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.)

REFERENCES

1.
Raymond J, Hardy JF: Oxygenation par tracheostomie. Can J Anaesth 1990; 37:274-5