BACK GROUND: Supraglottic airway devices have revolutionized anaesthesia practice with their utility as an excellent alternative to mask ventilation and tracheal intubation. In the Intensive Care Unit however, the role of these devices has been limited to being a bridge between securing an emergency airway and achieving definitive airway access, either by endotracheal intubation, or tracheostomy.

CASE REPORT: A 73 year old male, a case of carcinoma buccal mucosa who underwent reconstruction of cheek and oral cavity was found to have respiratory difficulty progressing to unconsciousness in the ward on 14th post-operative day. On evaluation, he was unconscious with a pulse of 132/min, BP of 90/60mmHg, oxygen saturation of 80% with 10L oxygen and a respiratory rate of 35/min. ABG revealed a PaO2 of 51.8 mm Hg, PaCO2 of 144.8 mm Hg, pH of 6.9 and HCO3 of 23.8mEq/L. Due to evidence of hypoventilation patient was mask ventilated. The saturation increased to 90%. Endotracheal intubation was attempted but visualization of glottis was difficult due to its anterior displacement and distorted position. Attempts to pass a gum elastic bougie were unsuccessful. Patientdesaturated to 50% and had bradycardia followed bycardiopulmonary arrest. 0.6mg atropine and 1 mL of 1:1000 adrenaline was given intravenously and he was again taken on bag and face mask and ventilated till saturation improved. There was return of pulse rate to 90/min and BP increased to 90/60mm Hg. In view of this ‘can’t intubate but can ventilate’ situation, ProsealLMA (PLMA) was inserted and ventilation resumed. The patient’s oxygen saturation gradually improved to 100% with adequate chest lift and heart rate settled to 110/min. Patient was immediately shifted to ICU and put on ventilatory support on P-SIMV mode of ventilation. A repeat blood gas analysis revealed a pO2 of 61mmHg, pCO2 of 31.8 mm Hg. On the next morning, patient was put on C-PAP mode through the LMA.

He was very easily being ventilated with the LMA so it was decided to continueventilationwith the LMA. After 36 hours, it was decided to perform a tracheostomy as it was felt that his cough was insufficient for him to clear his secretions. He underwent this procedure uneventfully and was transitioned to long term care.On chart review, it was found that the patient was a difficult intubation on the first surgery for his buccal carcinoma and had required fibreoptic intubation.

CONCLUSION :: LMA is a suitable alternative in patients who require positive pressure ventilation due to altered oxygenation/ ventilation, but are difficult to intubate. In such patients, it forms a bridge until a definite airway can be established.

AUTHOR DETAILS :

[a]- Dr. Anusha.k, Post Graduate, Anaesthesiology, Command Hospital, Air Force, Bangalore-560007

[b]- GpCapt. (Dr.) AdityaSapra, Assistant Professor, Dept. of. Anaesthesiology, Command Hospital, Air Force, Bangalore- 560007

[c]- Col R. Setlur, Professor, HOD, Dept. of Anaesthesiology, Command Hospital, Air Force, Bangalore-7