Air-Q blocker: A novel supraglottic airway device for patients with difficult airway and risk of aspiration

Darlong, Vanlal; Biyani, Ghansham; Baidya, Dalim Kumar; Pandey, Ravindra Mohan; Punj, Jyotsna

doi:10.4103/0970-9185.142904

Cited by 6 publications

(2 citation statements)

References 7 publications

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“… 244 – 248 Fibre-optically guided tracheal intubation through the i-gel has been reported with a high success rate. 249 250 Second-generation SADs specifically designed to facilitate tracheal intubation have been described, 190 251 252 but data regarding their efficacy are limited.…”

Section: Plan B Maintaining Oxygenation: Supraglottic Airway Device mentioning

confidence: 99%

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults

Frerk

Mitchell

McNarry

et al. 2015

British Journal of Anaesthesia

1,751

1,537

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These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

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Section: Plan B Maintaining Oxygenation: Supraglottic Airway Device mentioning

confidence: 99%

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults

Frerk

Mitchell

McNarry

et al. 2015

British Journal of Anaesthesia

1,751

1,537

View full text Add to dashboard Cite

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“…This device has been used in various situations for rescue ventilation and also aids in suctioning and venting the esophagus. [67]…”

Section: Introductionmentioning

confidence: 99%

A comparison between ProSeal laryngeal mask airway and Air-Q Blocker in patients undergoing elective laparoscopic cholecystectomy

Gupta

Mahajan

Jatinder

et al. 2019

J Anaesthesiol Clin Pharmacol

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Background and Aims:ProSeal laryngeal mask airway (PLMA) is an established device for airway management, while Air-Q Blocker (AQB) is a relatively new supraglottic device. The aim of this study is to compare AQB against PLMA in adults undergoing laparoscopic cholecystectomy under general anesthesia.Material and Methods:Eighty-eight adult patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomly allocated into two groups. A drain tube (gastric tube for PLMA and blocker tube for AQB) was inserted through the drain channel of the respective device. PLMA was inserted in Group P (n = 44) and AQB was inserted in Group A (n = 44) to secure the airway. The primary endpoint was airway seal pressure. Secondarily, we sought to compare overall insertion success, ease of insertion, hemodynamic effects after initial placement, ease of drain tube placement, and perioperative oropharyngolaryngeal morbidity between the devices.Results:Oropharyngeal seal pressures for AQB and PLMA were 31.5 ± 2.41 and 29.41 ± 2.14 cm H2O, respectively (P = 0.01). Insertion time was longer with AQB than PLMA, 25.59 ± 5.71 and 18.66 ± 3.15 seconds, respectively (P = 0.001). Ease and success rate of insertion was better with PLMA compared to AQB. Failure of device insertion was seen in 2 cases of Group A. Gastric distension was seen in 4 patients in Group A, requiring replacement with endotracheal tube in two patients. Ventilation was successful in all 44 patients with PLMA. Both the devices were comparable in providing a patent airway and adequate oxygenation during controlled ventilation. There was an increased trend of airway trauma and complications in the AQB group.Conclusion:Both PLMA and AQB show similar efficacy in maintaining ventilation and oxygenation, during laparoscopic surgery. However, proper positioning and functioning of the blocker tube of AQB is a limiting factor, and needs further evaluation.

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Guidelines for the management of tracheal intubation in critically ill adults

Higgs

McGrath²,

Goddard

et al. 2018

British Journal of Anaesthesia

647

521

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These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4 National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.

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Air-Q blocker: A novel supraglottic airway device for patients with difficult airway and risk of aspiration

Cited by 6 publications

References 7 publications

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults

A comparison between ProSeal laryngeal mask airway and Air-Q Blocker in patients undergoing elective laparoscopic cholecystectomy

Guidelines for the management of tracheal intubation in critically ill adults

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