Supraglottic airways in difficult airway management: successes, failures, use and misuse

Abstract

SummarySupraglottic airway devices (SAD) play an important role in the management of patients with difficult airways. Unlike other alternatives to standard tracheal intubation, e.g. videolaryngoscopy or intubation stylets, they enable ventilation even in patients with difficult facemask ventilation and simultaneous use as a conduit for tracheal intubation. Insertion is usually atraumatic, their use is familiar from elective anaesthesia, and compared with tracheal intubation is easier to learn for users with limited experienced in airway management. Use of SADs during difficult airway management is widely recommended in many guidelines for the operating room and in the pre‐hospital setting. Despite numerous studies comparing different SADs in manikins, there are few randomised controlled trials comparing different SADs in patients with difficult airways. Therefore, most safety data come from extended use rather than high quality evidence and claims of efficacy and particularly safety must be interpreted cautiously.

Incidence of and risk factors for difficult ventilation via a supraglottic airway device in a population of 14 480 patients from South‐East Asia

“…Jersey, UK). None of the devices used was deemed superior to any other, and the choice was left to the discretion of the attending anaesthetist [11]. Insertion of the SAD was performed by a senior operator (a certified anaesthetist or resident anaesthetist with more than two years of experience), or by a junior operator (resident anaesthetist with less than two years of experience) with the anaesthetist in attendance.…”

“…Maintenance of oxygenation or rapid recovery from hypoxaemia is by far the most crucial consideration of airway management [10]. Supraglottic airway devices have been used as a rescue strategy for the difficult airway and maintenance of oxygenation, which is the key to reducing morbidity and mortality [11,12]. As such, identification of risk factors for difficult ventilation via a SAD should be an essential part of airway management.…”

A randomised comparison of free-handed vs air-Q™ assisted fibreoptic-guided tracheal intubation in children < 2 years of age

“…Several studies have demonstrated the efficacy of supraglottic airway device assisted fibreoptic-guided tracheal intubation in children [6,13,15,[19][20][21], even when traditional techniques have failed [6,22], suggesting that this technique may be an indispensable anaesthetic skill [23]. Successful placement of the air-Q on the first attempt may suggest that most clinicians, regardless of experience, should not have difficulty with its insertion.…”

“…In addition, these devices may be useful when difficulties with mask ventilation and/or tracheal intubation are encountered [5,6], supporting their inclusion as rescue devices in difficult airway algorithms [7][8][9]. In the paediatric population, children under the age of one year have been reported to have the highest incidence of difficult airway [10,11].…”

Use of Supraglottic Airway Devices in the Prone Position

“…They can be classified as first and second generation [2]. First-generation devices are simple airway tubes, whereas second-generation devices incorporate specific features to protect against gastric regurgitation and aspiration [3].…”