Supraglottic Airway Devices Research Articles

Anaesthetic management of a case of dilated cardiomyopathy for breast surgery with supraglottic airway device

Anaesthetic management of a case of dilated cardiomyopathy for breast surgery with supraglottic airway device

Comparision of Ambu AuraGain™ and LMA® ProSeal in children under controlled ventilation.

Background and Aims:The LMA ProSeal® is considered a prototype among the second-generation supraglottic airway devices (SAD). The Ambu AuraGain™ is a relatively new, single use, second-generation SAD with a preformed shape. We conducted this study with the aim of comparing the difference in clinical performance between Ambu AuraGain™ and LMA ProSeal® in children receiving controlled ventilation.Methods:Ninety-four children, aged between 6 months to 12 years, weighing 5 to 30 kg, belonging to American Society of Anesthesiologists Physical Status I and II, undergoing elective surgical procedures, were randomized into two groups. The primary end-point was oropharyngeal seal pressure, and the secondary parameters were the number of attempts, time of insertion, ease of placement of the device and gastric tube, and fiberoptic visualization of the laryngeal aperture.Results:The mean oropharyngeal seal pressure with Ambu AuraGain™ was significantly higher than LMA ProSeal® (23.3 ± 4.6 cmH2O vs 20.6 ± 4.8 cmH2O, P = 0.007, respectively). The ease and success rate for device placement, fiberoptic visualization of the larynx, and complications were comparable. However, the time for insertion in Ambu AuraGain™ group was shorter when compared to LMA ProSeal® group, median (IQR [range]); 12 (10–15) s vs 20 (18–23) s (P < 0.001), respectively. The gastric drain was significantly easier to insert in Ambu AuraGain™ compared to LMA® ProSeal (P = 0.01).Conclusion:Our study suggests that Ambu AuraGain™ could be a useful disposable alternative to LMA ProSeal® for securing airway in children.

Assessment of awake i-gel™ insertion for fiberoptic-guided intubation in patients with predicted difficult airway: A prospective, observational study.

Background and Aims:Orotracheal intubation (OTI) with fiberoptic bronchoscope (FOB) in spontaneous ventilation is one of the main techniques for patients with predicted difficult airway. Latest generation supraglottic airway devices have been designed to allow OTI through them. We assessed the safety and effectiveness of FOB-guided OTI through i-gel™ device which was inserted in spontaneously breathing patients with predicted difficult airway.Material and Methods:Eighty-five patients with difficult airway predictors were included. The i-gel was inserted under oropharyngeal local anaesthesia and sedation. After checking the adequate ventilation through the i-gel with capnography curve, general anaesthesia was induced in order to introduce the endotracheal tube guided by FOB. We recorded the i-gel insertion time (tgel), intubation time (tint), O2 saturation in pulse oximetry (SpO2) at different times: basal (t0), after 3 min of preoxygenation with a face mask at 100% FiO2 (t1), after i-gel mask insertion (t2) and after intubation (t3). Adverse events during the procedure were also recorded.Results:All patients were successfully intubated. SpO2 values were: 96.9 ± 1.2 (t0), 99.0 ± 0.9 (t1), 96.2 ± 2.4 (t2), 96.0 ± 2.5 (t3). tgel and tint were 38.0 ± 7.8 s and 36.5 ± 5.6 s, respectively. No serious adverse events were recorded and no patient suffered airway trauma.Conclusion:I-gel insertion in spontaneous ventilation secures the airway before achieving fiberoptic intubation without the occurrence of adverse events. More studies might be necessary in order to confirm the results presented, but we consider that the technique described is a safe and effective alternative to classic OTI with FOB in spontaneously breathing patients with predicted difficult airway.

A comparison between the Supreme laryngeal mask airway and the laryngeal tube suction during spontaneous ventilation: A randomized prospective study.

Background and Aims:The Supreme laryngeal mask airway (SLMA) and the laryngeal tube suction-disposable (LTS-D), both second-generation supraglottic airway devices, have a record of efficiency when used for airway management in mechanically ventilated patients, during general anesthesia. There is no published data comparing these two devices in patients breathing spontaneously during general anesthesia.Material and Methods:Eighty patients with normal airways undergoing elective general anesthesia with spontaneous ventilation were randomized to airway management with a SLMA or LTS-D. Efficacy and adequacy of oxygenation and ventilation were compared.Results:No cases of desaturation of oxygen saturation (SpO2) values of less than 95% occurred with either device. The mean difference for SpO2 between the two devices (0.7%) has no clinical significance. Slight hypercapnia was noted with both devices to acceptable values during spontaneous ventilation.Conclusions:Both SLMA and LTS-D are suitable and effective for airway management in patients breathing spontaneously during general anesthesia for minor surgery of short duration.

