Supraglottic Airway Devices: Present State and Outlook for 2050.
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
01 Feb 2024
01 Feb 2024
Historique:
medline:
13
1
2024
pubmed:
13
1
2024
entrez:
12
1
2024
Statut:
ppublish
Résumé
Correct placement of supraglottic airway devices (SGDs) is crucial for patient safety and of prime concern of anesthesiologists who want to provide effective and efficient airway management to their patients undergoing surgery or procedures requiring anesthesia care. In the majority of cases, blind insertion of SGDs results in less-than-optimal anatomical and functional positioning of the airway devices. Malpositioning can cause clinical malfunction and result in interference with gas exchange, loss-of-airway, gastric inflation, and aspiration of gastric contents. A close match is needed between the shape and profile of SGDs and the laryngeal inlet. An adequate first seal (with the respiratory tract) and a good fit at the second seal of the distal cuff and the gastrointestinal tract are most desirable. Vision-guided insertion techniques are ideal and should be the way forward. This article recommends the use of third-generation vision-incorporated-video SGDs, which allow for direct visualization of the insertion process, corrective maneuvers, and, when necessary, insertion of a nasogastric tube (NGT) and/or endotracheal tube (ETT) intubation. A videoscope embedded within the SGD allows a visual check of the glottis opening and position of the epiglottis. This design affords the benefit of confirming and/or correcting a SGD's position in the midline and rotation in the sagittal plane. The first clinically available video laryngeal mask airways (VLMAs) and multiple prototypes are being tested and used in anesthesia. Existing VLMAs are still not perfect, and further improvements are recommended. Additional modifications in multicamera technology, to obtain a panoramic view of the SGD sitting correctly in the hypopharynx and to prove that correct sizes have been used, are in the process of production. Ultimately, any device inserted orally-SGD, ETT, NGT, temperature probe, transesophageal scope, neural integrity monitor (NIM) tubes-could benefit from correct vision-guided positioning. VLMAs also allow for automatic recording, which can be documented in clinical records of patients, and could be valuable during teaching and research, with potential value in case of legal defence (with an airway incident). If difficulties occur with the airway, documentation in the patient's file may help future anesthesiologists to better understand the real-time problems. Both manufacturers and designers of SGDs may learn from optimally positioned SGDs to improve the design of these airway devices.
Identifiants
pubmed: 38215712
doi: 10.1213/ANE.0000000000006673
pii: 00000539-202402000-00012
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
337-349Informations de copyright
Copyright © 2023 International Anesthesia Research Society.
Déclaration de conflit d'intérêts
Conflicts of Interest: See Disclosures at the end of the article.
Références
van Zundert TC, Brimacombe JR, Ferson DZ, Bacon DR, Wilkinson DJ. Archie Brain: celebrating 30 years of development in laryngeal mask airways. Anaesthesia. 2012;67:1375–1385.
Danha RF, Thompson JL, Popat MT, Pandit JJ. Comparison of fibreoptic-guided orotracheal intubation through classic and single-use laryngeal mask airways. Anaesthesia. 2005;60:184–188.
Rai MR, Scott SH, Marfin AG, Popat MT, Pandit JJ. A comparison of a flexometallic tracheal tube with the intubating laryngeal mask tracheal tube for nasotracheal fibreoptic intubation using the two-scope technique. Anaesthesia. 2009;64:1303–1306.
Pandit JJ, MacLachlan K, Dravid RM, Popat MT. Comparison of times to achieve tracheal intubation with three techniques using the laryngeal or intubating laryngeal mask airway. Anaesthesia. 2002;57:128–132.
Panjwani S, Seymour P, Pandit JJ. A manoeuvre for using the flexible fibreoptic bronchoscope through the Intubating Laryngeal Mask Airway. Anaesthesia. 2001;56:696–697.
Pandit JJ. The intubating laryngeal mask airway as a guide to fibreoscopy. Anaesthesia. 2002;57:410–411.
Van Zundert AAJ, Kumar CM, Van Zundert TCRV, Gatt SP, Pandit JJ. The case for a 3rd generation supraglottic airway device facilitating direct vision placement. J Clin Monit Comput. 2021;35:217–224.
