Use Of Supraglottic Airway Research Articles

Using supraglottic airways by paramedics for airway management in analogue microgravity increases speed and success of ventilation

In the next few years, the number of long-term space missions will significantly increase. Providing safe concepts for emergencies including airway management will be a highly challenging task. The aim of the present trial is to compare different airway management devices in simulated microgravity using a free-floating underwater scenario. Five different devices for airway management [laryngeal mask (LM), laryngeal tube (LT), I-GEL, direct laryngoscopy (DL), and video laryngoscopy (VL)] were compared by n = 20 paramedics holding a diving certificate in a randomized cross-over setting both under free-floating conditions in a submerged setting (pool, microgravity) and on ground (normogravity). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the time to ventilation. A total of 20 paramedics (3 female, 17 male) participated in this study. Success rate was highest for LM and LT and was 100% both during simulated microgravity and normogravity followed by the I-GEL (90% during microgravity and 95% during normogravity). However, the success rate was less for both DL (60% vs. 95%) and VL (20% vs. 60%). Fastest ventilation was performed with the LT both in normogravity (13.7 ± 5.3 s; n = 20) and microgravity (19.5 ± 6.1 s; n = 20). For the comparison of normogravity and microgravity, time to ventilation was shorter for all devices on the ground (normogravity) as compared underwater (microgravity). In the present study, airway management with supraglottic airways and laryngoscopy was shown to be feasible. Concerning the success rate and time to ventilation, the optimum were supraglottic airways (LT, LM, I-GEL) as their placement was faster and associated with a higher success rate. For future space missions, the use of supraglottic airways for airway management seems to be more promising as compared to tracheal intubation by DL or VL.

Outcomes of Transfemoral Transcatheter Aortic Valve Replacement Performed With General Anesthesia Using a Supraglottic Airway Versus Monitored Anesthesia Care

Compare general anesthesia with a supraglottic airway versus monitored anesthesia care for transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients with aortic stenosis. The authors hypothesized that the supraglottic airway group would have similar operating room and procedure times, postanesthesia care unit (PACU) and hospital stays, and similar rates of intraprocedural and postprocedural complications compared with the monitored anesthesia care group. Retrospective chart review with 1:1 propensity score matching of supraglottic airway to monitored anesthesia care patients. Tertiary care academic medical center. TF-TAVR patients between 2017 and 2019. Supraglottic airway or monitored anesthesia care. One hundred forty-eight supraglottic airway patients were matched with 148 monitored anesthesia care patients. Monitored anesthesia care patients had slightly shorter operating room (p < 0.001) and procedure times (p = 0.015). No difference was observed in hospital length of stay (p = 0.34). Fewer patients in the supraglottic airway group required a PACU stay >2 hours (p < 0.001). Use of intraprocedural vasopressors (p < 0.001) and fentanyl dosage (p < 0.001) was higher in the supraglottic airway group. No differences were observed in postoperative complications or procedural success rates. In this, the first study to compare these 2 modalities, supraglottic airway use was demonstrated to be a safe, feasible alternative to monitored anesthesia care during TF-TAVR and did not increase organ-specific morbidity, 30-day mortality, hospital length of stay, or PACU length of stay. Even though supraglottic airway was associated with slight increases in procedure and operating room times, these were not clinically significant.

Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management

BackgroundPrehospital emergency airway management challenges every paramedic. Emergencies evacuated from difficult areas by armed forces need airway maintenance throughout evacuation. Effective use of supraglottic airway (SGA) devices during prehospital transfer is life saving. This study compared use of four commonly available SGAs by Armed Forces paramedics in simulated emergency situations. MethodsThis prospective observational study conducted in a tertiary care institution, included 58 volunteer paramedics. They were trained on manikins before the study in basic airway skills and insertion of the four SGA devices under study viz. Classic laryngeal mask airway (cLMA), laryngeal tube (LT), I-gel, and Combitube. SGA device insertions were performed on 474 patients scheduled for short elective surgical procedures under general anesthesia. All volunteers inserted and assessed the four SGA devices equal number of times in different patients. Overall success rate, time for successful insertion, first attempt success rate, number of attempts for successful insertion, oro-pharyngeal leak pressures, ease of insertion, durability of device, and complications were recorded. ResultsDifferences among the four groups were statistically significant in all parameters. Intergroup comparison revealed that both I-gel and LT were comparable to each other, however superior to cLMA and Combitube in all outcome measures except ease of insertion and durability of device where I-gel was better and oro-pharyngeal seal pressures where Combitube was better. ConclusionConsidering all parameters, I-gel proved superior with minimal complications compared with other SGA devices tested. I-gel may be recommended for emergency airway rescue use in patients by military paramedics.