A comparative evaluation of ProSeal laryngeal mask airway, I-gel and Supreme laryngeal mask airway in adult patients undergoing elective surgery: A randomised trial.

Background and Aims:Second-generation supraglottic airway devices are widely used in current anaesthesia practice. This randomised study was undertaken to evaluate and compare laryngeal mask airway: ProSeal laryngeal mask airway (PLMA), Supreme laryngeal mask airway (SLMA) and I-gel.Methods:Eighty-four adult patients undergoing elective surgery were randomly allocated to three groups: group P (PLMA), group I (I-gel) and group S (SLMA) of 28 patients each. Insertion times, number of insertion attempts, haemodynamic response to insertion, ease of insertion of airway device and gastric tube, oropharyngeal leak pressure (OLP) and pharyngolaryngeal morbidity were assessed. The primary outcome measure was the OLP after successful device insertion. Statistical analysis was performed using Statistical Package for the Social Sciences version 18.0 software using Chi-squared/Fisher's exact test (categorical data) and analysis of variance (continuous data) tests. P < 0.05 was considered statistically significant.Results:The demographic profile of patients was comparable. OLP measured after insertion, 30 minutes later and at the end of surgery differed significantly between the three groups (P < 0.001). The mean OLP was 32.64 ± 4.14 cm·H2O in group P and 29.79 ± 3.70 cm·H2O in group S. In group I, the mean OLP after insertion was 26.71 ± 3.45 cm H2O, which increased to 27.36 ± 3.22 cm H2O at 30 minutes and to 27.50 ± 3.24 cm H2O towards the end of surgery. However, these increases were not statistically significant (P = 0.641). Device insertion time was longest for group P (P = 0.001) and gastric tube insertion time was longest for group I (P = 0.001). Haemodynamic response to insertion and pharyngolaryngeal morbidity were similar with all three devices.Conclusion:PLMA provides better sealing pressure but takes longer to insert. I-gel and SLMA have similar sealing pressures. I-gel insertion time is quicker.

An Audit of Use of Supraglottic Airway Devices in Pediatric Patients

An Audit of Use of Supraglottic Airway Devices in Pediatric Patients

Assessment of Clinical Performance of Supraglottic Airway Devices in Adults for Short Surgical Procedures

Assessment of Clinical Performance of Supraglottic Airway Devices in Adults for Short Surgical Procedures

Pattern of usage of supraglottic airway devices in Pediatric patients among anesthesiologists

Background: The most vital element in providing functional respiration is the airway. The present study was conducted to determine the pattern of usage of supraglottic airway devices among anesthesiologists. Materials & Methods: The present study was conducted on 62 Pediatric anesthesiologists of both genders. Their qualification, area of practice, type of institution, experience and average daily cases were assessed. Complications arising from use of SGAD were also recorded. Results: 20 were practicing in rural and 42 in urban, 25 were MD, 20 were DA and 17 had fellowship, 26 were in college, 16 were private practitioner and 20 were in other. 32 had > 5years of experience and 32 had daily >5 patient consultation. The difference was significant (P

Comparison of I-gel for general anesthesia in obese and nonobese patients.

Context:I-gel is a second-generation supraglottic airway device. Despite several studies on i-gel, there are very few studies on the use of i-gel in obese patients.Aims:The aim of the study was to compare the clinical performance of i-gel between obese and nonobese patients.Settings and Design:Prospective, controlled, nonrandomized, hospital-based study.Subjects and Methods:After obtaining informed consent, patients were divided into two groups of 16 patients each: group O consisted of patients with body mass index (BMI) >30 kg/m2 and Group C consisted of patients with BMI 18.5–29.9 kg/m2. I-gel was inserted after induction of anesthesia and muscle relaxation. Oropharyngeal leak pressure (OLP) (primary outcome variable), leak fraction, time taken to insert the device, ease of insertion, fiberoptic view of glottis through i-gel's airway tube, and adverse effects were recorded.Statistical Analysis Used:Data were analyzed using SPSS 20. Continuous, ordinal, and categorical variables were analyzed using students t-test, Mann–Whitney U–test, and Fischer's exact test, respectively.Results:OLP was slightly higher in Group O (25.38 ± 4.79 cm H2O) but was not statistically different than Group C (27.38 ± 4.38 cm H2O). Other parameters except weight and BMI (which were higher in Group O) were statistically similar in both groups. There was no statistical difference in side effects.Conclusions:We concluded that i-gel is as effective in obese patients as in nonobese patients when used for securing the airway for surgical procedures.

