Exchanging a King Laryngeal Tube for an Endotracheal Tube Using a Fiberoptic Bronchoscope-Aintree Catheter Combination in a Known Difficult Airway

Purpose: To present the first case where a King Laryngeal Tube (LT) was exchanged for an endotracheal tube (ETT) using a fiberoptic bronchoscope-Aintree intubating catheter (FOB-AIC) combination in a patient with a proven... [ view full abstract ]

Purpose: To present the first case where a King Laryngeal Tube (LT) was exchanged for an endotracheal tube (ETT) using a fiberoptic bronchoscope-Aintree intubating catheter (FOB-AIC) combination in a patient with a proven difficult airway.

Clinical features:

A 24-yr-old male was admitted to trauma service with multiple facial injuries including extensive oral and perioral edema. A King LT was placed in the field after difficulty with tracheal intubation. Anesthesiology service was consulted for definitive airway management. After advancing an FOB through the ventilation port of the King LT for evaluation of the tracheobronchial tree, the decision was made to exchange the King LT for an ETT utilizing a FOB-AIC combination. The FOB-AIC combination was advanced through a bronchoscopy elbow allowing maintenance of positive pressure ventilation (PPV) on FiO2 1.0 throughout the airway exchange.

Conclusion:

The King LT is a supraglottic airway often employed as an airway management alterative for patients in which endotracheal intubation is difficult. It is important for providers to have a safe and effective method for exchanging a King LT for an ETT in these patients. Currently there is no consensus on the preferred method to accomplish this exchange. Our case demonstrates that the FOB-AIC exchange can be done safely and effectively in an unstable trauma patient. In addition, and opposed to other methods of King LT exchange, the FOB-AIC technique offers the advantages of maneuverability when loaded onto a FOB, minimal ID-OD discrepancy, and the ability to fit through a bronchoscopy elbow and thus maintain PPV.