The use of supraglottic airway vs tracheal tube for endoscopic nasal sinus surgery

BackgroundThe purpose of this study is to find whether supraglottic devices (SGD) have some advantages over tracheal intubation for a group of patients undergoing nasal sinus surgery. Since its invention, the supraglottic airway has revolutionized anesthetic practice. It is being used extensively for patients’ airway management and can have a positive effect on induction time, and patients’ airway stimulation, both at induction and during emergence from anesthesia. MethodsWith Institutional Review Board approval, 98 patients were enrolled in the study, excluding those with a history of prior gastric surgery, history of aspiration pneumonia, gastroparesis, patient-stated history of gastroesophageal reflux when lying supine, or a given history of hiatal hernia. Patients received either an endotracheal tube or a supraglottic airway for airway management during their sinus procedures. All patients were maintained with general anesthesia. Study designNon-randomized, prospective. ResultsNo Patients exhibited clinical signs of aspiration. There were no instances of oxygen desaturation. All patients were discharged home as planned and there were no hospital admissions. ConclusionsAdvantages of the SGD are that it is easy to insert, and does not require muscle relaxants or laryngoscopy for placement. Hemodynamic and stress responses associated with both laryngoscopy and tracheal intubation are avoided. Environmental inhalational gas exposure is comparable to the use of an endotracheal tube. There is also lower reported incidence of coughing, laryngospasm and breath holding. In the SGD, anesthetic requirement for tolerating the airway is less than with an endotracheal tube. An endotracheal tube in the airway at the time of emergence is a stimulus for coughing, which can provoke nasal bleeding, and which is important to avoid in sinonasal operations. In this sample of data, there was no difference in airway irritation between the two methods of maintaining the airway. The use of a supraglottic airway or laryngeal mask airway device was comparable in maintaining the airway during sinus surgeries in this sample of data. There were no differences in outcomes for the variables studied.

Airway management during in-hospital cardiac arrest: An international, multicentre, retrospective, observational cohort study

AimTo determine the type of airway devices used during in-hospital cardiac arrest (IHCA) resuscitation attempts. MethodsInternational multicentre retrospective observational study of in-patients aged over 18 years who received chest compressions for cardiac arrest from April 2016 to September 2018. Patients were identified from resuscitation registries and rapid response system databases. Data were collected through review of resuscitation records and hospital notes. Airway devices used during cardiac arrest were recorded as basic (adjuncts or bag–mask), or advanced, including supraglottic airway devices, tracheal tubes or tracheostomies. Descriptive statistics and multivariable regression modelling were used for data analysis. ResultsThe final analysis included 598 patients. No airway management occurred in 36 (6%), basic airway device use occurred at any time in 562 (94%), basic airway device use without an advanced airway device in 182 (30%), tracheal intubation in 301 (50%), supraglottic airway in 102 (17%), and tracheostomy in 1 (0.2%). There was significant variation in airway device use between centres. The intubation rate ranged between 21% and 90% while supraglottic airway use varied between 1% and 45%. The choice of tracheal intubation vs. supraglottic airway as the second advanced airway device was not associated with immediate survival from the resuscitation attempt (odds ratio 0.81; 95% confidence interval 0.35–1.8). ConclusionThere is wide variation in airway device use during resuscitation after IHCA. Only half of patients are intubated before return of spontaneous circulation and many are managed without an advanced airway. Further investigation is needed to determine optimal airway device management strategies during resuscitation following IHCA.

