oa Facilitated LMA fiberoptic intubation while keeping on ventilation in ischemic heart patient with unexpected difficult airway

Facilitated LMA fiberoptic intubation while keeping on ventilation in ischemic heart patient with unexpected difficult airway Authors: Mahmoud Abdalla MD. Hesham Ewila,MD. Hany Osman, MD. Abdulrashed Pattah MD. Institution: HMC, heart hospital, DOHA QATAR Difficult tracheal intubation remains an important cause of mortality and morbidity during general anesthesia, especially in ischemic cardiac patients where hypoxia rapidly compromise myocardial function and may induce dysrrhythmias. We report 68 years old male was admitted to Qatar heart center for elective CABG with poor left ventricular function EF 30 -35 % .No signs of difficult intubation were appreciated preoperatively. Intraoperatively LMA was inserted due to unexpected difficult airway after failing of 3 optimized trials of intubation. Endotracheal fiberoptic intubation through LMA also failed as patient rapidly desaturated. We attached T piece to the distal end of LMA, keeping patient ventilated through the side port of T piece, fiberoptic intubation achieved through pre cut plastic venous cap 0.5 inch which was attached to distal end of LMA. Endotracheal tube with ID 6.5 mm was inserted over the fiberscope then exchanged over a ventilating bougie to 8.5 mm tube. No significant changes in heart rate, blood pressure or oxygen saturation were appreciated throughout the procedure time. This maneuver allowed us to secure the airway while keeping on ventilation without compromising the poorly reserved cardiac function or exposing the patient to hypoxia or hypercarbia. Key Words: fiberoptic bronchoscope, unexpected difficult intubation, laryngeal mask airway. Ischemic heart disease