Case Reports *Professor of Anesthesia Address correspondence to Dr. Brock-Utne at the Department of Anesthesia, Room H3580, Stanford University School of Medi- cine, Stanford, CA 94305-5640, USA. E-mail: brockutn@stanford.edu Received for publication April 8, 2002; re- vised manuscript accepted for publication April 9, 2002. A Modification of the Yodfat Laryngeal Mask Airway Insertion Technique Richard A. Jaffe, MD, PhD,* John G. Brock-Utne, MD, PhD* Department of Anesthesia, Stanford University School of Medicine, Stanford, CA We present here a case of a common problem for the anesthesiologist, i.e., difficulty in placing a Laryngeal Mask Airway (LMA). One solution is the use of the Yodfat technique to facilitate placement of the LMA. © 2002 by Elsevier Science Inc. Keywords: Airway management; Laryngeal Mask Airway; Yodfat technique. Case Report A 45-year-old ASA physical status I female, with Mallampati class 2 airway presented for a cytoscopy with random biopsies of the bladder. She was 160 cm in height and weighed 75 kg. Although she had a history of hematuria, she was otherwise asymptomatic. She was not taking any medication, and she had had no previous hospital admissions. General anesthesia was induced with propofol 150 mg. Placement of the Laryngeal Mask Airway (LMA) with the Brain technique proved difficult because the LMA would not pass the junction with the posterior pharynx. After a few attempts, including rotating the device 180 degrees, the LMA was withdrawn and the patient was ventilated gently with isoflurane 1% to 2% in oxygen (O 2 ). What now follows is our modification of the Yodfat technique. 1 We advocate this technique for both difficult and routine placement of the LMA. A conventional endotracheal tube stylet, i.e., Slick®# Stylette (Polamedco, Marina Del Rey, CA), is folded in half (Figure 1A), shortening it to a length of approximately 22 cm. The stylet is lubricated and inserted into a standard LMA (Figure 1B). Care must be taken to ensure that the tips of the stylet do not protrude beyond the aperture bars. The LMA with the stylet is then bent nearly 90 degrees close to the junction of the airway tube and mask (Figure 1C). The LMA is lubricated in the conventional manner and held by the airway tube (Figure 2). The LMA cuff is partially inflated and the tip is curled anteriorly. The patient’s mouth is opened by grasping the mandible with the nondominant hand while the LMA is inserted in a manner that effectively mimics the force vectors used in the Brain technique: the tip is placed against the hard palate and advanced using continuous pressure, rotating the LMA so that the mask follows the curvature of the airway into its final position in the pharynx. The strongly curved stylet serves as a functional replacement for the anesthesiologist’s finger, which can be kept safely outside the patient’s mouth. The stylet is removed by Journal of Clinical Anesthesia 14:462– 463, 2002 © 2002 Elsevier Science Inc. All rights reserved. 0952-8180/02/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0952-8180(02)00378-1