I-gel supraglottic airway use is efficient and safe during minimal flow anesthesia with volume controlled ventilation - a randomized controlled trial

Background: A fear of potential gas leak limits the wide spread use of minimal flow anesthesia with supraglottic airway devices. Second generation supraglottic airway devices have been claimed to be come with good airway seal. I-gel is one of these and it has been extensively evaluated for spontaneous as well as assisted ventilation. We conducted this study to evaluate its use with low flow anesthesia and volume controlled ventilation.&#x0D; Methodology: In a prospective randomized controlled trial, 50 patients undergoing laparoscopic surgeries for less than 2 h duration were administered general anesthesia, with controlled ventilation, using either endotracheal tube or an I-gel for airway control. The total fresh gas flow was gradually reduced until it was 400 mL/min. Patients were monitored for evidence of loss of respiratory gas volume in the breathing circuit and other parameters for ventilation failure.&#x0D; Results: Ventilation could be maintained at a fresh gas flow of 400 mL/min, without clinical or volumetric evidence of gas leak in all patients in the two groups. Two patients in the I-gel group had intraoperative gas leak leading to ventilator failure alarm but the same was corrected by repositioning of the head. The vital signs, peak airway pressure, end-tidal carbon dioxide, set tidal volume and expired tidal volumes were statistically similar in the two groups.&#x0D; Conclusion: I-gel supraglottic airway can be safely and efficiently used for laparoscopic surgery using minimal flow anesthesia and volume controlled ventilation.&#x0D; Citation: Khan A, Kapoor MC, Garg S, Puri A, Sinha A. I-gel supraglottic airway use is efficient and safe during minimal flow anesthesia with volume controlled ventilation - a randomized controlled trial. Anaesth pain intensive care 2020;24(1):__&#x0D; Abbreviations: Supraglottic airway device – SAD; Volume controlled ventilation – VCV; Pressure controlled ventilation – PCV; Endotracheal tube – ETT; Laryngeal Mask Airway - LMA&#x0D; &#x0D; DOI: https://doi.org/10.35975/apic.v24i1.&#x0D; Received – 11 June 2019;&#x0D; Reviewed – 20, 23 October 2019;&#x0D; Revised – 31 January 2020;&#x0D; Second Review – 2, 7 January 2020;&#x0D; Accepted – 02 February 2020;

Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review.

Personal protective equipment has become an important and emotive subject during the current coronavirus disease 2019 epidemic. Coronavirus disease 2019 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately 1 metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain. Contact, droplet and airborne transmission are each relevant during airway manoeuvres in infected patients, particularly during tracheal intubation. Personal protective equipment is an important component, but only one part, of a system protecting staff and other patients from coronavirus disease 2019 cross-infection. Appropriate use significantly reduces risk of viral transmission. Personal protective equipment should logically be matched to the potential mode of viral transmission occurring during patient care - contact, droplet or airborne. Recommendations from international organisations are broadly consistent, but equipment use is not. Only airborne precautions include a fitted high-filtration mask, and this should be reserved for aerosol generating procedures. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.

Choosing the best supraglottic airway for ophthalmic general anaesthesia: a manikin study.

General anaesthesia is sometimes favoured over regional anaesthesia in ophthalmic surgery. The use of supraglottic airway (SGA) or laryngeal mask airway (LMA) as the primary airway device is increasing due to numerous advantages over tracheal intubation. Compared with 1st generation SGAs, 2nd generation SGAs have an added benefit of isolating the airway from the alimentary tract. However, the vertical profile of SGAs may encroach into the surgical field and hence interfere with surgery. We investigated the vertical projections of 1st generation SGAs (LMA Classic, Ambu AuraFlex) and commonly used 2nd generation SGAs in our institution (LMA ProSeal, LMA Supreme, LMA Protector, Ambu AuraGain and I-gel) in a manikin model. Each device was connected to a corrugated catheter mount or angled connector following insertion as per usual clinical practice in our institutions. Vertical projections of all devices were measured from the chin using a centimetre ruler. Securing of airway device to the chin with an adhesive tape was possible for the LMA Classic and Ambu AuraFlex with straight corrugated connector, whereas the stiffer 2nd generations SGAs required the addition of an angled connector or straight corrugated tubing to direct the airway tube caudally, away from the surgical field. The LMA ProSeal had the lowest vertical projection amongst the 2nd generation SGAs and may be the suitable choice for ophthalmic surgery. We also describe a novel technique of utilising a 1st generation SGA with placement of an orogastric tube, although with some reservations. This study has several limitations and transferability of our findings into clinical practice is questionable as the use of a manikin may not fully imitate the real condition of the patient. Our study is the first study comparing vertical projected height of different SGAs in manikin, but future studies should investigate the use of SGA in the clinical setting during ophthalmic surgery.

