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Continuous Patient Oxygenation During Endotracheal Intubation Through the LMA-FastrackTM

Goto, Hiroshi, MD; McKeag, Burt J., MD

doi: 10.1097/00000539-200203000-00063
Letters To The Editor: Letters & Announcements
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Department of Anesthesiology

University of Kansas Medical Center

Kansas City, KS

To the Editor:

The use of LMA-Fastrack™ (The Laryngeal Mask Company, Limited, San Diego, CA) has become a popular method to intubate patients when endotracheal intubation is otherwise difficult or impossible. The maneuvers for using the LMA-Fastrack™ to guide and insert an endotracheal tube into the trachea and to remove the LMA-Fastrack™ after endotracheal intubation are well documented in the “LMA-Fastrack™ Instruction Manual” by Brain and Verghese (1). It states, “Because the LMA-Fastrack™ can be used as an airway device in its own right, ventilatory control and patient oxygenation may be continuous during intubation attempts, lessening the likelihood of desaturation.” However, compromised patients may become desaturated during insertion of a wire-reinforced endotracheal tube through the shaft of the LMA-Fastrack™ and during removal of the LMA-Fastrack™ after successful endotracheal intubation.

During intubation attempts using the LMA-Fastrack™ without fiberoptic assistance, the wire-reinforced endotracheal tube can be connected to the anesthesia breathing circuit so that the patient can get apneic oxygenation or the lungs can be ventilated. When using a fiberoptic bronchoscope to guide the wire-reinforced tube into the trachea through the LMA-Fastrack™, a self-sealing connector with a side arm can permit continuous ventilation, as stated in the manual. The period of removal of the LMA-Fastrack™ after the trachea has been intubated is a critical period for oxygenation. The manual advises using an endotracheal tube stabilizer rod to keep the endotracheal tube in place when removing the LMA-Fastrack™. During this maneuver, patients cannot be ventilated or receive oxygen. By inserting the tip of a noncuffed endotracheal tube (6–7.5 mm) into the top end of the wire-reinforced endotracheal tube (instead of the stabilizing rod), the patient can be ventilated during removal of the LMA-Fastrack™ (Figs. 1 and 2).

Figure 1

Figure 1

Figure 2

Figure 2

At the same time, one can avoid the possibility of dislodging the endotracheal tube from the trachea and losing it in the patient’s mouth because the two tubes are tightly connected. A problem occurs when disconnecting the non-cuffed tube from the wire-reinforced endotracheal tube (Fig. 2). The disconnection is best performed by a second person because the person intubating must hold the wire-reinforced endotracheal tube tightly to prevent inadvertent extubation.

Hiroshi Goto, MD

Burt J. McKeag, MD

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Reference

1. Brain AIJ, Verghese C. LMA-Fastrack™ instruction manual. San Diego, Laryngeal Mask Company, 1998.
© 2002 International Anesthesia Research Society