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GENERAL ARTICLES

The Use of the Laryngeal Mask Airway During Guidewire Dilating Forceps Tracheostomy

Davide Cattano, MD^*, Steven Abramson, MD, Stefano Buzzigoli, MD, Candido Zoppi, MD, Ettore Melai, MD^*, Francesco Giunta, MD^*, and Carin Hagberg, MD

From the *Department of Surgery, Division of Anesthesiology and Intensive Care, University of Pisa, Pisa, Italy; Department of Intensive Care, Anaesthesia and Analgesia, Versilia Hospital, Lidodi Camaiore, Italy; and Department of Anesthesiology, The University of Texas Medical School, Houston, Texas.

Address correspondence and reprint requests to Carin A. Hagberg, MD, Professor, Department of Anesthesiology, The University of Texas Medical School at Houston, 6431 Fannin, MSB 5.020, Houston, TX 77030. Address e-mail to carin.a.hagberg{at}uth.tmc.edu.

Percutaneous tracheostomy has become a common alternative to the classical open tracheostomy because of its convenience, cost effectiveness, and decreased complication rates. We retrospectively reviewed our intensive care practice using a guidewire dilatating forceps percutaneous tracheostomy technique with an endotracheal tube, as compared with the Classic Laryngeal Mask Airway (LMA) for these procedures. From 1998 to 2004, 274 patients underwent a tracheostomy procedure. Two-hundred-fifty-four (92.7%) of these patients underwent a guidewire dilatating forceps tracheostomy and 20 (7.3%) underwent a surgical tracheostomy. In the guidewire dilatating forceps group, 188 (74%) were performed by endoscopy via LMA-guided bronchoscopy, and 66 (26%) were performed through an endotracheal tube. Endoscopic views obtained via the LMA were subjectively better than those obtained with the endotracheal tube. Acute complications were significantly more frequent when using an endotracheal tube as compared with the LMA (6 of 66 versus 4 of 188; P = 0.022 Fisher's exact test, odds ratio = 4.6). There was a significant difference in terms of acute (10 of 254 versus 6 of 20; P < 0.001, odds ratio = 10.5) and chronic (0 of 254 versus 4 of 20; P < 0.001) complications between the 2 groups. There were no ventilatory complications or reports of gastric aspiration. The LMA provides a safe and effective alternative to an endotracheal tube for airway management during guidewire dilatating forceps tracheostomies in selected patients.

This article has been cited by other articles:

				C. A. Hagberg and D. Cattano The Laryngeal Mask Airway for Airway Management During Percutaneous Tracheostomy: Everything Should Be Made as Simple as Possible but Not Simpler Anesth. Analg., March 1, 2007; 104(3): 744 - 745. [Full Text] [PDF]

				M. Beiderlinden and M. Eikermann The Laryngeal Mask Airway for Airway Management During Percutaneous Tracheostomy: Everything Should Be Made as Simple as Possible but Not Simpler Anesth. Analg., March 1, 2007; 104(3): 743 - 744. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999