title: Using the intubating laryngeal mask airway for ventilation and endotracheal intubation in anesthetized and unparalyzed acromegalic patients.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Hôpital Foch, Université Paris-Ouest, Suresnes, France.
authors.forename: Jean-Dominique
authors.initials: JD
authors.lastname: Law-Koune
authors.forename: Ngai
authors.initials: N
authors.lastname: Liu
authors.forename: Barbara
authors.initials: B
authors.lastname: Szekely
authors.forename: Marc
authors.initials: M
authors.lastname: Fischler
mesh_terms: D000172:Acromegaly / Q000601:surgery*; D000758:Anesthesia; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data; D017214:Laryngeal Masks / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000187:drug effects / Q000502:physiology; D010911:Pituitary Neoplasms / Q000601:surgery; D015175:Prolactinoma / Q000601:surgery; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol