Do mask aperture bars of extraglottic airway devices prevent prolapse of epiglottis causing airway obstruction? A randomized crossover trial in anesthetized adult patients

Zundert, Tom C. R. V. Van; Hendrickx, Jan F. A.; Witte, Jan L. De; Wong, David T.; Cattano, Davide; Brimacombe, J.

doi:10.1016/j.jclinane.2015.12.004

Cited by 7 publications

(9 citation statements)

References 14 publications

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“…The endoscopic evaluation did not demonstrate any difference between the EADs with or without MABs. 47 The morphometric studies of the adult human epiglottis have reported the width of the epiglottis as ±27 mm for males and ±21 mm for females which is in contrast to the width of the aperture of EADs (±15 mm) and therefore questions the need for the MABs. 48 …”

Section: Specific Eadsmentioning

confidence: 99%

Extraglottic airway devices: technology update

Sharma

Sahai

Sood

2017

MDER

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Extraglottic airway devices (EADs) have revolutionized the field of airway management. The invention of the laryngeal mask airway was a game changer, and since then, there have been several innovations to improve the EADs in design, functionality, safety and construction material. These have ranged from changes in the shape of the mask, number of cuffs and material used, like rubber, polyvinylchloride and latex. Phthalates, which were added to the construction material in order to increase device flexibility, were later omitted when this chemical was found to have serious adverse reproductive outcomes. The various designs brought out by numerous companies manufacturing EADs resulted in the addition of several devices to the airway market. These airway devices were put to use, many of them with inadequate or no evidence base regarding their efficacy and safety. To reduce the possibility of compromising the safety of the patient, the Difficult Airway Society (DAS) formed the Airway Device Evaluation Project Team (ADEPT) to strengthen the evidence base for airway equipment and vet the new extraglottic devices. A preuse careful analysis of the design and structure may help in better understanding of the functionality of a particular device. In the meantime, the search for the ideal EAD continues.

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Section: Specific Eadsmentioning

confidence: 99%

Extraglottic airway devices: technology update

Sharma

Sahai

Sood

2017

MDER

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“…The LMA Supreme size was determined based on patient body weight according to the manufacturer's instructions 19 . In the control group, the LMA Supreme was inserted using a 7‐cm height pillow (Figure 1A,B), which is conventionally used for the insertion of a LMA Supreme 7,10‐12 . In the high group, an LMA Supreme was inserted using a 14‐cm height pillow made with two 7 cm height pillows (Figure 1C,D).…”

Section: Methodsmentioning

confidence: 99%

“…The LMA have been inserted using the sniffing position 9 . The LMA has generally been inserted by conventional head elevation with a 7‐cm height pillow 7,9‐12 . However, the appropriate height of head elevation is unclear.…”

Section: Introductionmentioning

confidence: 99%

Head elevation and laryngeal mask airway Supreme insertion: A randomized controlled trial

Park

Hong

et al. 2020

Acta Anaesthesiol Scand

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Background A laryngeal mask airway (LMA) is usually inserted by conventional 7 cm head elevation. However, little is known about the association of head elevation degree and LMA insertion. We hypothesized that 14 cm head elevation would increase the first attempt success rate of LMA Supreme insertion compared with conventional 7 cm head elevation in patients undergoing transurethral resection of bladder tumour. Methods Patients were randomly allocated to the high group (n = 55, 14 cm head elevation) or the control group (n = 55, conventional 7 cm head elevation). The primary outcome was the first attempt success rate of LMA Supreme insertion. Results The first attempt success rate was significantly higher in the high group than in the control group (53 [96.4%] vs 40 [72.7%], P = .001, relative risk = 1.30, 95% confidence interval [CI] = 1.12‐1.57, absolute risk reduction = 23.7%). Fibreoptic bronchoscope grade 4 (ie optimal position of the LMA) was significantly higher in the high group (35 [64.8%] vs 18 [36.7%], P = .004, relative risk = 1.76, 95% CI = 1.16‐2.68, absolute risk reduction = 30.9%). Conclusions Head elevation of 14 cm height increased the first attempt success rate of LMA Supreme insertion and fibreoptic bronchoscopic grade in patients undergoing transurethral resection of bladder tumour. High head elevation can be an effective option for successful LMA Supreme insertion. Trial Registry Number: Clinicaltrials.gov (NCT04229862).

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“…For example, the aperture bars on some SGDs have no function; certainly, no protective role in preventing epiglottis prolapse and may indeed cause trauma to epiglottis and arytenoids. 34 They certainly need negotiating with a fiberscope so pose an unnecessary barrier in this regard. 5 Aperture bars are best avoided.…”

Section: Not All Parts Of Device Manufacturing Are Usefulmentioning

confidence: 99%

Supraglottic Airway Devices: Present State and Outlook for 2050

van Zundert,

Gatt,

van Zundert

et al. 2024

Anesthesia &Amp; Analgesia

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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.

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Do mask aperture bars of extraglottic airway devices prevent prolapse of epiglottis causing airway obstruction? A randomized crossover trial in anesthetized adult patients

Cited by 7 publications

References 14 publications

Extraglottic airway devices: technology update

Extraglottic airway devices: technology update

Head elevation and laryngeal mask airway Supreme insertion: A randomized controlled trial

Supraglottic Airway Devices: Present State and Outlook for 2050

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