Use of the intubating lma-fastrach in 254 patients with difficult-to-manage airways

Background: The laryngeal mask airway (LMA^TM; North America, Inc., San Diego, CA) has a well-established role in the emergency and elective treatment of patients with difficult-to-manage airways (DA). In this study, the authors report their clinical experience with the intubating LMA (LMA-Fastrach^TM; LMA North America, Inc., San Diego, CA) in 254 patients with different types of DA. Methods: The authors reviewed the anesthetic and medical records of patients with DA in whom the LMA-Fastrach^TM was used electively or emergently at four institutions from October 1997 through October 2000. In each case, the number of insertion and intubation attempts was recorded. Success rates for blind and fiberoptically guided intubation through the LMA-Fastrach^TM were calculated, up to a maximum of five attempts per patient. Results: The LMA-Fastrach^TM was used in 257 procedures performed in 254 patients with DA, including patients with Cormack-Lehane grade 4 views; patients with immobilized cervical spines; patients with airways distorted by tumors, surgery, or radiation therapy; and patients wearing stereotactic frames. Insertion insertion of the LMA-Fastrach^TM was accomplished in three attempts or fewer in all patients. The overall success rates for blind and fiberoptically guided intubations through the LMA-Fastrach^TM were 96.5% and 100.0%, respectively. Conclusions: The LMA-Fastrach^TM was used successfully in a high percentage of patients who presented with a variety of DA. The clinical experience presented herein indicates that this device may be particularly useful in the emergency and elective treatment of patients in whom intubation with a rigid laryngoscope has failed and in the treatment of patients with immobilized cervical spines.