To the Editor:-It is occasionally difficult to ventilate a tracheotomized patient. In such a patient, controlled ventilation through a face mask is difficult. Some patients can easily tolerate topical anesthesia and awake insertion of an endotracheal tube through a tracheotomy orifice, followed by the anesthesia. However, for those who cannot, deep anesthesia and muscle relaxation before tube placement may be preferable.
In such a situation, ventilation using a small laryngeal mask fitted over a stoma has proven to be a reasonable solution (Figure 1). With this method, we can easily ventilate a patient and control the depth of anesthesia.
Ventilation via a tracheostomy using a pediatric mask over the stoma has been reported previously. [1]Unfortunately, in some cases, it is difficult to fit a pediatric mask because of a hollow between clavicles, the sternum, and sternocleidomastoid muscles. In such cases, the use of a small laryngeal mask airway may be of value.
Yasuhiro Morita, M.D.
Resident
Makoto Takenoshita, M.D.
Assistant Professor; Department of Anesthesiology; Osaka University Medical School; Osaka, Japan;makoto@anes.med.osaka-u.ac.jp
(Accepted for publication June 11, 1998.)
