Intubating Through Supraglottic Airway Devices: A Narrative Review

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Say Yang Ong ◽  
Vanessa Moll ◽  
Berthold Moser ◽  
Amit Prabhakar ◽  
Elyse M. Cornett ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Airway Device ◽  
Narrative Review ◽  
Supraglottic Airway ◽  
Successful Intubation ◽  
Success Rates ◽  
Supraglottic Airway Device ◽  
Supraglottic Airway Devices ◽  
Consistent Performance

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.

Airway Management in Children

2019 ◽  
Author(s):  
James Peyton ◽  
Raymond Park
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Fiberoptic Bronchoscopy ◽  
Difficult Tracheal Intubation ◽  
Airway Device ◽  
Successful Outcome ◽  
Supraglottic Airway ◽  
Supraglottic Airway Device ◽  
Factors Associated ◽  
Life Threatening

Airway management in children is usually very straightforward. Unfortunately, when it is not straightforward complications associated with problems encountered while managing the airway can be life-threatening. Airway management can be considered to consist of several different techniques for oxygenating and ventilating an anesthetized patient, namely mask ventilation, supraglottic airway device ventilation, and tracheal intubation. This chapter discusses these techniques and the factors associated with difficulty in performing them. There are anatomic features associated with difficulty in all of these techniques that are caused by syndromes or abnormal airway anatomy in children, although around 20% of difficult intubations are unanticipated. The majority of complications occur when attempting a difficult tracheal intubation. Morbidity and mortality relating to tracheal intubation correlate to the number of attempts at tracheal intubation. Severe hypoxia is estimated to occur in around 9% of children who are difficult to intubate and hypoxic cardiac arrest in nearly 2%, so the key to successful airway management is to focus on maintaining oxygenation and choosing a technique with the best chance of a successful outcome during the first attempt at airway management. This review contains 6 figures, 7 tables, and 41 references.  Keywords: cricothyrotomy, difficult airway, direct laryngoscopy, fiberoptic bronchoscopy, front of neck access, intubation, pediatric, videolaryngoscopy

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

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

scholarly journals Cervical tracheal resection without intubation

2021 ◽  
Vol 102 (3) ◽  
pp. 381-388
Author(s):  
A A Akopov ◽  
M G Kovalev
Keyword(s):  
Endotracheal Tube ◽  
Tracheal Stenosis ◽  
Airway Device ◽  
Early Postoperative Period ◽  
Supraglottic Airway ◽  
Tracheal Resection ◽  
Supraglottic Airway Device ◽  
Airway Patency ◽  
Surgical Interventions ◽  
Tube Removal

Aim. To present the experience in a new approach for the surgical treatment of cicatricial cervical tracheal stenosis tracheal resection without using an endotracheal tube. Methods. The technique includes preliminary metal stent placement instead of bougienage in the stenosis zone; introduction of the supraglottic airway device I-Gel instead of the endotracheal tube and; jet ventilation through the supraglottic airway device. The stent is removed together with the resected trachea. The technique of cervical tracheal resection using the supraglottic airway device was implemented in 22 patients with cicatricial tracheal stenosis. Results. The resection length ranged from 15 to 45 mm (on average, 273 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 1099 minutes). Preliminary stenting excluded preoperative bougienage of the trachea and facilitated intraoperative assessment of the extent of the stenosis. The absence of an endotracheal tube facilitated the formation of anastomosis of the trachea, eliminated the risk of trauma to the anastomosis during tube removal. There were no complications in the early postoperative period. The length of postoperative hospital stay ranged from10 to 14 days (on average, 122 days). No restenosis was detected at long term follow-up. Conclusion. Performing tracheal resection without intubation allows the surgeon to work comfortably, observing the safety conditions for ensuring airway patency throughout the operation by installing a supraglottic airway device.

scholarly journals Blind Intubation through Self-pressurized, Disposable Supraglottic Airway Laryngeal Intubation Masks