Strategies for the prevention of airway complications - a narrative review.

Despite being infrequent, complications of airway management remain an important contributor to morbidity and mortality during anaesthesia and care of the critically ill. Developments in the last three decades have made anaesthesia safer, and this has been mirrored in the equipment and techniques available for airway management. Modern technology including novel oxygenation modalities, widespread availability of capnography, second-generation supraglottic airway devices and videolaryngoscopy provide the tools to make airway management safer still. However, technology will only take safety so far, and non-technical aspects of airway management are critically important for communication and decision making during airway crises, acknowledging a 'cannot intubate, cannot oxygenate' situation and transitioning to emergency front of neck airway. Randomised controlled trials provide little useful information about safety in this setting, and data from registries and databases are likely to be of more value. This narrative review focuses on recent evidence in this area.

The optimum sevoflurane concentration for supraglottic airway device Blockbuster\u2122 insertion with spontaneous breathing in obese patients: a prospective observational study

BackgroundAirway management of the obese patient presenting for surgery is more likely to be a challenging problem. Supraglottic airway device has been adopted as a bridge to connect ventilation and tracheal intubation in obese patients who would be suffered with difficult intubation. The optimum sevoflurane concentration for supraglottic airway device insertion allowing spontaneous breathing in 50% of obese patients (ED50) is not known. The purpose of this study was to determine the ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients requiring general anesthesia.MethodsThirty elective obese patients (body mass index 30-50 kg/m2) undergoing bariatric surgery were recruited in this study. The predetermined target sevoflurane concentration (initiating at 2.5% with 0.5% as a step size) was sustained for >5 min using a modified Dixon’s up-and-down method, and then the supraglottic airway device Blockbuster™ was inserted. The patient’s response to supraglottic airway device insertion was classified as either ‘movement’ or ‘no-movement’. The ED50 of sevoflurane were determined by calculating the midpoint concentration of crossover point from ‘movement’ or ‘no-movement’ response.ResultsThe ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion in obese patients calculated using up-and-down method were 2.50 ± 0.60%. The ED50 and ED95 (95% confidence interval) obtained by probit regression analysis were 2.35 (1.28–3.42) % and 4.03 (3.16–17.83) % for supraglottic airway device Blockbuster™ insertion, respectively.ConclusionWe conclude that the optimum end-tidal sevoflurane concentration required for the supraglottic airway device Blockbuster™ insertion allowing spontaneous breathing in 50% of obese patients (ED50) is 2.5 ± 0.6%.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-16009071, Registered on 24 August 2016.

An assessment of ventilation and perfusion markers in out-of-hospital cardiac arrest patients receiving mechanical CPR with endotracheal or supraglottic airways

Aim of the studyMechanical chest compression (MCPR) devices are considered equivalent to manual compressions in patient outcomes in out-of-hospital cardiac arrest (OHCA). However, recent data suggest possible harm in patients with a supraglottic airway device (SGA) during MCPR. The aim of this study was to evaluate differences in direct and indirect markers of ventilation and perfusion in patients with cardiac arrest receiving MCPR and who had their airway managed with an endotracheal tube (ETT) or SGA. MethodsWe retrospectively reviewed Emergency Medical Services (EMS) agencies and emergency department (ED) records over a two-year period. We included patients with OHCA who underwent MCPR and who had an advanced airway placed. The primary outcome was differences in intra-arrest end-tidal carbon dioxide (etCO2) measurements. Secondary outcomes included intra-arrest ventilation rates, rates of prehospital return of spontaneous circulation (ROSC), blood pressure upon prehospital ROSC, and 24-h survival. ResultsValid data sets were available for 126 patients. Eighty-four (66.7%) had an ETT placed, and 42 (33.3%) had a SGA placed. Twenty-eight (22.6%) achieved prehospital ROSC. Twenty-four-hour survival data were available for 13 (10.3%) of these patients. There were no significant differences in primary or secondary outcomes. ConclusionIn this retrospective study, we found no evidence of differences in markers of ventilation, perfusion or prehospital ROSC and survival in patients with OHCA who had their airway managed with either an ETT or SGA while receiving MCPR.

