Le PAxpress™ est un appareil de ventilation efficace, mais présente un taux d’échec de 18 % pour l’intubation trachéale sous guidage lumineux flexible chez les patients anesthésiés paralysés

Abstract

P Pu ur rp po os se e: : The PAxpress™ is a new, single-use, extraglottic airway device. We evaluate: 1) insertion success rates; 2) airway sealing pressure, ventilatory capability and calculated mucosal pressures (in vitro minus in vivo intracuff pressure) at 30-60 mL cuff inflation volume; 3) the feasibility of lightwand-guided tracheal intubation; and 4) the incidence of mucosal trauma.M Me et th ho od ds s: : Ninety anesthetized, paralyzed adults were studied. Airway management was by senior anesthesiologists with no prior experience with the PAX, but considerable experience with extraglottic airway devices and the flexible-lightwand.

Performance of the PAX press ™ vs the ProSeal™ laryngeal mask airway during general anesthesia

“…These results are in accordance with previous reports for both devices, 1,6,12 and with other data showing higher hemodynamic changes upon insertion of the PA X ™ when compared to the Classic LMA™. 3 Such observations suggest that trauma is more likely to occur if the PA X ™ is used instead of the PLMA™.…”

“…First attempt insertion rates observed for the PLMA™ (84%) and the PA X ™ (76%) in our study are similar to observations from other studies. 1,2,[11][12][13] The failure rate was low (4%) for both devices.…”

“…It has been shown to be an easily inserted, effective airway device. [1][2][3] The ProSeal™ (PLMA™) is a modified version of the classic LMA™ with a modified cuff to improve the seal and a drainage tube to isolate the glottis from the esophagus. 4 Although its insertion has been shown to be longer and first time insertion success rates slightly lower, the PLMA™ provided higher airway sealing pressures when compared to the classic LMA™ 5,6 without causing more sore throats or intraoperative complications.…”

Assessment of manoeuvres required for successful blind tracheal intubation through the PAXpress™

“…Over the last 20 years, since the introduction of the laryngeal mask airway, there has been a change from the use of tracheal tubes to supraglottic airway devices for maintenance of the airway during anaesthesia. A number of these devices have been recommended for blind tracheal intubation [1–3]. Blind intubation through one of these devices may require various manipulations to improve the alignment of the device with the larynx.…”

“…Despite this, Dimitriou et al. [3] recommended the PAX as an aid to intubation. They described the technique required to intubate through PAX using a light wand for guidance.…”