Intubating laryngeal mask and rapid sequence induction in patients with cervical spine injury

The Intubating Laryngeal Mask (FastrachTM), a modified conventional laryngeal mask airway, and its prototype cuffed silicone tube, continue to be an appropriate intubating tool in combination with fibreoptic bronchoscopy in the emergency situation. This is an account of two patients with suspected cervical spine fracture admitted to our emergency room in a haemodynamically unstable condition and requiring a rapid sequence induction of anaesthesia, in whom we successfully applied this newly developed intubating device for the first time. Provided that there are no intubation difficulties, direct laryngoscopy is still the fastest method of securing an airway; however, this procedure leads to an extension of the cervical spine, which may be hazardous in the case of a cervical spine injury. Intubation by means of the Intubating Laryngeal Mask avoids dangerous hyperextension of the occipito-atlanto-axial complex, a fact that we were able to verify by lateral cervical spine fluoroscopy during intubation.