ROLE OF THE LARYNGEAL MASK AIRWAY IN THE IMMOBILE CERVICAL-SPINE

Study Objective: To determine whether the laryngeal mask airway has a useful role in the airway management of patients whose cervical spines are immobilized in a rigid cervical collar. Design: A randomized stud y comparing the difficulty, rapidity, and success rate Of ventilating patients with immobilized cervical spines using a laryngeal mask airwa y and an endotracheal tube. Setting: Medical center surgical unit. Pat ients: Twenty-eight ASA physical status I and II women scheduled to un dergo elective gynecologic surgery requiring general anesthesia. Inter ventions: Tracheas of all anesthetized patients were sequentially intu bated with an endotracheal tube and had a laryngeal mask inserted in r andom order. Measurements and Main Results: Mouth opening was measured , and a Mallampati classification was made in each subject both with a nd without a rigid Philadelphia collar in situ. The view at laryngosco py was recorded. The time taken to insert both devices to allow for sa tisfactory ventilation and the degree of difficulty encountered were d etermined. With a cervical collar in situ, mouth opening was reduced u p to 60%. The Mallampati assessment and laryngoscopic view were shifte d to one suggestive of a more difficult intubation. The time taken to ventilate these patients and the difficulties encountered were signifi cantly less when using the laryngeal mask (p = 0.0001). A successful o utcome was more likely following insertion of the laryngeal mask than when attempting intubation with an endotracheal tube. Conclusions: The laryngeal mask airway compared favorably with an endotracheal tube in success rate, difficulty of insertion, and time to position correctly in this patient population. Although the laryngeal mask does not reli ably protect against aspiration, we believe it may play a useful role if more conventional methods of airway management fail. Further studie s in the trauma scenario are indicated.