Comparing Surf Lifeguards and Nurse Anesthetists' Use of the i-gel Supraglottic Airway Device - An Observational Simulation Study.

PurposeUsing a supraglottic airway (SGA) may provide more effective ventilations compared with a mouth-to-pocket-mask for drowning victims. SGAs are widely used by nurse anesthetists but it is unknown whether surf lifeguards can use SGAs effectively. We aimed to compare the use of SGA by surf lifeguards and experienced nurse anesthetists.Materials and MethodsSurf lifeguards inserted a SGA (i-gel O2, size 4) in a resuscitation manikin during cardiopulmonary resuscitation (CPR) and nurse anesthetists inserted a SGA in a resuscitation manikin placed on a bed, and performed ventilations. Outcome measures: time to first ventilation, tidal volume, proportion of ventilations with visible manikin chest rise, and ventilations within the recommended tidal volume (0.5–0.6 L).ResultsOverall, 30 surf lifeguards and 30 nurse anesthetists participated. Median (Q1–Q3) time to first ventilation was 20 s (15–22) for surf lifeguards and 17 s (15–21) for nurse anesthetists (p=0.31). Mean (SD) tidal volume was 0.55 L (0.21) for surf lifeguards and 0.31 L (0.10) for nurse anesthetists (p<0.0001). Surf lifeguards and nurse anesthetists delivered 100% and 95% ventilations with visible manikin chest rise (p=0.004) and 19% and 5% ventilations within the recommended tidal volume, respectively (p<0.0001).ConclusionIn a simulated setting, there was no significant difference between surf lifeguards and experienced nurse anesthetists in time to first ventilation when using a SGA. Surf lifeguards delivered a higher tidal volume, and a higher proportion of ventilations within guideline recommendations, but generally ventilations caused visible manikin chest rise for both groups.

Comparing the neurologic outcomes of patients with out-of-hospital cardiac arrest according to prehospital advanced airway management method and transport time interval.

ObjectiveThe incidences of prehospital advanced airway management by emergency medical technicians in South Korea are increasing; however, whether this procedure improves the survival outcomes of patients experiencing out-of-hospital cardiac arrest remains unclear. The present study aimed to investigate the association between prehospital advanced airway management and neurologic outcomes according to a transport time interval (TTI) using the Korean Cardiac Arrest Research Consortium database.MethodsWe retrospectively analyzed the favorable database entries that were prospectively collected between October 2015 and December 2016. Patients aged 18 years or older who experienced cardiac arrest that was presumed to be of a medical etiology and that occurred prior to the arrival of emergency medical service personnel were included. The exposure variable was the type of prehospital airway management provided by emergency medical technicians. The primary endpoint was a favorable neurologic outcome.ResultsOf 1,871 patients who experienced out-of-hospital cardiac arrest, 785 (42.0%), 121 (6.5%), and 965 (51.6%) were managed with bag-valve-mask ventilation, endotracheal intubation (ETI), and supraglottic airway (SGA) devices, respectively. SGAs and ETI provided no advantage in terms of favorable neurologic outcome in patients with TTIs ≥12 minutes (odds ratio [OR], 1.37; confidence interval [CI], 0.65–2.87 for SGAs; OR, 1.31; CI, 0.30–5.81 for ETI) or in patients with TTI <12 minutes (OR, 0.57; CI, 0.31–1.07 for SGAs; OR, 0.63; CI, 0.12–3.26 for ETI).ConclusionNeither the prehospital use of SGA nor administration of ETI was associated with superior neurologic outcomes compared with bag-valve-mask ventilation.

