Tag Archives: SGA

Video: Flexible endoscopic intubation through SGAs

A description of the technique for intubating through a supraglottic airway that offers a sufficiently large internal bore to allow an appropriate-sized endotracheal tube using an adult fibreoptic or flexible video endoscope.  Take note of the method of providing ventilation during the endoscopy!

As usual, this is an unscripted video, and constructive critique is welcomed to help us improve the educational offering.

Video: Overview of intubating through SGAs

Yip, another whirlwid tour, this time of the situations and considerations that may lead to intubating through a supraglottic airway.  Each method will be expanded upon in later videos.

These videos are made off-the-cuff and can certainly be improved, so if you have suggestions, please put them in the comments!

Video: Using supraglottic airways

A whirlwind tour through selection, indications, precautions, sizing and troubleshooting.  For an overview of the types and classifications, see this post.

These videos are all unscripted, so if you have suggestions for improvement, please leave a comment below!

VIdeo: Supraglottic airway overview

A brief (7 min) overview of the some of the types, classification and classes of SGAs, as part of some preparatory material for SMACCdub Airway Workshop participants.

For the next video on using SGAs, see this post.

These videos are all unscripted, so if you have suggestions for improvement, please leave a comment below!

7 airway questions posed to 6 airway experts

Click the image to go to the article on Anesthesiology News
Click the image to go to the article on Anesthesiology News

This month’s edition of Anesthesiology News features a worthwhile piece from Prof John Doyle, in which he poses 7 questions on the current state of airway management to 6 airway experts from around the world (Abdelmalak, Cooper, Frova, Rosenblatt, Spiegel and Doyle himself), and collates their responses into a dialogue.  Definitely worth reading to determine what some (certainly not all) of the biggest names in the world are thinking on:

  • The place for DL a decade from now
  • The (under)use of bougies
  • What airway algorithm to choose
  • Tracheostomy vs cricothyroidotomy in emergencies
  • The impact of VL on the use of flexible ‘scopes
  • Favourite SGA
  • Favourite VL

You can read the article on the Anesthesiology News site by clicking here or the image above, or download the PDF version here.

For what it is worth, here are my own answers, distilled into one-liners.  I’m very willing to enter into discussions about them!

  • Place for DL in the future: Definitely; just look at the huge needs in the Third World and then ask if (even very cheap) VLs are a priority.
  • Use of bougies: Along with good positioning and mastery of face-mask skills, I think this is one of the most neglected parts of airway training.
  • What airway algorithm: The expert can do what they wish; the trainee should learn something appropriate (like ASA or DAS); the infrequent practitioner should use the Vortex.
  • Trache vs Cric:  Cric all the way; scalpel-finger-bougie
  • Impact of VL in AFOI:  Definitely reducing the use of AFOI, but a flexible scope remains an essential tool, and every airway master should be competent in it’s use.
  • Favourite SGA:  Would love to say the 3gLM, but we need to publish the research first…
  • Favourite VL:  Hasn’t been invented yet, but watch this space.  The C-MAC with Pocket Monitor is my daily workhorse, but I have (and use) GlideScope, McGrath, AirTraq, King Vision, etc.

There are a lot of excellent (and complementary) views expressed in the article, which are worth reading.  Check it out!

Quick Tip: IntraOp Temperature Monitoring with a 2nd generation SGA

Without getting into a lengthy argument about what constitutes a second-generation supraglottic airway (or an extraglottic vs. supraglottic, for that matter), if you are using an SGA with a gastric drainage port (such as the LMA Proseal, LMA Supreme, i-Gel, etc) you have a very simple and easy conduit to insert a mid-oesophageal thermistor probe to monitor patient temperature.

Mid-oesophageal temperature probe inserted via the gastric drainage tube of an LMA Supreme
Mid-oesophageal temperature probe inserted via the gastric drainage tube of an LMA Supreme

Ideally, to achieve a mid-oesophageal position, you need the probe to extend 5-10 cm past the tip of the SGA, so try and remember to measure the probe against the device before insertion and mark it with a small piece of dressing tape.  This has an added advantage of helping prevent air leak via the drainage tube if your SGA is not seated or strapped ideally.   Of course, this means that drainage via the oespophageal lumen is significantly impaired, and you cannot insert a gastric tube without removing the probe first, so it is only suited to patients in whom you have little concern regarding reflux and aspiration.  Devices that offer twin drainage tubes (such as the 3gLM) are a way around this problem.

TotalTrack for Intubation in OSA

The TotalTrack is a new video laryngeal mask that allows intubation through the device without interruption of ventilation.  Recruitment of the first independent clinical trial is well underway in Cape Town, with European studies nearing commencement.  Here is an example video taken with the device, showing intubation in a patient with severe obstructive sleep apnoea (OSA).