Actualización en dispositivos supraglóticos para la vía aérea pediátrica

IntroductionFollowing the introduction of the laryngeal mask in the 1980's, several similar devices have been developed, changing paediatric airway management under anaesthesia. This reflective article describes and examines the different paediatric supraglottic airway devices currently available in the U.K. MethodologyThis perspective article is based on a narrative review of articles that discussed paediatric supraglottic airway devices using Cochrane, Medline, Ovid and PubMed databases as well as text books. ResultsAs new devices continue to be developed with a clear indication of clinical relevance and genuine advantages, so high quality research will also continue to be required in order to improve features in new devices.

Paediatric supraglottic airway devices update

IntroductionFollowing the introduction of the laryngeal mask in the 1980s, several similar devices have been developed, changing paediatric airway management under anaesthesia. This reflective article describes and examines the different paediatric supraglottic airway devices currently available in the U.K. MethodologyThis perspective article is based on a narrative review of articles that discussed paediatric supraglottic airway devices using Cochrane, meddling, Ovid and pubmed databases as well as text books. ResultsAs new devices continue to be developed with a clear indication of clinical relevance and genuine advantages, so high quality research will also continue to be required in order to improve features in new devices.

Optimum end-tidal concentration of sevoflurane to facilitate supraglottic airway device insertion with propofol at induction allowing spontaneous respiration in obese patients: A prospective observational study.

Obese patients are more likely to encounter with difficult airway management, and supraglottic airway device has been adopted to facilitate tracheal intubation. The optimum anesthetic concentration for obese patients to insert a supraglottic airway device with spontaneous respiration has not been investigated. This study was designed to determine the end-tidal concentration of sevoflurane that would provide acceptable condition for supraglottic airway device insertion with propofol at induction in obese patients without using neuromuscular blockade.Thirty elective obese patients [body mass index (BMI) 30–50 kg/m2] scheduled for bariatric surgery were enrolled in this study. Sevoflurane was inhaled at a concentration of 5% after infusion of 1 mg/kg propofol (within 1 minute) according to lean body weight. The target concentration of sevoflurane was initiated at 2.5% with 0.5% as a step size using a modified Dixon up-and-down method. Five minutes after target concentration achieved, the insertion of supraglottic airway device was attempted.The minimum alveolar concentration of sevoflurane for successful insertion of supraglottic airway device calculated using up-and-down method were 2.25 (0.53) % for obese patients. The values of the effective concentration of sevoflurane for successful supraglottic airway device insertion in 50% (EC50) and 95% (EC95) of the obese patients obtained by probit regression analysis were 2.09% (95% confidence interval 1.48–2.68) and 3.31% (95% confidence interval 2.70–8.12), respectively.We conclude that sevoflurane at a minimum alveolar concentration of 2.25% can provide optimal conditions for insertion of supraglottic airway device with spontaneous respiration in obese patients with 1 mg/kg propofol at induction.

Clinical Comparison of I-Gel Supraglottic Airway Device and Cuffed Endotracheal Tube for Pressure-Controlled Ventilation During Routine Surgical Procedures.

Recently, there has been a trend favouring the use of supraglottic airway devices over endotracheal tubes (ETT) during short surgical procedures. In this study, we are going to assess the suitability of one such supraglottic airway device, i-gel, for pressure-controlled ventilation (PCV) during routine surgical procedures. The airway management for 60 patients was done with either i-gel (Group I) or cuffed tracheal tube (Group E) for this prospective, randomised, double-blinded study. Insertion time, number of attempts, ease of insertion and haemodynamic monitoring were recorded before, during and after insertion of these devices. Airway leak tests, leak volume and leak fraction were measured at 15, 20 and 25 cm H2O PCV, and pharyngolaryngeal morbidity was evaluated postoperatively. I-gel is easier to insert than a tracheal tube (p=0.0056). The increase in heart rate and MAP was higher following insertion of tracheal tube in the first few minutes (p<0.001) and subsequently became comparable between the two groups. The leak volume and leak fraction between the two groups were comparable at 15 cm H2O PCV, but significant difference was seen at 20 and 25 H2O PCV between the two groups (p=0.232, p<0.001, p<0.001). Thirty minutes later, the leak volume and leak fraction between groups were comparable at 15 cm H2O PCV (p=0.495, p=0.104) but not at 20 and 25 H2O PCV (p<0.001, p<0.001). Pharyngolaryngeal morbidity was significantly lesser in the i-gel group. I-gel provides a reasonable alternative to cuffed ETT for pressure-controlled ventilation provided the pressures can be limited to 15 to 20 cm H2O.