Supraglottic airway versus endotracheal tube during interventional pulmonary procedures \u2013 a retrospective study

BackgroundAs the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution.MethodsFrom 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed.ResultsInhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use.ConclusionsIn this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.

SUPRAGLOTTIC AIRWAY PLACEMENT REDUCES TIME TO ADVANCED AIRWAY DURING IN-HOSPITAL CARDIAC ARREST

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Airway assessment is integral to advanced cardiac life support (ACLS). Cardiac arrests in the intensive care unit (ICU) may facilitate rapid advanced airway placement owing to more staff and proximity of intensivists. Inpatient floors are more challenging however, as staff experienced in rapid advanced airway placement are not immediately available. Our institution, a 914 bed quaternary care referral center, previously relied on certified registered nurse anesthetists (CRNAs) to perform endotracheal intubation during non-ICU in-hospital cardiac arrests (ICHAs). In an effort to shorten the time to establish an airway in non-ICU ICHAs, our respiratory therapy department hypothesized that allowing rapid-response respiratory therapists (RRTs) to insert a supraglottic airway during ICHAs should decrease the time between ICHA announcement and placement of an advanced airway. Previous studies have not shown a difference between supra- and subglottic airways and markers of ventilation/perfusion or outcomes in out-of-hospital cardiac arrests. METHODS: In October of 2018, supraglottic airway training and education on inclusion/exclusion criteria was performed. Inclusion criteria: unconscious non-ICU patients experiencing IHCA. Exclusion criteria: consciousness, trismus, pharyngo-perilaryngeal trauma or mass. Subsequently, a project was approved by the institution’s code blue committee that allowed RRTs to insert supraglottic airways (i-gel® Intersurgical) in patients suffering an IHCA on inpatient floors. Data was collected on 12 IHCAs over 5 months, including arrest time, time to supraglottic airway placement, and time to subglottic intubation (if performed). For comparison, data on length of time from IHCA to intubation was collected on 12 randomly selected non-ICU ICHAs prior to 2018. RESULTS: Prior to supraglottic airway use, the average time from ICHA announcement to intubation was 15.33 minutes (range 4-38 minutes). After initiation of the supraglottic airway project, average time from ICHA to supraglottic airway was 4.7 minutes (range 1-7 minutes). For those intubated after supraglottic airway placement, the average time from IHCA to subglottic intubation was 17.6 minutes (range 10-30 minutes). During this project, no dislodgements of the supraglottic airway or aspiration events occurred. In all cases, the ACLS protocol based on American Heart Association guidelines was followed with no complications noted. CONCLUSIONS: Empowerment of RRTs to insert a supraglottic airway significantly reduces time between IHCA and advanced airway placement. More research is needed to determine correlation between time to advanced airway and immediate survival, survival to hospital discharge, and neurologic sequelae. CLINICAL IMPLICATIONS: This study demonstrates that an advanced airway can be established during IHCA without having to wait for personnel experienced in endotracheal intubation. DISCLOSURES: No relevant relationships by Idrees Mogri, source=Web Response No relevant relationships by Adan (Adam) Mora, source=Web Response No relevant relationships by Robert Ritchey, source=Web Response No relevant relationships by Rahul Sawhney, source=Web Response No relevant relationships by Mark Whitford, source=Web Response

A review of the use of supraglottic airways in neonates for use during interhospital transfer

A secure and patent airway is a prerequisite to safe interhospital transfer and this has traditionally been via endotracheal tubes. Neonatal intubation success rates are falling as there is declining opportunities amongst paediatric junior doctors and consultants, therefore being able to successfully intubate an infant before or during a transfer, especially if they have an airway anomaly, may be very challenging. The use of supraglottic airways is increasingly popular in neonatology as an alternative to facemask ventilation or endotracheal intubation. This review considers the role of supraglottic airway devices during the stabilisation and transfer of neonates.

Correction.

