Comparison of the intubating laryngeal mask airway with the fiberoptic intubation in anticipated difficult airway management

Background: The intubating laryngeal mask airway (ILMA; Fastrach (TM); Lary ngeal Mask Company, Henley-on-Thames, UK) may provide an alternative techni que to fiberoptic intubation (FIB) to facilitate the management of the anti cipated difficult airway. The authors therefore compared the effectiveness of the ILMA with FIB in patients with anticipated difficult intubation, Methods: One hundred patients, with at least one difficult intubation crite ria (Mallampati class III or IV, thyromental distance < 65 mm, interincisor distance < 35 mm) were enrolled (FIB group, n = 49; ILMA group, n = 51) in this prospective randomized study, Anesthesia was induced with propofol an d maintained with alfentanil and propofol after an efficient mask ventilati on has been demonstrated. The success of the technique (within three attemp ts), the number of attempts, duration of the successful attempt, and advers e events (oxygen saturation < 90%, bleeding) were recorded. Results: The rate of successful tracheal intubation with ILMA. was 94% and comparable with FIB (92%). The number of attempts and the time to succeed m ere not significantly different between groups. In case of failure of the f irst technique, the alternative technique always succeeded. Failures in FIB group were related to oxygen desaturation (oxygen saturation < 90%) and bl eeding, and to previous cervical radiotherapy in the ILMA group. Adverse ev ents occurred significantly more frequently in FIB group than in ILMA group (18 vs. 0%, P < 0.05), Conclusion: The authors obtained a high success rate and comparable duratio n of tracheal intubation with ILMA and FIB techniques, In patients with pre vious cervical radiotherapy, the use of ILMA cannot be recommended. Neverth eless, the use of the ILMA was associated with fewer adverse events.