Use and evaluation of the McMurray enhanced airway - Distal pharyngeal airway for improved airway management under deep sedation in the endoscopy clinic

Abstract

BackgroundThe distal pharyngeal airway (DPA) is a novel airway management tool that relieves airway obstruction. Elongated tubing extends to distal pharyngeal tissues which traditional oral and nasal airways fail to reach. This Quality Improvement initiative aimed to develop and implement a DPA guideline for improving airway management and patient safety in patients undergoing deep sedation for endoscopic procedures. MethodsA quasi-experimental design was used to evaluate the use of a commercially available DPA, the McMurray Enhanced Airway (MEA), in comparison to another new solution, nasal positive airway pressure (nPAP) (SuperNO2VA). Adult patients (n = 47) receiving deep sedation for endoscopic procedures received either a DPA or nPAP based on the preference of the anesthesia provider. During the procedure, the number of airway obstructions and manual airway maneuvers was recorded, as were any adverse events. Anesthesia providers were surveyed regarding perceptions of how well the DPA worked to improve airway management in sedated patients. ResultsThere were no statistically significant differences between the DPA and nPAP groups. A desaturation event was reported for five (20 %) patients in the DPA group and five patients (22.7 %) in the nPAP group, p = 0.999. An airway maneuver was performed for seven (29.2 %) patients in the DPA group and nine (40.9 %) in the nPAP group (p = 0.538). No serious complications were seen in either group. In a subset of patients receiving a colonoscopy, 2 of 15 (13.3 %) in the DPA and 5 of 14 (35.7 %) in the nPAP group had a desaturation event (p = 0.215). In the anesthesia provider survey, 92 % agreed the DPA was successful in relieving an upper airway obstruction. ConclusionThis project shows that the DPA was useful in managing airway obstructions and most providers expressed overall satisfaction with its function. The rate of desaturations and airway maneuvers was equivalent in the two groups despite the DPA group having substantially higher BMIs. We found the DPA to be a useful multi-functional rescue device to restore adequate ventilation quickly and easily. As a result, a guideline and a flowchart based on this study were adopted at our institution.