AnaesthesiaVolume 74, Issue 2 p. 246-246 CorrectionFree Access Correction This article corrects the following: Characteristics of children aged 2–17 years undergoing anaesthesia in Danish hospitals 2005–2015: a national observational study C. Strøm, L. H. Lundstrøm, A. Afshari, N. Lohse, Volume 73Issue 11Anaesthesia pages: 1321-1336 First Published online: September 5, 2018 First published: 03 December 2018 https://doi.org/10.1111/anae.14521AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the paper by Strøm et al., ‘Characteristics of children aged 2–17 years undergoing anaesthesia in Danish hospitals 2005–2015: a national observational study’ 1, the figure legends for figures 5 and 6 are incorrect. The figure legend for Figure 5 should be:Use of regional anaesthesia for surgery in children aged 2–5 years and 6–17 years anaesthetised in Denmark between 2005 and 2015. Columns show the proportion of cases where regional techniques were employed and whiskers are 95%CI. *Data from 2015 are incomplete, because an updated version of the database was implemented in a stepwise fashion at Danish hospitals from 1 February 2015 and data were retrieved from the earlier version. The figure legend for Figure 6 should be:Use of supraglottic airway in children aged 2–5 years and 6–17 years anaesthetised in Denmark between 2005 and 2015. Columns show the proportion of cases where a supraglottic airway was employed and whiskers are 95%CI. *Data from 2015 are incomplete, because an updated version of the database was implemented stepwise at Danish hospitals from 1 February 2015 and data were retrieved from the earlier version. The journal apologises for these errors. Reference 1Strøm C, Lundstrøm LH, Afshari A, Lohse N. Characteristics of children aged 2–17 years undergoing anaesthesia in Danish hospitals 2005–2015: a national observational study. Anaesthesia 2018; 73: 1321– 6. Volume74, Issue2February 2019Pages 246-246 ReferencesRelatedInformation

Successful use of supraglottic airway in a professional singer undergoing laparoscopic living donor right hepatectomy - A case report -

Successful use of supraglottic airway in a professional singer undergoing laparoscopic living donor right hepatectomy - A case report -

Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery.

The supraglottic airway (SGA) represents an alternative to endotracheal intubation (endotracheal tube [ETT]) in many types of ambulatory surgery. Adoption of the SGA has progressed slowly in sinonasal surgery due to concerns about airway protection. The purpose of this study was to compare quality of life measures and indices of airway protection between patients undergoing sinonasal surgery who were ventilated via an SGA or ETT. Patients undergoing outpatient sinonasal surgery were enrolled into a randomized, single-blind study in which patients would be ventilated with either an SGA or ETT. At the first postoperative visit, a symptom severity and quality of life questionnaire was completed. Additional objective metrics were extracted from the anesthesia record. A total of 102 patients were enrolled; 49 assigned to the SGA group and 53 assigned to the ETT group. No significant differences in swallowing function or cough were identified. SGA patients reported more difficulty returning to a normal diet (p = 0.03) with a trend toward reduced throat pain (p = 0.07) and improved phonation (p = 0.06). No significant difference in perioperative oxygen desaturations, emesis, recovery time, or airway blood penetration were identified. While the use of the SGA results in patient diet modification postoperatively, it may also be associated with a reduction in throat pain and dysphonia. SGA use had no appreciable effect on postanesthesia recovery times, oxygen desaturations, or emesis. Use of the SGA in sinonasal surgery appears to be a safe and reliable option for airway management in selected adult patients undergoing routine ambulatory sinonasal surgery.

