,2001 4.Br J. Anesth 89:103-5,2000 5. Anesth 89:103-5,2000 6. Anesth Analg 88:662-6,1999.

Anesthesiology 2003; 99: A1497