title: Awake insertion of the laryngeal mask airway using topical lidocaine and intravenous remifentanil.
abstract: We assessed the use of intravenous remifentanil for the insertion of the laryngeal mask airway in 10 healthy awake volunteers, a technique primarily developed to facilitate functional magnetic resonance imaging studies of anaesthesia. Each volunteer received 200 microg glycopyrronium intravenously. Topical airway anaesthesia was effected by 4 ml nebulised lidocaine 4%, followed by 12 sprays of lidocaine 10%. Remifentanil was subsequently infused to achieve an initial target effect-site concentration of 2 ng.ml(-1); increments of 1 ng.ml(-1) were allowed with the maximum effect-site concentration limited to 6 ng.ml(-1). Insertion of the laryngeal mask airway was successful on the first attempt in all cases. The median (IQR [range]) target effect-site remifentanil concentration at insertion was 2.5 (2-3 [2-4]) ng.ml(-1). All volunteers were co-operative during the procedure and only one reported discomfort. Sore throat was a complication in all volunteers. We conclude that the technique allows successful insertion of the laryngeal mask airway in healthy awake volunteers under conditions that were safe and reproducible.
authors.affiliation: University Department of Anaesthesia, Addenbrooke's NHS Trust, Cambridge, UK. ml404@cam.ac.uk
authors.forename: M C
authors.initials: MC
authors.lastname: Lee
authors.forename: A R
authors.initials: AR
authors.lastname: Absalom
authors.forename: D K
authors.initials: DK
authors.lastname: Menon
authors.forename: H L
authors.initials: HL
authors.lastname: Smith
mesh_terms: D000328:Adult; D000771:Anesthesia, Intravenous / Q000379:methods; D000772:Anesthesia, Local / Q000379:methods; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D001364:Awareness; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D017214:Laryngeal Masks / Q000009:adverse effects; D008012:Lidocaine; D008279:Magnetic Resonance Imaging; D008297:Male; D017060:Patient Satisfaction; D010880:Piperidines; D000077208:Remifentanil
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010880:Piperidines; D008012:Lidocaine; D000077208:Remifentanil