Impact of prehospital airway management on combat mortality

IntroductionAnalysis of modern military conflicts suggests that airway compromise remains the second leading cause of preventable death of combat fatalities. This study compares outcomes of combat casualties that received prehospital airway interventions, specifically bag valve mask (BVM) ventilation, cricothyrotomy, and supraglottic airway (SGA) placement. The goal is to compare the effectiveness of airway management strategies used in the military pre-hospital setting. MethodsThis retrospective chart review of 1267 US Army medical evacuation patient care records, compared outcomes of casualties that received prehospital advanced airway interventions. The patients consisted of US military injured in Operation Enduring Freedom January 2011–March 2014. Compared outcomes consisted of vent-, ICU-, and hospital-free days. ResultsThose with SGA placement experienced fewer vent-free days, ICU-free days, and hospital-free days compared to BVM and cricothyrotomy patients. The groups did not significantly differ in rates of 30-day survival. The odds for survival were not significantly higher for BVM versus SGA patients (OR 1.5, 95% CI 0.2–9.8), cricothyrotomy versus SGA patients (OR 3.9, 95% CI 0.6–24.9), or cricothyrotomy versus BVM patients (OR 2.7, 95% CI 0.5–13.8) in a logistic regression model adjusting for GCS. ConclusionThis study supports prehospital BVM ventilation as a possible alternative to cricothyrotomy as there was no difference in measured outcomes between the groups. It further cautions against SGA use in the prehospital combat setting due to higher morbidity demonstrated by fewer ventilator, hospital, and ICU free days than those receiving cricothyrotomy or BVM ventilation. There was no difference in 30-day survival between the groups.

Obstructive sleep apnea as a risk factor associated with difficult airway management - A narrative review

Study objectiveThe association between obstructive sleep apnea (OSA) and difficult airway had been studied in various clinical trials but the relationship between the two conditions has not been clearly established. The objective of this narrative review is to determine if OSA is a risk factor associated with difficult airway. DesignThe OVID Medline in process, Medline (vis Pub Med), EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS were searched up to April 2016 using specific keywords. Inclusion criteria were: [1] airway management in patients with a diagnosis of OSA, [2] comparison of airway management between OSA and non-OSA patients, [3] publications or abstracts in the English language. The incidence of difficult airway between OSA and non-OSA patients was compared using Chi-square analysis or Fisher's exact test. Main resultsTen studies were included in the final review. Overall, the incidence of difficult tracheal intubation was higher in OSA patients versus non-OSA patients [56/386 (14.5%) vs. 69/897 (7.7%); P=0.0002]. OSA patients also have a higher incidence of difficult mask ventilation [115/4626 (2.5%) vs. 471/64,684 (0.7%); P<0.0001]. Compared to non-OSA patients, OSA was not associated with difficulty in the use of a supraglottic airway (SGA) device [10/663 (1.5%) vs. 162/15,171 (1.1%); P=0.38]. No studies compared difficult surgical airway in OSA and non-OSA patients. ConclusionsOSA was found to be a risk factor associated with difficult tracheal intubation and difficult mask ventilation. There was no association between OSA and difficult SGA use.

Prehospital Supraglottic Airway Was Associated With Good Neurologic Outcome in Cardiac Arrest Victims Especially Those Who Received Prolonged Cardiopulmonary Resuscitation.

We performed this study to investigate the association of prehospital supraglottic airway (SGA) on neurologic outcome in cardiac arrest victims with adjustment of postresuscitation variables as well as prehospital and resuscitation variables. This study was a retrospective study based on a multicenter prospective cohort registry from December 2013 to April 2016. According to the 28-day cerebral performance categories (CPCs) scale, patients were divided into the good-outcome group (CPC1-2) and the poor-outcome group (CPC3-5). We compared the two groups with respect to demographic variables, prehospital and in-hospital resuscitation variables, and postresuscitation variables. A total of 869 cardiac arrest victims who received in-progress cardiopulmonary resuscitation (CPR) were delivered to the emergency department of three hospitals, and 310 patients were admitted to the intensive care unit. The use of a prehospital SGA was independently associated with 28-day good neurologic outcome (odds ratio [OR]= 7.88; 95% confidence interval [CI]= 1.33-46.53; p=0.023] when postresuscitation variables were adjusted, although there were no significant association with the acquisition of sustained return of spontaneous circulation (OR= 0.992; 95% CI= 0.591-1.666; p=0.976). Furthermore, a prehospital SGA was significantly associated with good neurologic outcome, especially in patients who received prolonged CPR (low flow time>15 minutes; OR= 3.41; 95% CI= 1.23-9.45; p=0.018) rather than in patients with nonprolonged CPR (OR= 4.50; 95% CI= 0.75-27.13; p=0.101). When postresuscitation variables were adjusted, the prehospital SGA was independently associated with 28-day good neurologic outcome in cardiac arrest victims.

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.