2017 ◽  
Vol 127 (2) ◽  
pp. 307-316 ◽  
Author(s):  
Kurt Ruetzler ◽  
Sandra Esther Guzzella ◽  
David Werner Tscholl ◽  
Tanja Restin ◽  
Marco Cribari ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Muscle Relaxation ◽  
Intensive Therapy ◽  
Airway Device ◽  
University Hospital ◽  
Supraglottic Airway ◽  
Leak Pressure ◽  
Supraglottic Airway Device ◽  
Air Leak ◽  
Supraglottic Airway Devices

Abstract Background Supraglottic airway devices commonly are used for securing the airway during general anesthesia. Occasionally, intubation with an endotracheal tube through a supraglottic airway is indicated. Reported success rates for blind intubation range from 15 to 97%. The authors thus investigated as their primary outcome the fraction of patients who could be intubated blindly with an Air-Qsp supraglottic airway device (Mercury Medical, USA). Second, the authors investigated the influence of muscle relaxation on air leakage pressure, predictors for failed blind intubation, and associated complications of using the supraglottic airway device. Methods The authors enrolled 1,000 adults having elective surgery with endotracheal intubation. After routine induction of general anesthesia, a supraglottic airway device was inserted and patients were ventilated intermittently. Air leak pressure was measured before and after full muscle relaxation. Up to two blind intubation attempts were performed. Results The supraglottic airway provided adequate ventilation and oxygenation in 99% of cases. Blind intubation succeeded in 78% of all patients (95% CI, 75 to 81%). However, the success rate was inconsistent among the three centers (P < 0.001): 80% (95% CI, 75 to 85%) at the Institute of Anesthesia and Pain Therapy, Kantonsspital Winterthur, Winterthur, Switzerland; 41% (95% CI, 29 to 53%) at the Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland; and 84% (95% CI, 80 to 88%) at the Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Leak pressure before relaxation correlated reasonably well with air leak pressure after relaxation. Conclusions The supraglottic airway device reliably provided a good airway and allowed blind intubation in nearly 80% of patients. It is thus a reasonable initial approach to airway control. Muscle relaxation can be used safely when unparalyzed leak pressure is adequate.

scholarly journals The evaluation of the insertion parameters and complications of the i-gel Plus airway device for maintaining patent airway during planned procedures under general anaesthesia: a protocol for a prospective multi-center cohort study.

2021 ◽  
Author(s):  
Pavel Michalek ◽  
Olga Klementova ◽  
Taranpreet Kaur Bhoday ◽  
Jakub Werner ◽  
Ana Lopez ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Success Rate ◽  
General Anaesthesia ◽  
Airway Device ◽  
University Hospital ◽  
Supraglottic Airway ◽  
Military Hospital ◽  
Supraglottic Airway Device ◽  
Supraglottic Airway Devices

Introduction: Supraglottic airway devices represent a less invasive method of airway management than tracheal intubation during general anaesthesia. Their continued development is focused mainly on improvements in the insertion success rate and minimalization of perioperative and postoperative complications. The i-gel Plus is a novel, anatomically preshaped supraglottic airway device which achieves a perilaryngeal seal due to a non-inflatable cuff made of a soft thermoplastic elastomer. The purpose of this trial is to assess the success rate of the i-gel Plus use during elective procedures under general anaesthesia, its intraoperative performance, and the degree of postoperative complications. Methods and analysis: This is a multicenter, prospective, interventional cohort study. The enrolment will take place in seven centers in four European countries. We plan to enrol 2000 adult patients in total, who are scheduled for elective surgery under general anaesthesia, and with an indication for use of a supraglottic airway device for management of their airway. The study is projected to run over a period of 18 months. The primary outcome of the study is the total success rate of the i-gel Plus insertion in terms of successful ventilation and oxygenation through the device. Secondary outcomes include perioperative parameters, such as insertion time, seal/leak pressures, number of insertion attempts, and postoperative adverse events and complications. Postoperative follow-up will be performed at 1 hour, 24 hours in all patients, and for selected patients at 3 and 6 months. Ethics and dissemination: The trial has received the following ethical approvals: General University Hospital Prague, University Hospital Olomouc, University Military Hospital Prague, University Hospital Barcelona, University Hospital Lodz, Antrim Area Hospital, Craigavon Area Hospital, Office for Research Ethics Committees Northern Ireland. The results will be published in peer-reviewed journals and presented at relevant anaesthesia conferences.

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