Supraglottic airway

Revision as of 10:04, 27 June 2015 by Mholtz (talk | contribs)

Indications

  • Need for positive pressure ventilation (PPV)
    • Can be used both as primary and rescue airway (if BVM or intubation fail)[1]
    • Can also be used as a conduit/guide for elective or rescue fiberoptic intubation[2]

Contraindications

  • No absolute contraindications

Equipment Needed

  • Supraglottic Airway (SGA) device (many options exist)
  • Appropriate sedation/paralytic agents, if indicated
Mask Size Weight (kg) Age (yr) LMA Length (cm) LMA Cuff Vol (mL) Largest ETT^ (mm)
1 <5 <0.5 10 4 3.5
1.5 5-10 <1 10 5-7 4
2 6.5-20 1-5 11.5 7-10 4.5
2.5 20-30 5-10 12.5 14 5
3 30-60 10-15 19 15-20 6
4 60-80 >15 19 25-30 6.5
5 >80 >15 19 30-40 7

^Largest ETT that can pass thorough "Intubating LMA" (ILMA)

Procedure

Complications[1]

  • Bronchospasm
  • Hoarseness
  • Laryngeal nerve injury
  • Hypoglossal nerve injury
  • Pharyngeal edema
  • Dysphagia

Special Considerations

  • There are 2 generations of supraglottic airway devices[3][2]
    • 1st Gen = classic LMA, other standard LMAs
    • 2nd Gen = iGel, LMA Supreme, Pro-Seal LMA (PLMA)
  • Second generation devices achieve improved esophageal and pharyngeal seal (causes ↑ oropharyngeal leak pressure), incorporate a "drain tube" that allows access to the esophagus and stomach, and usually have an incorporated bite block.
  • Oropharyngeal leak pressure = the applied pressure at which the seal between the device and the larynx begins to leak.
    • Peak inspiratory pressure needs to be less than the oropharyngeal leak pressure for effective ventilation and to prevent gastric insufflation.[4]
  • Higher failure rate with obese patients, inappropriate pt position (e.g. trendelenberg), and placement by inexperienced provider[2]

See Also

References

  1. 1.0 1.1 Apfelbaum JL, et al.; American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013 Feb;118(2):251-70
  2. 2.0 2.1 2.2 Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Br J Anaesth. 2011 May;106(5)
  3. Timmermann, A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia, 2011, 66(Suppl. 2), pages 45–56.
  4. Patel B., Bingham R. Laryngeal mask airway and other supraglottic airway devices in paediatric practice. Contin Educ Anaesth Crit Care Pain (2009) 9 (1): 6-9.