European Journal of Anaesthesiology 2000, 17, 46–49 Use of an illuminated flexible catheter for light- guided tracheal intubation through the intubating laryngeal mask by nurses V. Dimitriou and G. S. Voyagis Departments of Anaesthesiology, ‘G. Gennimatas’ and ‘Sotiria’ Hospitals, Athens, Greece inserted. When an adequate airway was established, Summary patients received atracurium and the endotracheal We evaluated the ability of inexperienced personnel tube preloaded with the device was inserted through in using a prototype illuminated flexible catheter to the intubating laryngeal mask and by observing the assist tracheal intubation through the intubating laryn- glow in the neck was advanced into the trachea. The geal mask in anaesthetised, paralysed patients. The final outcome and the duration of the procedure were device consists of a completely flexible thin plastic recorded. The intubating laryngeal mask was inserted catheter, a bulb attached to its distal end and a 15-mm successfully in all patients. The success rate of in- concentric adapter at its proximal end. The illuminated tubation was 57/60 (95%); 38 patients at first attempt catheter is placed into a straight silicone tracheal tube and 19 after two or three attempts. The mean (±SD) duration of the procedure in the first five patients in in such a way that the bulb is placed at the distal the series of each nurse was 74±40 s while in the last end of the tracheal tube. Six nurses inexperienced in five patients it was diminished to 52±23 s (P=0.01). tracheal intubation followed a 2-hr training program We conclude that the described methodology has the by using the device through the intubating laryngeal potential for more widespread use of tracheal in- mask in a mannequin and then intubated 10 patients tubation through the intubating laryngeal mask even each, with instruction from an anaesthetist. All patients by inexperienced personnel. (n=60) were ASA 1–2, scheduled to undergo general anaesthesia for elective surgery. After fentanyl/pro- Keywords:  ; intubation tracheal; tech- nique; training pofol induction the intubating laryngeal mask was Introduction skill for inexperienced personnel to acquire and may occasionally be impossible [3]. It has been dem- It has been suggested that the standard laryngeal onstrated that unskilled personnel succeed proper mask airway (LMA) is included in the curriculum of placement of LMA more rapidly and reliably than any airway management training program and that tracheal intubation under direct laryngoscopy [3–5]. all non-anaesthetic personnel involved in airway man- The intubating laryngeal mask (ILM) is a modi- agement should receive some training in LMA fication of the standard LMA which is designed to act usage [1]. A prototype LMA was first used in emer- as a ventilatory device and an aid for blind tracheal gency medicine by a nurse in 1983 [2]. The advantage intubation in patients with normal or abnormal of the LMA is that it is relatively easy to insert. How- airways [6]. However, the tracheal intubation through ever, tracheal intubation is the most suitable method the ILM is a blind-on-blind’ technique, since both the of securing the airway in the emergency medicine ILM and the endotracheal tube (ETT) are inserted setting, but the use of laryngoscopes is not a simple without direct vision of the larynx [7]. Reports in the literature suggest that transillumination of the soft Accepted September 1999 tissues of the neck using a light wand or a lighted Correspondence: V. Dimitriou, 9, Chrisippou Str., GR-11631 Athens, Greece. stylet could provide physicians and paramedics with 46  2000 European Academy of Anaesthesiology