The intubating laryngeal mask airway does not facilitate tracheal intubation in the presence of a neck collar in simulated trauma |
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Authors: | Wakeling H G Nightingale J |
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Institution: | Anaesthetic Department, Queen Alexandra Hospital, Cosham, Portsmouth, UK. |
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Abstract: | Tracheal intubation must be performed with great care in the multiply
injured patient when it must be assumed that the cervical spine may be
damaged. Use of conventional direct laryngoscopy usually requires removal
of the neck collar and manual in-line stabilization of the head and neck.
The intubating laryngeal mask (ILMA) has been designed to facilitate
tracheal intubation in the neutral position. We used the ILMA to intubate
the trachea in 10 patients wearing a neck collar and with cricoid pressure
applied in a simulated trauma scenario. The ILMA was difficult to insert
and ventilation proved difficult. In only two patients was intubation
successful. These problems were probably caused by the neck collar strap
under the chin lifting up and tipping the larynx anteriorly. On the basis
of these findings, ILMA use in a subject wearing a neck collar cannot be
recommended.
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