Features of new vision-incorporated third-generation video laryngeal mask airways

Abstract

Numerous studies have shown that blindly inserted supraglottic airway devices (SADs) are sub-optimally placed in 50 to 80% of all cases. Placement under direct vision has been recommended. We describe the very first two new SADs of the third generation that incorporate a videoscope with flexible tip. Both devices are made up of two interlocking components-the SAD and a videoscope. The 3rd generation, direct vision SADs allow vision-guided insertion, corrective manoeuvres, if needed, and correct placement in the hypopharynx and possess additional features which permit insertion of a gastric tube and endotracheal intubation should the need arise. This article describes the two new devices' physical characteristics, features, rationale for use, advantages and limitations in comparison to existing devices. Each of the two new devices-the Video Laryngeal Mask (VLM TM , UE Medical®) and the SafeLM® Video Laryngeal Mask System (SafeLM TM VLMS, Magill Medical Technology®) consist of two parts: (a) a disposable 2nd generation SAD with a silicone cuff and an anatomically curved tube; and (b) a reusable patient-isolated videoscope and monitoring screen, with the flexible scope located into a specially-designed, blind-end channel terminating in the bowl of the SAD, preventing the videoscope from contacting patient body fluids in the SAD bowl. Third generation placement-under-direct-vision supraglottic airway devices possess several theoretical safety and ease of use advantages which now need to be validated in clinical use.

What is new in airway management

“…Currently, first-, and second-generation SADs have a larger global market share than ETTs during surgical interventions [ 9 , 10 ], yet those markets are territorial and operator/standards dependent and they were definitely modified by the pandemic.…”

“…Recently conceptualization and designing of a SAD with an integrated videoscope has regained interest [ 9 , 11 ]: a combination of a second-generation SAD with a scope is considered a third-generation SAD [ 9 , 11 ]. Two of these third-generation devices have recently been released and their characteristics and functionality described in this journal [ 9 , 11 ].…”

“…Recently conceptualization and designing of a SAD with an integrated videoscope has regained interest [ 9 , 11 ]: a combination of a second-generation SAD with a scope is considered a third-generation SAD [ 9 , 11 ]. Two of these third-generation devices have recently been released and their characteristics and functionality described in this journal [ 9 , 11 ]. In reality integrated-videoscope for guided intubation through an SAD are not new: the LMA-C Trach and Total-Track VLM were manufactured in the past, although the production of the former has been discontinued since then, but their goal was on intubation of the trachea and not on the successful-insertion of the SAD per se [ 9 , 11 ].…”

“…SADs in general are considered easier to insert than ETTs and result in fewer complications and high patient satisfaction [9]. Indications for use include the perioperative and prehospital period, the emergency, obstetric and ICU patient [9][10][11]. Furthermore, SADs have also been advocated during cardiac resuscitation [9][10][11].…”

“…Indications for use include the perioperative and prehospital period, the emergency, obstetric and ICU patient [9][10][11]. Furthermore, SADs have also been advocated during cardiac resuscitation [9][10][11].…”