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LETTERS TO THE EDITOR

Use of a Fiberscope and Closed-Circuit Television for Teaching Laryngeal Mask Insertion

First Department of Anesthesiology Dokkyo University School of Medicine Mibu, Tochigi, 321-0293, Japan Department of Anesthesiology Kansai Medical University Moriguichi City, Osaka, 570-8507, Japan

The laryngeal mask often allows adequate ventilation, even if the mask position is suboptimal. However, it is important to master correct positioning of the mask, because a suboptimally positioned mask is associated with increased risk of complications and with difficulty in intubating the trachea through it (1–3). Fiberscopy after insertion of the laryngeal mask can help assess the mask position and has been reported to be useful for training (4). One problem with this method is that if ventilation through the laryngeal mask has failed, it may be practically difficult to assess the cause of the failure, because fiberscopy after insertion of the mask prolongs apnea time. Therefore, the cause of failed ventilation is often not elucidated. We suggest that after a fiberscope, which is connected to a closed-circuit television, is inserted into the laryngeal mask, the mask is inserted while the fiberoptic view is being shown on the television (Figure 1). This method enables one to see the anatomical course of the mask, in relation to the tongue, epiglottis or glottis during insertion. The cause for airway obstruction, if any, can be detected without prolonging the apnea time.

View larger version (177K): [in this window] [in a new window]   Figure 1. Anatomical course of laryngeal mask insertion can be displayed on a closed-circuit television.

1. Brimacobe J, Berry A. Insertion of the laryngeal mask: a prospective study of four techniques. Anaeth Intensive Care 1993;21:89–92.
2. Asai T. Difficulty in insertion of the laryngeal mask. In: Latto IP, Vaughan RS, eds. Difficulties in tracheal intubation. 2nd ed. Philadelphia:WB Saunders, 1997:177–96.
3. Asai T, Morris S. The laryngeal mask airway: its features, effects and role. Can J Anaesth 1994;41:930–60.[Web of Science][Medline]
4. Asai T, Shingu K. Training method for placement of the laryngeal mask [letter]. Anaesthesia 1999;54:811.

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