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Difficult Airway in Obstetric Using Ilma-Fastrach®

Minville, Vincent MD; N’Guyen, Luc MD; Coustet, Bernard MD; Fourcade, Olivier MD; Samii, Kamran MD

doi: 10.1213/01.ANE.0000137805.40261.06
Letters to the Editor: Letters & Announcements

Departement d’anesthésie et de réanimation; Centre Hospitalo-Universitaire de Toulouse; Toulouse, France;

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To the Editor:

Failed intubation in obstetrics is a rare but life-threatening event. We report a case in which a pregnant patient with an unidentified difficult airway required emergent cesarean delivery for “fetal distress,” necessitating rapid sequence induction of general anesthesia. After preoxygenation and induction of anesthesia, several intubation attempts of the trachea with a Macintosh 4 blade failed. An ILMA-fastrach® was then inserted and intubation was easily performed through the device. Neither the parturient nor the neonate suffered any morbidity or mortality. On the basis of this case, we believe that ILMA-fastrach® may be a useful alternative to the methods which have been previously proposed for management of the failed intubation in obstetrics. Its ease of use does not require new training for anesthesiologists who are experienced with use of the classic LMA, and it is associated with a high success rate of blind intubation while allowing for continuous ventilation between attempts. While our experience suggests that the ILMA may have a place in the initial management of the difficult obstetric airway, further study is necessary to evaluate the potential advantages and disadvantages of this method.

Vincent Minville, MD

Luc N’Guyen, MD

Bernard Coustet, MD

Olivier Fourcade, MD

Kamran Samii, MD

Departement d’anesthésie et de réanimation

Centre Hospitalo-Universitaire de Toulouse

Toulouse, France

© 2004 International Anesthesia Research Society