The Laryngeal Mask Airway: A New Standard for Airway Evaluation in Thoracic Surgery

Background. Thoracic surgeons typically perform fiberoptic bronchoscopy (FOB) before thoracotomy, usually on the day of the operation after intubation with a single-lumen endotracheal tube (ETT) and before insertion of a double-lumen ETT. This routine requires two laryngoscopies and two intubations. The laryngeal mask airway (LMA) is an airway device developed in England and approved by the Food and Drug Administration in 1991 for clinical use in the United States. It requires neither mask ventilation nor laryngoscopy and allows FOB visualization of the epiglottis, larynx, and entire trachea. We assessed the LMA as an alternative to a single-lumen ETT for FOB before thoracotomy. Methods. Through prospective assessment, 50 patients underwent FOB after insertion of an LMA before thoracotomy. Pulse rate, blood pressure, ease of insertion of the LMA, quality of FOB, and complications of LMA insertion were assessed. Results. During LMA insertion, blood pressure and pulse rate increased less than 5% from baseline in all patients. The LMA was inserted successfully in all patients within 10 seconds. No complications occurred as a result of LMA insertion. Conclusions. Insertion of the LMA causes minimal hemodynamic response. From the time of induction of general anesthesia, insertion of the LMA is quick, simple, and safe and eliminates the need for endotracheal intubation with a single-lumen ETT before double-lumen tube insertion. The LMA, in contrast to the ETT, allows a complete survey of the larynx and trachea. The LMA is autoclavable, reusable, and cost effective. Therefore, in patients who require FOB immediately before thoracotomy, LMA use should be the standard for airway evaluation.