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Using the Intubating Laryngeal Mask Airway for Ventilation and Endotracheal Intubation in Anesthetized and Unparalyzed Acromegalic Patients

Law-Koune, Jean-Dominique MD; Liu, Ngai MD; Szekely, Barbara MD; Fischler, Marc MD

Journal of Neurosurgical Anesthesiology: January 2004 - Volume 16 - Issue 1 - p 11-13
Clinical Report
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Airway management may be difficult in acromegalic patients. The purpose of the study was to evaluate the intubating laryngeal mask airway (ILMA) as a primary tool for ventilation and intubation in acromegalic patients. Twenty-three consenting consecutive adult acromegalic patients presenting for transsphenoidal resection of pituitary adenoma were enrolled in the study. Anesthesia was induced using propofol (1.5 mg/kg followed by 0.5-mg/kg increments); the ILMA was inserted when the bispectral index fell below 50. The ILMA was successful as a primary airway for oxygenation and ventilation at the first attempt for 21 (91%) patients, while 2 (9%) patients required a second attempt. Patient movement was noticed in five (21.7%) of the patients during ILMA insertion. An attempt at tracheal intubation through the ILMA was performed following administration of a mean 395 ± 168-mg dose of propofol. Overall success rates for tracheal intubation were 82% (19 patients). The first-attempt success rate for tracheal intubation was 52.6% (10 patients), second- and third-attempt success rates were 42.1% (8 patients) and 5.3% (1 patient), respectively. Coughing or movement during intubation was observed in 12 (63.2%) of the patients. Direct laryngoscopy permitted intubation in three cases and blind intubation using a bougie in the fourth case. ILMA can be used as a primary airway for oxygenation in acromegalic patients (manual bag ventilation), but the rate of failed blind intubation through the ILMA precludes its use as a first choice for elective airway management.

From the Department of Anesthesiology, Hôpital Foch, Université Paris-Ouest, Suresnes, France.

Received for publication March 10, 2003; accepted June 23, 2003.

Reprints: M. Fischler, Service d'Anesthésie, Hôpital Foch, 40 rue Worth, 92151 Suresnes, France (E-mail: fischler@hopital-foch.org).

© 2004 Lippincott Williams & Wilkins, Inc.