Value of knowing physical characteristics of the airway device before using it

Extraglottic airway devices (EADs) have revolutionized the field of airway management. The invention of the laryngeal mask airway was a game changer, and since then, there have been several innovations to improve the EADs in design, functionality, safety and construction material. These have ranged from changes in the shape of the mask, number of cuffs and material used, like rubber, polyvinylchloride and latex. Phthalates, which were added to the construction material in order to increase device flexibility, were later omitted when this chemical was found to have serious adverse reproductive outcomes. The various designs brought out by numerous companies manufacturing EADs resulted in the addition of several devices to the airway market. These airway devices were put to use, many of them with inadequate or no evidence base regarding their efficacy and safety. To reduce the possibility of compromising the safety of the patient, the Difficult Airway Society (DAS) formed the Airway Device Evaluation Project Team (ADEPT) to strengthen the evidence base for airway equipment and vet the new extraglottic devices. A preuse careful analysis of the design and structure may help in better understanding of the functionality of a particular device. In the meantime, the search for the ideal EAD continues.

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“…50 The Baska mask and LMA-Protector have two drain tubes which emerge proximally as separate ports. 51 …”

Section: Specific Eadsmentioning

confidence: 99%

Extraglottic airway devices: technology update

Sharma

Sahai

Sood

2017

MDER

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“…Obvious deficiencies in devices have been noted before, such as a ‘low dead space’ inline CO 2 adaptor that in fact barely has any lumen at all (and hence causes complete airway obstruction), or other CO 2 adaptors that disintegrate causing massive leaks from the breathing circuit . It was observations like these that led to the consensus that anaesthetic departments should purchase new airway devices only when supported by published evidence from at least one clinical trial (the Difficult Airway Society's ADEPT strategy) . Although this remains sensible advice, it would be difficult to power such trials for important clinical safety end‐points, such as major airway complications .…”

Section: Test Before You Investmentioning

confidence: 99%

Medical device regulation: the need for clinical vigilance and oversight

Charlesworth

Zundert

2019

Anaesthesia

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“…A BVM with incorporated PEEP valve is routinely used for pre-oxygenation in our pre-hospital and retrieval medicine service, with the addition of nasal prong oxygen from a second source. Our practice is based on both Groombridge et al's previous work [2] demonstrating BVM with PEEP to be an effective pre-oxygenation strategy, and that of our own team, showing that the addition of nasal cannulae may compensate for the mask leaks that frequently beset pre-hospital pre-oxygenation scenarios [3]. Presumably, PEEP may increase the oxygen reservoir in patients undergoing anaesthesia by both increasing the functional residual capacity as well as the increase in FEO 2 (expired fraction of oxygen) demonstrated in the article.…”

Section: J J Panditmentioning

confidence: 99%

“…the vast majority of the billions on this planet). By their logic, the airways of all these patients should undergo extensive imaging etc., in order to tailor the exact supraglottic airway (SAD) type and size [2], or other management method that fits the specific anatomy. Instead, using a binary pragmatic approach as we suggest, these patients are simply to be classed 'plausibly easy' and any SAD to hand could then be used.…”

mentioning

confidence: 99%