Van Zundert AAJ, Gatt SP, Van Zundert TCRV, Kumar CM, Pandit JJ. Features of new vision-incorporated third-generation video laryngeal mask airways. J Clin Monit Comput. 2022;36:921–928.
Pandit JJ, Popat MT, Cook TM, et al. The Difficult Airway Society “ADEPT” guidance on selecting airway devices: the basis of a strategy for equipment evaluation. Anaesthesia. 2011;66:726–737.
Ní Eochagáin A, Athanassoglou V, Cumberworth A, et al. Assessing a novel second generation laryngeal mask airway using the “ADEPT” approach: results from the LMA® Protector™ observational study. J Clin Monit Comput. 2023;37:517–524.
Athanassoglou V, O’Sullivan EP, van Zundert A, Pandit JJ. New guidelines for research in airway device evaluation: time for an updated approach (ADEPT-2) to the Difficult Airway Society’s “ADEPT” strategy? J Clin Monit Comput. 2023;37:345–350.
Eschertzhuber S, Brimacombe J, Hohlrieder M, Stadlbauer KH, Keller C. Gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to the digital and introducer tool techniques in patients with simulated difficult laryngoscopy using a rigid neck collar. Anesth Analg. 2008;107:1253–1256.
van Zundert AA, Skinner MW, Van Zundert TC, Luney SR, Pandit JJ. Value of knowing physical characteristics of the airway device before using it. Br J Anaesth. 2016;117:12–16.
Van Zundert T, Gatt S. The Baska Mask® - A new concept in Self-sealing membrane cuff extraglottic airway devices, using a sump and two gastric drains: a critical evaluation. J Obstet Anaesth Crit Care. 2012;2:23–30.
Fan H, Li L, Zhu L, Yi Z, Diao Y. Comparison of the third-generation streamlined liner of the pharynx airway (SLIPA-3G) with the laryngeal mask airway supreme for laparoscopic cholecystectomy: a randomized prospective study. BMC Anesthesiol. 2022;22:97.
Jackson KM, Cook TM. Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices. Anaesthesia. 2007;62:388–393.
Kulnig J, Füreder L, Harrison N, Frass M, Robak O. Performance and skill retention of five supraglottic airway devices for the pediatric difficult airway in a manikin. Eur J Pediatr. 2018;177:871–878.
Cook T, Howes B. Supraglottic airway devices: recent advances. Cont Edu Anaesth Crit Care, Pain. 2011;11:56–61.
Hinkelbein J, Ahlbäck A, Antwerber C, et al. Using supraglottic airways by paramedics for airway management in analogue microgravity increases speed and success of ventilation. Sci Rep. 2021;11:9286.
Brimacombe J, Irving S, Keller C. Ease placement of LMA ProSeal with a gastric tube inserted: In Response. Anesth Analg. 2004;98:1817–1817.
Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia. 2011;66:45–56.
Henlin T, Sotak M, Kovaricek P, Tyll T, Balcarek L, Michalek P. Comparison of five 2nd-generation supraglottic airway devices for airway management performed by novice military operators. Biomed Res Int. 2015;2015:201898.
Brimacombe JR. Laryngeal Mask Anesthesia. Principles and Practice. Chapter 8. Placement Phase. 2nd ed. Saunders, Elsevier; 2005.
Van Zundert TCRV. Improvements towards safer extraglottic airway devices. PhD Thesis. The University of Maastricht, Maastricht, the Netherlands. 4 June 4, 2015. DOI: 10.13140/RG.2.2.28178.66242
Rosenblatt W. Airway on demand: tutorial on SGA insertion. Anesthesiology News. 2023. Accessed May 14, 2023. Available at: https://www.youtube.com/@AirwayOnDemand/videos.
Kumar CM, Van Zundert TC, Seet E, Van Zundert AA. Time to consider supraglottic airway device oropharyngeal leak pressure measurement more objectively. Acta Anaesthesiol Scand. 2021;65:142–145.
