Use of an illuminated flexible catheter for light-guided tracheal intubation through the intubating laryngeal mask by nurses

We evaluated the ability of inexperienced personnel in using a prototype il luminated flexible catheter to assist tracheal intubation through the intub ating laryngeal mask in anaesthetised, paralysed patients. The device consi sts of a completely flexible thin plastic catheter, a bulb attached to its distal end and a 15-mm concentric adapter at its proximal end. The illumina ted catheter is placed into a straight silicone tracheal tube in such a way that the bulb is placed at the distal end of the tracheal tube. Six nurses inexperienced in tracheal intubation followed a 2-hr training program by u sing the device through the intubating laryngeal mask in a mannequin and th en intubated 10 patients each, with instruction from an anaesthetist. All p atients (n = 60) were ASA 1-2, scheduled to undergo general anaesthesia for elective surgery. After fentanyl/propofol induction the intubating larynge al mask was inserted. When an adequate airway was established, patients rec eived atracurium and the endotracheal tube preloaded with the device was in serted through the intubating laryngeal mask and by observing the glow in t he neck was advanced into the trachea. The final outcome and the duration o f the procedure were recorded. The intubating laryngeal mask was inserted s uccessfully in all patients. The success rate of intubation was 57/60 (95%) ; 38 patients at first attempt and 19 after two or three attempts. The mean (+/- SD) duration of the procedure in the first five patients in the serie s of each nurse was 74 +/- 40 s while in the last five patients it was dimi nished to 52 +/- 23 s (P=0.01). We conclude that the described methodology has the potential for more widespread use of tracheal intubation through th e intubating laryngeal mask even by inexperienced personnel.