An update on newer pediatric supraglottic airways with recommendations for clinical use

Abstract

Supraglottic airways are an established part of routine and emergency pediatric airway management, including use in difficult airways and neonatal resuscitation. With the introduction of newer supraglottic airways in children, efficacy can only be determined by comparing these devices with those that are already well established (laryngeal mask airway Classic and laryngeal mask airway ProSeal). This narrative review aims to present the current literature on these newer supraglottic airways and give recommendations for their use in various clinical scenarios based on the existing evidence.

A randomised comparison of the Ambu® AuraGain™ and the LMA® supreme in infants and children

“…The initial airway leak pressures in this study for the AuraGain are similar to previous studies with the LMA Supreme [1,5,6,12], but slightly lower than the reported airway leak pressures of the LMA ProSeal [2,13] and i-gel [14][15][16] in children. The slight increase in airway leak pressures at 10 min in this study is suggestive that the airway sealing characteristics remain relatively stable during the initial phase of anaesthetic maintenance.…”

“…The slight increase in airway leak pressures at 10 min in this study is suggestive that the airway sealing characteristics remain relatively stable during the initial phase of anaesthetic maintenance. The 10-min airway leak pressures are similar to the airway leak pressures demonstrated in recent reports on the LMA ProSeal [2,17,18] and igel [1,15,16] in children.…”

“…Our insertion success rates were high, and similar to rates seen with other second-generation SADs studied in children (LMA ProSeal, i-gel, and LMA Supreme) [1,2]. In addition, only experienced clinicians were involved in this study and placed the device under neuromuscular blockade, which likely facilitated insertion, and mitigated reflex activation of the airway.…”

“…With most paediatric second-generation devices, the addition of a gastric access port improves their safety profile but potentially compromises the functionality of the device as a conduit for tracheal intubation. As newer SADs are released into clinical practice, it is important to evaluate their clinical performance and safety to establish superiority or equivalence to existing devices [1][2][3][4]. This is particularly true in infants and small children, where the scarcity of paediatric cadavers means many airway device manufacturers traditionally simply release 'scaled down' versions of adult SADs.…”

Singapore Paediatric Resuscitation Guidelines 2016

“…Second-generation supraglottic devices may have the added benefi ts of allowing drainage of gastric contents and facilitation of endotracheal intubation in these situations. (42) Recommendation When ventilation is diffi cult and/or endotracheal intubation is not possible during paediatric resuscitation, appropriate supraglottic airway devices, especially laryngeal mask airways, if available, are recommended when used by experienced providers to provide a patent airway and support ventilation.…”