HWN Suggests

Small is the new big

It is not that the “old order changeth” but it is the multifarious disposition of the new that has opened more doors for the pediatric airway. Notwithstanding the availability and cost factors, the newly introduced devices offer greater usability. The evolving SGAs have dawned a new era announcing novel horizons in pediatric airway management.

read full article

Featured

 i-gel Supraglottic Airway Sizes

Made from a medical grade thermoplastic elastomer, i-gel supraglottic airway has been designed to create a non-inflatable, anatomical seal of the pharyngeal, laryngeal, and perilaryngeal structures while avoiding compression trauma.

Articles of Interest

PEM Playbook – Supraglottic Airways

IGel - Pros: Molds more accurately to supraglottis; no need to inflate; good seal pressures. Cons: Cannot intubate through (without fiberoscopy)

A comparison of supraglottic devices in pediatric patients

When managing patients with a difficult airway, supraglottic airways (SGAs) have been used as rescue devices or to serve as a conduit for endotracheal intubation. The current study compares various clinical outcomes, including the bronchoscopic view of the glottis when using 2 SGAs, the Air-Q® laryngeal mask airway (LMA) and the i-gel® SGA, in pediatric patients.

Limitations of pediatric supraglottic airway devices as conduits for intubation - an in vitro study

The use of combinations of SGA and ETTs with a size mismatch can lead to airway complications during intubation or to accidental extubation and tearing of the cuff pilot balloon line when removing the SGA. To avoid these problems, we devised a table that simplifies the choice of an appropriate SGA and ETT combination.

Supraglottic Airway Devices for Pediatric Airway Management in the Emergency Department

Types of SGAs that are commonly used in pediatric patients (including the LMA® Classic™, intubating LMA/LMA® Fastrach™, LMA® ProSeal™, LMA® Supreme™, Combitube®, laryngeal tube airway/King LTS-D™, i-gel®, and Baska Mask®). Supraglottic airways are a group of airway devices used to secure a patient’s airway or as an aid to facilitate endotracheal intubation (ETI). The term supraglottic indicates that these devices sit just above the larynx and allow for oxygenation and ventilation. These devices are sometimes referred to as “extraglottic” instead of “supraglottic.” For the purposes of this article, these devices will be referred to as supraglottic airway devices (SGAs).

Supraglottic airway devices in children

Over the last two decades, the enormous success of the LMA has been followed by the proliferation of other SAD, each claiming advantages over devices already in use. Many new SADs, with the exception of the PLMA, appear to offer little or no benefit for the clinician or patient, over existing ones, and evidence supporting efficacy and safety is often absent or inadequate.

Supraglottic airway devices in children with difficult airways

In patients with difficult airways, supraglottic airways (eg, laryngeal mask airway or i-gel) permit oxygenation and ventilation until a definitive airway can be secured. Supraglottic airway devices may be lifesaving in children with difficult airways in whom conventional endotracheal intubation has failed. They should be available for any child undergoing emergency endotracheal intubation.

Resources

i-gel®

The i-gel® is the innovative second generation supraglottic airway device from Intersurgical. The first major development since the laryngeal mask airway, i-gel® has changed the face of airway management and is now widely used in anaesthesia and resuscitation across the globe. Made from a medical grade thermoplastic elastomer, i-gel® has been designed to create a non-inflatable, anatomical seal of the pharyngeal, laryngeal and perilaryngeal structures whilst avoiding compression trauma.