Brimacombe JR. Laryngeal Mask Anesthesia. Principles and Practice. Chapter 3. Applied Anatomy. 2nd ed. Saunders, Elsevier, 2005, 92–101.
Van Zundert AA, Kumar CM, Van Zundert TC. Malpositioning of supraglottic airway devices: preventive and corrective strategies. Br J Anaesth. 2016;116:579–582.
Van Zundert AAJ, Gatt SP, Kumar CM, Van Zundert TCRV. Vision-guided placement of supraglottic airway device prevents airway obstruction: a prospective audit. Br J Anaesth. 2017;118:462–463.
Van Zundert AAJ, Gatt SP, Kumar CM, Van Zundert TCRV, Pandit JJ. “Failed supraglottic airway”: an algorithm for suboptimally placed supraglottic airway devices based on videolaryngoscopy. Br J Anaesth. 2017;118:645–649.
Brimacombe JR. Laryngeal Mask Anesthesia. Principles and Practice. Chapter 8. Applied Anatomy. Assessment of function and position. 2nd Ed. Saunders, Elsevier, 2005, 226–231.
Chrimes N, Higgs A, Hagberg CA, et al. Preventing unrecognised oesophageal intubation: a consensus guideline from the project for universal management of Airways and international airway societies. Anaesthesia. 2022;77:1395–1415.
Cook TM, Kelly FE. Time to abandon the “vintage” laryngeal mask airway and adopt second-generation supraglottic airway devices as first choice. Br J Anaesth. 2015;115:497–499.
Van Zundert TC, Hendrickx JF, De Witte JL, Wong DT, Cattano D, Brimacombe JR. Do mask aperture bars of extraglottic airway devices prevent prolapse of epiglottis causing airway obstruction? A randomized crossover trial in anesthetized adult patients. J Clin Anesth. 2016;31:231–237.
Apfelbaum JL, Hagberg CA, Connis RT, et al. American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;2022:31–81.
van Zundert AAJ, Wyssusek KH, Pelecanos A, Roets M, Kumar CM. A prospective randomized comparison of airway seal using the novel vision-guided insertion of LMA-Supreme® and LMA-Protector®. J Clin Monit Comput. 2020;34:285–294.
Heir JS, Guo SL, Purugganan R, et al. A randomized controlled study of the use of video double-lumen endobronchial tubes versus double-lumen endobronchial tubes in thoracic surgery. J Cardiothorac Vasc Anesth. 2018;32:267–274.
Van Zundert TCRV, Gatt SP, Van Zundert AAJ. Videolaryngeal mask airway - a new monitor in airway management. J Clin Monit Comput. 2023;37:717–721.
Yan C, Chen Y, Sun P, Qv Z-Y, Zuo M-Z. Preliminary evaluation of SaCoVLM™ video laryngeal mask airway in airway management for general anesthesia. BMC Anesthesiol 2022;22:3.
Yan C, Zhang Y, Chen Y, Qv Z-Y, Zuo M-Z. Comparison of SaCoVLM™ video laryngeal mask-guided intubation and i-gel combined with flexible bronchoscopy-guided intubation in airway management during general anesthesia: a non-inferiority study. BMC Anesthesiol. 2022;22:302.
Zhi J, Deng XM, Zhang YM, Wei LX, Wang QY, Yang D. Preliminary evaluation of SaCoVLM video laryngeal mask-guided intubation in airway management for anesthetized children. BMC Anesthesiol. 2023;23:49.
Sun Y, Huang L, Xu L, Zhang M, Guo Y, Wang Y. The application of a SaCoVLMTM visual intubation laryngeal mask for the management of difficult airways in morbidly obese patients: case report. Front Med (Lausanne). 2021;8:763103.
Levitan RM, Heitz JW, Sweeney M, Cooper RM. The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices. Ann Emerg Med. 2011;57:240–247.
Dean P, Edmunds K, Shah A, et al. Video laryngoscope screen visualization and tracheal intubation performance: a video-based study in a pediatric emergency department. Ann Emerg Med. 2022;79:323–332.