Laryngeal mask airway in laryngoscopies: A safer alternative for the difficult airway.

Objectives: To identify patients with potentially difficult airways, and to determine the benefits and risks of ventilating such patients during laryngeal or upper tracheal procedures using a Laryngeal Mask Airway (LMA). Methods: The computer records of the Otolaryngology and Anesthesia departments over a ten month period were used to identify all patients who had have been ventilated using an LMA due to a difficult airway. This procedure was used for bronchoscopies, laryngoscopies, laser treatments and biopsies of laryngeal and upper tracheal lesions. The clinic charts and postoperative notes of these patients were used to record demographic data, body mass index, reason for classification as a difficult airway and postoperative morbidity due to LMA use. Results: We identified six cases with a "difficult airway" over a ten period. Laryngeal pathologies included leukoplakia, hemangioma and laryngeotracheal stenosis. Each patient underwent an elective LMA insertion because these patients were predicted to have a difficult airway. Laryngeal surgeries were performed uneventfully with good results. There were no intraoperative or postoperative complications in any patient. Conclusion: In patients with difficult airways, it is safer and easier to insert a Laryngeal Mask Airway compared to an endotracheal tube. The lesions are easy to visualize with a flexible bronchoscope, there is minimal vocal cord trauma and it serves as a wide conduit for bronchoscopes and laryngoscopes. We recommend preoperative identification of difficult airways and consideration for elective LMA and bronchoscopy during such procedures.

Duke Scholars

Author Nazish Khalid Hashmi Anesthesiology, Cardiothoracic