DOI: http://dx.doi.org/10.5455/2349-3259.ijct20140802

A comparative study of overall efficacy and hemodynamic effects following blind oro-tracheal intubation with ILMA vs. conventional direct laryngoscopy guided intubation with Macintosh laryngoscope

Vijay Satishchandra Sharma, Sucheta Tidke, Benhur John Premendra

Abstract


Background: Intubating Laryngeal Mask Airway (ILMA) is a new device to guide blind oro-tracheal intubation thus offering a new approach for endotracheal intubation and is expected to produce less sympathetically driven haemodynamic stress response. The purpose of this study was to assess overall efficacy, haemodynamic advantage and complication rate with use of ILMA compared to conventional method of endotracheal intubation with use of Macintosh Laryngoscope (ML).

Methods: This randomized controlled study was conducted on 60 adult patients comparable in age, sex, weight, MPC and ASA status scheduled for elective surgeries. Patients were randomly allocated into two groups of 30 each. Both the groups received similar balanced anaesthesia technique (Inj. fentanyl 2 µg/kg, propofol 2-2.5 mg/kg, rocuronium 1 mg/kg). Tracheal intubation was done using either ILMA or Macintosh laryngoscope. The intubation time, number of attempts required for successful intubation, haemodynamic changes and oro-pharyngo-laryngeal complications encountered during both the methods were recorded.

Results: Time to intubation was comparatively longer in the ILMA group than laryngoscopy group (P <0.05). The success rate of intubation was 100% in both the groups. Overall haemodynamic changes in both the groups were statistically comparable (P >0.05) and ILMA appears to be offering no haemodynamic advantage over ML. The incidence of complications was rare and comparable amongst both the groups (P >0.05).

Conclusions: Therefore in patients with normal airway blind intubation with ILMA is a successful and equally efficacious method without significant oro-pharyngo-laryngeal morbidity but offers no added haemodynamic advantage compared to conventional direct laryngoscopy with ML. Thus ILMA may act as a suitable alternative to ML for patients with normal airway.

Keywords


Overall efficacy, Haemodynamic effects, Intubating laryngeal mask airway (ILMA), Macintosh Laryngoscope

Full Text:

PDF

References


Brain AI, Verghese C, Addy EV, Kapila A, Brimacombe J. The intubating laryngeal mask. II: A preliminary clinical report of a new means of intubating the trachea. Br J Anaesth. 1997;79(6):704-9.

Mason AM. Use of the intubating laryngeal mask airway in pre-hospital care: a case report. Resuscitation. 2001;51(1):91-5.

Agro F, Brimacombe J, Brain AI, Marchionni L, Cataldo R. The intubating laryngeal mask for maxillo-facial trauma. Eur J Anaesthesiol. 1999;16(4):263-4.

Reeves MD, Skinner MW, Ginifer CJ. Evaluation of the intubating laryngeal mask airway used by occasional intubators in simulated trauma. Anaesth Intensive Care. 2004;32(1):73-6.

Komatsu R, Nagata O, Sessler DI, Ozaki M. The intubating laryngeal mask airway facilitates tracheal intubation in the lateral position. Anaesth Analg. 2004;98(3):858-61.

Joo H, Rose K. Fastrach: a new intubating laryngeal mask airway: successful use in patients with difficult airways. Can J Anaesth. 1998;45(3):253-6. Epub 1998/05/14.

Prys-Roberts, Greene L, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension II: haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth. 1998;80:106-22.

Fox EJ, Sklar GS, Hill CH, Villanuff AR, King BD. Complications related to the pressor response to endotracheal intubation. Anaesthesiology. 1977;47:524-5.

Kihara S, Watanabe S, Taguchi N, Suga A, Brimacombe JR. Tracheal intubation with the Macintosh laryngoscope versus intubating laryngeal mask airway in adults with normal airways. Anaesth Intensive Care. 2000;28(3):281-6.

D. K. Singh, Parul Jindal, Preeti Agarwal, U. C. Sharma, J. P. Sharma. Comparative evaluation of haemodynamic changes during insertion and removal of laryngeal mask airway and intubating laryngeal mask airway. Intern J Anaesthesiol. 2006;11(1):2.

Zhang GH, Xue FS, Sun HY, Li CW, Sun HT, Li P, et al. Comparative study of hemodynamic responses to oro-tracheal intubation with intubating laryngeal mask airway. Chin Med J (Engl). 2006;119(11):899-904.

Keller C, Brimacombe J, Keller K. Pressures exerted against the cervical vertebrae by the standard and intubating laryngeal mask airways: a randomized, controlled, cross-over study in fresh cadavers. Anaesth Analg. 1999;89(5):1296-300.

Keller C, Brimacombe J. Pharyngeal mucosal pressures, airway sealing pressures, and fiberoptic position with the intubating versus the standard laryngeal mask airway. Anaesthesiology. 1999;90(4):1001-6.

Hirabayashi Y, Hiruta M, Kawakami T, Inoue S, Fukuda H, Saitoh K, et al. Effects of lightwand (Trachlight) compared with direct laryngoscopy on circulatory responses to tracheal intubation. Br J Anaesth. 1998;81(2):253-5.

Harnaya Y, Dohi S. Differences in cardiovascular response to airway stimulation at different sites and blockade of the responses by lidocaine. Anaesthesiology. 2000;93:95-103.

Shimoda O, Yoshitake A, Abe E, Koga T. Reflex responses to insertion of the intubating laryngeal mask airway, intubation and removal of the ILMA. Anaesth Intensive Care. 2002;30(6):766-70.

Adachi Y, Takamatsu I, Watanabe K, Uchihashi Y, Higuchi H, Satoh T. Evaluation of the cardiovascular responses to fiberoptic oral intubation with television monitoring: comparison with conventional direct laryngoscopy. J Clin Anaesth. 2000;12:503-5.

Bharti N, Naik A. Ease of insertion and haemodynamic effects following tracheal intubation using intubating laryngeal mask airway: a comparison with conventional Macintosh laryngoscope. Indian J Anaesth. 2006 June;50(3):205-8.

Kihara S, Brimacombe J, Yaguchi Y, Watanabe S, Taguchi N, Komatsuzaki T. Hemodynamic responses among three tracheal intubation devices in normotensive and hypertensive patients. Anaesth Analg. 2003;96(3):890-5.