Limitations of pediatric supraglottic airway devices as conduits for intubation - an in vitro study

Supraglottic airway devices (SGAs) can be used as conduits for intubation, but data and manufacturers' recommendations for pediatric SGA are incomplete and sometimes misleading. This situation can result in the use of incompatible combinations of SGAs and endotracheal tubes (ETTs). To address this mismatch possibility, we performed an in vitro study to establish an overview of possible combinations of SGAs and ETTs. We tested the passage of ETTs through SGAs in vitro and subsequent SGA removal with eight pediatric SGAs and six ETTs of different sizes in vitro. Results were compared with manufacturers' recommendations. Outcome parameters were the feasibility of passing the ETT through the SGA and then removing the SGA over the ETT. The Air-Q® and the Air-Q®sp™ SGAs showed the best compatibility with ETTs across all sizes. Whenever intubation was possible, removal was possible for all SGAs with uncuffed ETTs. With many cuffed ETTs, however, SGA removal was impossible because the ETT cuff's pilot balloon was larger than the inner diameter of the SGA. Thus, although intubation was possible, removal of the SGA was not. The manufacturers' booklets do not warn of this limitation. The use of combinations of SGA and ETTs with a size mismatch can lead to airway complications during intubation or to accidental extubation and tearing of the cuff pilot balloon line when removing the SGA. To avoid these problems, we devised a table that simplifies the choice of an appropriate SGA and ETT combination.

Supraglottic airway devices: indications, contraindications and management.

Supraglottic airway devices (SADs) have become an essential tool in airway management. Over the past three decades, these devices have been increasingly adopted as an alternative to face mask ventilation and/or endotracheal intubation. The range of proposed uses and features has increased significantly. They are used in pre- and in-hospital settings, elective and emergency anesthesia, in spontaneously breathing and ventilated patients, as conduits for intubation, as a bridge to extubation and for airway rescue. With SADs, serious complications such as aspiration and loss of airway are rare and largely preventable. Adequate operator experience, familiarity with the selected device, attention to details and careful patient selection are fundamental to safety and proficiency. In this review, we explore the increasing proposed uses for SADs and discuss possible complications and the management of these.

37 Supraglottic Airway Use vs Endotracheal Intubation Pre/Post Deployment of the i-gel Supraglottic Airway Device in a Large Ground and Air-based Emergency Medical Services Agency

37 Supraglottic Airway Use vs Endotracheal Intubation Pre/Post Deployment of the i-gel Supraglottic Airway Device in a Large Ground and Air-based Emergency Medical Services Agency

Human and equipment resources for difficult airway management, airway education programs, and capnometry use in Japanese emergency departments: a nationwide cross-sectional study

BackgroundAlthough human and equipment resources, proper training, and the verification of endotracheal intubation are vital elements of difficult airway management (DAM), their availability in Japanese emergency departments (EDs) has not been determined. How ED type and patient volume affect DAM preparation is also unclear. We conducted the present survey to address this knowledge gaps.MethodsThis nationwide cross-sectional study was conducted from April to September 2016. All EDs received a mailed questionnaire regarding their DAM resources, airway training methods, and capnometry use for tube placement. Outcome measures were the availability of: (1) 24-h in-house back-up; (2) key DAM resources, including a supraglottic airway device (SGA), a dedicated DAM cart, surgical airway devices, and neuromuscular blocking agents; (3) anesthesiology rotation as part of an airway training program; and (4) the routine use of capnometry to verify tube placement. EDs were classified as academic, tertiary, high-volume (upper quartile of annual ambulance visits), and urban.ResultsOf the 530 EDs, 324 (61.1%) returned completed questionnaires. The availability of in-house back-up coverage, surgical airway devices, and neuromuscular blocking agents was 69.4, 95.7, and 68.5%, respectively. SGAs and dedicated DAM carts were present in 51.5 and 49.7% of the EDs. The rates of routine capnometry use (47.8%) and the availability of an anesthesiology rotation (38.6%) were low. The availability of 24-h back-up coverage was significantly higher in academic EDs and tertiary EDs in both the crude and adjusted analysis. Similarly, neuromuscular blocking agents were more likely to be present in academic EDs, high-volume EDs, and tertiary EDs; and the rate of routine use of capnometry was significantly higher in tertiary EDs in both the crude and adjusted analysis.ConclusionsIn Japanese EDs, the rates of both the availability of SGAs and DAM carts and the use of routine capnometry to confirm tube placement were approximately 50%. These data demonstrate the lack of standard operating procedures for rescue ventilation and post-intubation care. Academic, tertiary, and high-volume EDs were likely to be well prepared for DAM.