Comparison of three supraglottic airway devices for airway rescue in the prone position: A manikin-based study

Abstract

Background:Accidental extubation during surgery in prone position can be life-threatening. Supraglottic airway devices (SAD) have been used successfully in such situations to rescue the airway. However, which SAD would be most appropriate in this setting has not been described in the literature.Aims:The aim of our study was to determine the most appropriate SAD for securing airway in a prone position during accidental extubation.Materials and Methods:In the study, Airway Trainer (Laerdal) manikin was used for studying insertion of three SADs; I-gel, Laryngeal Mask Airway ProSeal™ (PLMA) and LMA Classic™ (CLMA) in the prone position. Forty anesthesia resident doctors participated in this study. The time taken for insertion; ease of insertion and ventilation; bronchoscopic view; and insertion score were compared among the three groups.Results:The time taken for I-gel insertion was significantly lesser (12.89 ± 3.94 seconds) as compared to CLMA (17.07 ± 3.5 seconds) and PLMA (25 + 4.78 seconds). Least resistance was encountered in the insertion of I-gel, while maximum resistance was experienced in PLMA group (22.5% vs. 90%). The maneuver required for optimal positioning was observed in 27.5% of PLMA insertion, 2.5% in CLMA while no maneuver was required in any of the I-gel insertion. Ease of ventilation was comparable in all three SADs. The bronchoscopic view and insertion score were significantly higher with I-gel as compared to CLMA and PLMA.Conclusion:All three SADs were successful as rescue devices during accidental extubation in the prone position. However, the ease of insertion was maximum with I-gel, followed by CLMA and PLMA.

Blind intubation through an i-gel® in the prone position: A prospective cohort study

“…The i-gel is an SAD that can be inserted within ten seconds in the prone position and facilitates airway establishment. 5,6 In the prone position, mean airway seal pressures with the i-gel of 25 to 28 cmH 2 O are reported, which is comparable to other SADs. 6,7 The i-gel is not specifically designed for blind intubation, unlike some other SADs, but its use as a blind intubation conduit has been reported in the supine position (but not the prone position), resulting in an intubation rate of 80%.…”

Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position

“…[ 1 – 7 , 17 ] We identified only 1 crossover manikin study that compared airway rescue performances using the various SGAs in the prone position. [ 18 ] There are only a few case reports of airway rescue with tracheal intubation in this situation. [ 6 , 7 ] However, no randomized control trials have investigated the efficacy of airway rescue with tracheal intubation in the prone position.…”

The use of supraglottic airways in the prone position is useful in specific situations

“…Some clinicians still consider the SGA as contraindicated in procedures lasting more than 2 h, even supine, despite lack of evidence for that belief. 4 Although electively choosing to insert a SGA in the prone position is still a hot topic, we think that training all clinicians to insert a SGA for airway rescue of a patient in the prone position is a MUST. 5 With appropriate support of the mannequin's head and lowering the head of the operating table, insertion of the SGA device in the prone (or face slightly aside) position becomes straightforward.…”