Optimal size and length of the endotracheal tube for tracheal intubation via supraglottic airway devices

Implication Statement: Despite the increasing popularity of video laryngoscopes, the supraglottic airway device (SAD) remains a critical airway rescue tool. The SAD provides a conduit for tracheal intubation in failed laryngoscopy. This article aims to help the operator: (1) select an intubating SAD with consistent performance; (2) inform the appropriate SAD-endotracheal tube pairings; and (3) explain various SAD and endotracheal tube maneuvers available to increase chances of successful intubation. Objectives: The first supraglottic airway device (SAD) was introduced more than thirty years ago. Since then, SADs have undergone multiple iterations and improvements. The SAD remains an airway rescue device for ventilation and an intubation conduit on difficult airway algorithms. Data Sources: Several SADs are specifically designed to facilitate tracheal intubation, i.e., “intubating SADs,” while most are “non-intubating SADs.” The two most commonly reported tracheal intubation methods via the SADs are the blind and visualized passage of the endotracheal tube (ETT) preloaded on a fiberoptic scope. Fiberoptic guided tracheal intubation (FOI) via an intubating SAD generally has higher success rates than blind intubations and is thus preferred. However, fiberscopes might not always be readily available, and anesthesiologists should be skilled to successfully intubate blindly through a SAD. Summery: This narrative review describes intubating SAD with consistent performance, appropriate SAD-ETT pairings, and various SAD and ETT maneuvers to increase successful intubation chances.

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Supraglottic airway devices vs tracheal intubation in children: a quantitative meta-analysis of respiratory complications

Pediatric Anesthesia ◽

10.1111/pan.12495 ◽

2014 ◽

Vol 24 (10) ◽

pp. 1088-1098 ◽

Cited By ~ 51

Author(s):

Virginie Luce ◽

Hakim Harkouk ◽

Christopher Brasher ◽

Daphné Michelet ◽

Julie Hilly ◽

...

Keyword(s):

Tracheal Intubation ◽

Meta Analysis ◽

Supraglottic Airway ◽

Respiratory Complications ◽

Supraglottic Airway Devices ◽

Airway Devices

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Supraglottic airway devices as conduits for unassisted tracheal intubation: a network meta-analysis v1 (protocols.io.tcxeixn)

protocols.io ◽

10.17504/protocols.io.tcxeixn ◽

2018 ◽

Author(s):

EunJin Ahn ◽

GeunJoo Choi ◽

Hyun Kang ◽

ChongWha Baek ◽

YongHun Jung ◽

...

Keyword(s):

Tracheal Intubation ◽

Meta Analysis ◽

Supraglottic Airway ◽

Supraglottic Airway Devices ◽

Airway Devices

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Comparison of Safety and Efficacy of Endotracheal Tube, Laryngeal Mask Airway Supreme and I Gel in Laparoscopic Surgeries

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/122 ◽

2021 ◽

Vol 8 (11) ◽

pp. 623-628

Author(s):

Heena Saini ◽

Rajesh Angral ◽

Neelam Gupta

Keyword(s):

Laryngeal Mask Airway ◽

Endotracheal Tube ◽

Gastric Tube ◽

Airway Device ◽

Laryngeal Mask ◽

Supraglottic Airway ◽

Group I ◽

Supraglottic Airway Devices ◽

Lma Supreme ◽

Airway Devices

BACKGROUND Present study was undertaken to assess the feasibility of laryngeal mask airway (LMA) supreme and I gel, the second generation supraglottic airway devices in laparoscopic surgeries. METHODS 120 patients with American Society of Anaesthesiologists (ASA) I and II (20 - 50 years) of either sex who underwent laparoscopic surgery under general anaesthesia were randomly divided into three groups. Airway was secured with endotracheal tube (ETT) in group E (N = 40), with LMA supreme in Group S (N = 40) and with I-gel in group I (N = 40). Insertion characteristics of airway device, ease of gastric tube insertion, haemodynamic response and perioperative laryngopharyngeal morbidities were assessed. RESULTS I-gel was easier to insert with higher first attempt success rate (95 %) than LMA Supreme (85 %) and ETT (90 %) but it was statistically insignificant. Heart rate (HR) and mean arterial pressure (MAP) was significantly higher in ETT group at the time of intubation, continued till 5 minutes and also at the time of extubation but statistically significant increase in HR and MAP were noted in group S and I only at the time of device insertion. Gastric tube was easier to insert in group S with shortest insertion time which was statistically significant. Incidence of coughing, dysphonia, dysphagia and sore throat was significantly more in group E. CONCLUSIONS I-gel and LMA Supreme can be used as an alternative to ETT for airway management in adult patients undergoing elective laparoscopic surgeries. KEYWORDS Endotracheal Tube, I-gel, LMA Supreme, Supraglottic Airway Device

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