Continuous ventilation technique for laryngeal mask airway (LMA™) removal after fiberoptic intubation in children

Background: Fiberoptic tracheal intubation through the laryngeal mask airway (LMA(TM)) is a simple technique to establish a safe airway in neonates and infants with a difficult airway. The technique, however, is complicated by the removal of the laryngeal mask from the patient's mouth because of the similarity in length of the LMA and the tracheal tube. Methods: Several solutions have been presented to stabilize the tracheal tube within the trachea during withdrawal of the LMA. With all these techniques ventilation of the patient is interrupted. Results: We present a modified technique, using a double tube assembly, which allows uninterrupted ventilation of the patient during withdrawal of the LMA from the patient's mouth. Conclusions: The technique is simple and safe, can be performed without hurry and carries potential advantages for neonates and children with limited cardiorespiratory reserve.