Top

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-11-2010 | Review Article/Brief Review

Brief review: Airway rescue with insertion of laryngeal mask airway devices with patients in the prone position

Authors: Amir Abrishami, MD, Paul Zilberman, MD, Frances Chung, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 11/2010

Abstract

Purpose

Unintentional extubation of the trachea while the anesthetized patient is in the prone position is a potentially life-threatening situation that is usually managed by turning the patient supine for emergent re-intubation. However, this approach may delay definitive airway management and lead to irreversible complications. This review evaluates the efficacy of insertion of a laryngeal mask airway device (LMAD) with the patient in the prone position as a rescue method in airway management for unintentional tracheal extubation.

Principal findings

We searched MEDLINE and EMBASE databases in the English language for the period 1980 to October 2009 in order to identify observational studies and case reports describing insertion of the LMAD with the patient in the prone position. We found 12 such articles (n = 526 patients) consisting of four retrospective studies, one prospective cohort with a control group, one non-controlled prospective study, and six case reports. On the first attempt, the LMAD was inserted successfully in 87.5-100% of the patients involved in the included reports. On the second attempt, the LMAD was inserted successfully in all patients, with or without laryngoscopy. Ventilation was maintained successfully in the lungs of 83.3-100% of the patients involved in the reported articles. Following insertion of the LMAD with patients in the prone position, the most common complications reported were sore throat, bleeding, bradycardia, and laryngospasm.

Conclusions

Cumulative experience from published reports suggests the feasibility of placing the LMAD with the patient in the prone position in the elective setting; however, the evidence is lacking regarding the use of this method for emergency management of unintended tracheal extubation with the patient in the prone position.

Ng A, Raitt DG, Smith G. Induction of anesthesia and insertion of a laryngeal mask airway in the prone position for minor surgery. Anesth Analg 2002; 94: 1194-8.CrossRefPubMed

Weksler N, Klein M, Rozentsveig V, et al. Laryngeal mask in prone position: pure exhibitionism or a valid technique. Minerva Anestesiol 2007; 73: 33-7.PubMed

Raphael J, Rosenthal-Ganon T, Gozal Y. Emergency airway management with a laryngeal mask airway in a patient placed in the prone position. J Clin Anesth 2004; 16: 560-1.CrossRefPubMed

Ngan Kee WD. Anaesthesia 1992; 47: 446-7. Laryngeal mask airway for radiotherapy in the prone position

Asai T, Shingu K. Airway management of a patient with tracheal stenosis for surgery in the prone position. Can J Anesth 2004; 51: 733-6.CrossRefPubMed

Brimacombe JR, Wenzel V, Keller C. The proseal laryngeal mask airway in prone patients: a retrospective audit of 245 patients. Anaesth Intensive Care 2007; 35: 222-5.PubMed

Bahk JH. Insertion of a laryngeal mask airway in the prone position. Anesth Analg 2003; 96: 1241.CrossRefPubMed

Osborn IP, Cohen J, Soper RJ, Roth LA. Laryngeal mask airway–a novel method of airway protection during ERCP: comparison with endotracheal intubation. Gastrointest Endosc 2002; 56: 122-8.CrossRefPubMed

McCaughey W, Bhanumurthy S. Laryngeal mask placement in the prone position. Anaesthesia 1993; 48: 1104-5.CrossRefPubMed

10.

Brimacombe J, Keller C. An unusual case of airway rescue in the prone position with the ProSeal laryngeal mask airway. Can J Anesth 2005; 52: 884.CrossRefPubMed

11.

Agrawal S, Sharma JP, Jindal P, Sharma UC, Rajan M. Airway management in prone position with an intubating laryngeal mask airway. J Clin Anesth 2007; 19: 293-5.CrossRefPubMed

12.

Stevens WC, Mehta PD. Use of the laryngeal mask airway in patients positioned prone for short surgical cases in an ambulatory surgery unit in the United States. J Clin Anesth 2008; 20: 487-8.CrossRefPubMed

13.

Dingeman RS, Goumnerova LC, Goobie SM. The use of a laryngeal mask airway for emergent airway management in a prone child. Anesth Analg 2005; 100: 670-1.CrossRefPubMed

14.

Nathanson MH, Gajraj NM, Newson CD. Tracheal intubation in a manikin: comparison of supine and left lateral positions. Br J Anaesth 1994; 73: 690-1.CrossRefPubMed

15.

Hung MH, Fan SZ, Lin CP, Hsu YC, Shih PY, Lee TS. Emergency airway management with fiberoptic intubation in the prone position with a fixed flexed neck. Anesth Analg 2008; 107: 1704-6.CrossRefPubMed

16.

Kramer DC, Lo JC, Gilad R, Jenkins A 3rd. Fiberoptic scope as a rescue device in an anesthetized patient in the prone position. Anesth Analg 2007; 105: 890.CrossRefPubMed

17.

Benumof JL. Laryngeal mask airway and the ASA difficult airway algorithm. Anesthesiology 1996; 84: 686-99.CrossRefPubMed

18.

Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth 2008; 100: 165-83.CrossRefPubMed

19.

Milligan KA. Laryngeal maks in the prone position. Anaesthesia 1994; 49: 449.CrossRefPubMed

20.

Valero R, Serrano S, Adalia R. Anesthetic management of a patient in prone position with a drill bit penetrating the spinal canal at C1–C2, using a laryngeal mask. Anesth Analg 2004; 98: 1447-50.CrossRefPubMed

Title: Brief review: Airway rescue with insertion of laryngeal mask airway devices with patients in the prone position
Authors: Amir Abrishami, MD
Paul Zilberman, MD
Frances Chung, MD
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 11/2010
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-010-9378-1

At a glance: The STEP trials

Springer Medicine

Brief review: Airway rescue with insertion of laryngeal mask airway devices with patients in the prone position

Abstract

Purpose

Principal findings

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Principal findings

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2010

Hemodynamic rounds: Ascending aortic dissection as a mechanism of hemodynamic instability

Continuous local anesthetic infusion through ultrasound-guided rectus sheath catheters

Review article: Renal support in critical illness

Review article: Acute kidney injury in critical illness

Ultrasound simulation of internal jugular vein cannulation in pregnant and non-pregnant women

2010 Guidelines and international standards to the practice of anesthesia