Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.03.007
Brazilian Journal of Anesthesiology
Clinical Informations

Awake insertion of a Laryngeal Mask Airway-Proseal™ as alternative to awake fiberoptic intubation in management of anticipated difficult airway in ambulatory surgery

Inserção de máscara laríngea ProSeal™ em paciente acordado como opção para intubação por meio de fibra óptica para o manejo de via aérea difícil prevista em cirurgia ambulatorial

Matilde Zaballos; María Dolores Ginel; Maite Portas; María Barrio; Ana María López

http://dx.doi.org/10.1016/j.bjane.2014.03.007 Braz J Anesthesiol, vol.66, n5, p.539-542, 2016
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Abstract

Abstract Background and objectives 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. Case report 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. Conclusion 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.

Keywords

Difficult airway, Ambulatory surgery, Laryngeal Mask Airway

Resumo

Resumo Justificativa e objetivo A decisão quanto ao manejo de paciente ambulatorial com via aérea difícil previamente diagnosticada com o uso de dispositivo supraglótico permanece controversa. Relatamos o caso de inserção de máscara laríngea ProSeal™ em paciente acordado, com via aérea difícil prevista, agendado para cirurgia ambulatorial. Relato de caso Paciente do sexo feminino, 46 anos, programada para cirurgia de ressecção de nódulo de mama com alta hospitalar no mesmo dia. A história anestésica incluía uma intubação impossível, com o cancelamento da cirurgia e posterior intubação com o uso de fibroscópio, com a paciente acordada. A paciente relatou que ficou emocionalmente abalada com a experiência anterior e recusou essa abordagem. Considerando essa experiência anterior, uma abordagem das vias aéreas com a paciente acordada e o uso de uma máscara laríngea ProSeal™ foi planejada, após se explicar o procedimento para a paciente e tranquilizá-la. Após topicalização adequada, uma máscara laríngea (LMA ProSeal™) de tamanho 4 foi inserida com sucesso depois de duas tentativas e a permeabilidade foi confirmada por capnografia. A anestesia foi induzida por via intravenosa e a cirurgia foi feita sem intercorrências. Conclusão Descrevemos uma estratégia opcional viável para a intubação em uma paciente acordada com via aérea difícil previamente diagnosticada submetida a cirurgia ambulatorial. Nessa situação clínica específica, quando a intubação traqueal é considerada desnecessária, a via aérea supraglótica em paciente acordado pode permitir uma ventilação adequada e seu uso deve ser considerado.

Palavras-chave

Vias aéreas difícil, Procedimentos Cirúrgicos Ambulatoriais, Máscaras Laríngeas

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