Abstract
We report two cases of fiberoptic bronchoscopy-guided percutaneous dilational tracheostomy (PDT) using a laryngeal mask airway instead of a tracheal tube. Case 1: A 65-year-old woman who had undergone colectomy was admitted to our intensive care unit because of postoperative acute respiratory failure. Impaired pulmonary oxygenation was improved, but PDT was indicated because she could hardly excrete sputum by herself. Case 2: An 87-year-old woman who had been resuscitated from cardiopulmonary arrest with unknown origin was underwent PDT because of remaining in a vegetative state. In either case a laryngeal mask airway #3 was inserted following 30mg of intravenous propofol, which was continuously administered during the procedure as an anesthetic. A bronchofiberscope was inserted through the laryngeal mask airway to show the 2nd tracheal ring. Monitoring inside with a bronchoscope, the trachea was punctured percutaneously by a double-sheath needle and thereafter a guidewire was inserted through it. A Blue Rhino(R) dilator was inserted to enlarge subcutaneous passage to trachea enough for the tracheostomy tube. Time from the initial needle puncture to the insertion of the tracheostomy tube was 4 minutes and 2.5 minutes respectively. Hypoxia was not recognized during the procedure in neither case so far as inhaling 100% oxygen. No other complication was associated with our PDT procedure. We suggest that a laryngeal mask airway may be a useful option for fiberoptic bronchoscopy-guided PDT.
