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Aura-iTM laryngeal mask as a conduit for elective fibreoptic intubation
Article first published online: 12 OCT 2010
DOI: 10.1111/j.1365-2044.2010.06528.x
Anaesthesia © 2010 The Association of Anaesthetists of Great Britain and Ireland
Additional Information
How to Cite
McAleavey, F. and Michalek, P. (2010), Aura-iTM laryngeal mask as a conduit for elective fibreoptic intubation. Anaesthesia, 65: 1151. doi: 10.1111/j.1365-2044.2010.06528.x
Publication History
- Issue published online: 12 OCT 2010
- Article first published online: 12 OCT 2010
- Abstract
- Article
- References
- Cited By
The supraglottic airway’s usefulness as a dedicated airway has been the subject of considerable interest and is the subject of continuing development [1, 2]. Supraglottic airways have been used to facilitate tracheal intubation in situations where difficulty with conventional laryngoscopy has been predicted [3, 4].
We wish to report the use of a new disposable supraglottic airway, the Ambu Aura-iTM disposable intubating laryngeal mask (Ambu A/S, Ballerup, Denmark), as a conduit for fibreoptic tracheal intubation in a patient with predicted difficulty in airway management. We could find no similar reports in the English language.
The patient was a 42-year-old, 65-kg woman, ASA 1, scheduled to undergo elective breast surgery. She gave a history of trauma to her neck and jaw some years previously. On examination, we found her airway to be a Mallampati class 2, with mouth opening of approximately 3.5 cm and grade B jaw protrusion. She exhibited restricted craniocervical extension. Because of her slim build, we did not anticipate difficulty with mask ventilation. She was extremely anxious, and following discussion, we decided to proceed with fibreoptic intubation following induction of general anaesthesia.
The patient was premedicated with 10 mg temazepam. Anaesthesia was induced with 75 μg fentanyl and 150 mg propofol. Following confirmation of the ability to ventilate the patient’s lungs using a bag and facemask, we administered 40 mg atracurium. We subsequently confirmed loss of train-of-four response with a peripheral nerve stimulator. We then inserted a size-4 Ambu Aura-i without difficulty and inflated the cuff with 10 ml air. We achieved satisfactory ventilation after 12 s. We then used the Ambu Aura-i as a conduit to pass a size 7.5-mm tracheal tube (Teleflex Medical Ltd, High Wycombe, UK) into the trachea with the aid of an intubating bronchoscope. We gained a full view of the glottic opening from the end of the device. Satisfactory ventilation was confirmed in 27 s. Anaesthesia and emergence proceeded uneventfully.
The Ambu Aura-i is a newly available disposable supraglottic airway device that may prove useful in the management of the difficult airway. When compared with the commonly used LMA FastrachTM (Intavent Orthofix Ltd., Maidenhead, UK), the Aura-i readily accepts a standard tracheal tube (Fig. 3), but lacks an epiglottic elevating bar, which may be a disadvantage if intubation is attempted blindly, but could improve the camera view from the end of the device. Its disposable nature gives an improved infection control profile and it is significantly cheaper than the reusable device.
Figure 3. Aura-i laryngeal mask size 4 with a standard orotracheal tube size 7.5 mm inserted.
No external funding and no competing interests declared. Published with the patient’s written consent.
References
- 1, . The “dedicated airway”: a review of the concept and an update of current practice. Anaesthesia 1999; 54: 778–86.
- 2, , , . A comparison of the i-gel supraglottic airway as a conduit for tracheal intubation with the intubating laryngeal mask airway: a manikin study. Resuscitation 2010; 81: 74–7.
- 3, , . Fibreoptic intubation through an i-gel supraglottic airway in two patients with predicted difficult airway and intellectual disability. Anesthesia and Analgesia 2008; 106: 1501–4.
- 4, , , et al. Difficult Airway Society guidelines for the management of unanticipated difficult intubation. Anaesthesia 2004; 59: 675–94.