title: Awake insertion of a Laryngeal Mask Airway-Proseal™ as alternative to awake fiberoptic intubation in management of anticipated difficult airway in ambulatory surgery.
abstract: OBJECTIVE
  The decision whether to manage an ambulatory patient with a previously documented difficult airway with a supraglottic device remain controversial. We report an awake insertion of a Laryngeal Mask Airway Proseal™ in a patient with known difficult airway scheduled for ambulatory surgery.
  
  
  METHODS
  A 46-yr-old woman was programmed as a day case surgery for breast nodule resection. Her anesthetic record included an impossible intubation with cancelation of surgery and subsequent awake fibroscopic intubation. She reported emotional distress with the previous experience and declined this approach. In view of the previous experience, an awake airway control with a Laryngeal Mask Airway Proseal™ was planned after explaining and reassuring the patient. After adequate topicalisation, a size 4 Laryngeal Mask Airway Proseal™ was successfully inserted after two attempts, and their patency was confirmed by capnography. Anesthesia was induced intravenously and the surgery was uneventful.
  
  
  CONCLUSIONS
  We describe a feasible alternative strategy to awake intubation in a patient with known difficult airway undergoing ambulatory surgery. In this specific clinical situation, if tracheal intubation is deemed unnecessary, awake supraglottic airway might allow adequate ventilation and their use should be considered.
authors: Department of Anesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain. Electronic address: mati@plagaro.net.
authors: Matilde
authors: M
authors: Zaballos
authors: Department of Anesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors: María Dolores
authors: MD
authors: Ginel
authors: Department of Anesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors: Maite
authors: M
authors: Portas
authors: Department of Anesthesiology, Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors: María
authors: M
authors: Barrio
authors: Department of Anesthesiology, Hospital Clinic, Barcelona, Spain.
authors: Ana María
authors: AM
authors: López
mesh_terms: D058109:Airway Management / Q000379:methods*; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D008875:Middle Aged
keywords: Ambulatory surgery; Difficult airway; Laryngeal Mask Airway; Máscaras Laríngeas; Procedimentos Cirúrgicos Ambulatoriais; Vias aéreas difícil