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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 c...
Citations
... The Baska mask (BM) and the Ambu AuraGain (AAG) are two recently introduced SADs. [1,2] Both devices have unique design elements and have shown promising clinical performance in recent trials. [3][4][5][6] These airway equipment have high oropharyngeal leak pressure (OLP) and a high first-attempt success rate with low leak fraction (LF) and shorter device insertion time. ...
Background and Aims
The Baska mask (BM) and the Ambu AuraGain (AAG) have shown promising results in recent trials but have not been compared. Therefore, we aimed to compare the clinical performance of the BM and the AAG for airway management of adult patients.
Methods
In this randomised comparative study, patients aged 18–60 years and with an expected surgical duration of less than 2 h were enroled. Patients were randomly allocated to AAG (Group A, n = 37) and BM (Group B, n = 37) for airway management. After induction of anaesthesia, an allocated supraglottic airway device (SAD) was inserted. Oropharyngeal leak pressure (OLP), time taken to insert SAD, number of insertion attempts, leak fraction (LF), first-attempt success rate, overall success rate, ease of insertion, fiberoptic view of the glottis, and complications were compared. The data were analysed using Student’s t -test, Mann–Whitney U test, and Fisher’s exact tests.
Results
Baseline and demographic characteristics were comparable. OLP (31.32 ± 2.59 versus 27.54 ± 1.32 cmH 2 O) was higher ( P < 0.001), and LF (6.19% ± 1.20% versus 7.24% ± 1.72%) was lower ( P = 0.003) in the BM group. First-attempt and overall success rate, time taken to insert, number of insertion attempts, ease of insertion, and fibreoptic view of glottis through the SADs were statistically similar between groups. However, the incidence of sore throat ( P = 0.007) and cough ( P = 0.028) was higher with AAG.
Conclusion
Clinical performance of BM was better than AAG as the former had higher OLP, lower LF and complications.
... The term "third-generation" SAD is still not unambiguously accepted as some authors use it to denote the presence of a selfenergizing sealing cuff (Baska) [7], whereas others employ it for devices that introduce yet another channel used for a reusable patient-isolated camera [8]. For the latter group, the term video laryngeal mask (VLM) is also used. ...
... The definition of a third generation SADs is not consensual, usually referred to as a mask with a self-energizing sealing cuff (Baska Mask™) or as vision-guided SADs. [30,31] The Baska Mask™ is an extraglottic device that allows a peri-laryngeal seal with a self-energizing sealing cuff. A non-inflatable cuff reduces the risk of oropharyngeal tissue and nerve damage, related to cuff overinflation. ...
... It has 2 gastric drain tubes, providing better protection against gastric content aspiration. [30,32] Although Baska Mask™ is more challenging to insert, it achieves higher mean oropharyngeal seal pressure when compared to Supreme laryngeal mask™ (33.28 ± 6.80 cm H 2 O vs 27.47 ± 2.34 cm H 2 O, P < .001). [33] The intubating laryngeal tube (ILTS-D™) is a 2 nd generation extraglottic device that allows laryngeal tube suction and the possibility of secondary tracheal intubation. ...
The evolution of medical knowledge and technological growth have contributed to the development of different techniques and devices for airway management. These appear to play a role in optimizing the number of attempts and overall success, ultimately reducing the negative consequences of airway manipulation. In this literature review, we highlight the recent evidence regarding new technologies applied to airway management.
Before intubation, every patient should have an individualized structured airway management plan. Technology can help with both airway evaluation and tracheal intubation. Point-of-care cervical ultrasound and artificial intelligence models with automated facial analysis have been used to predict difficult airways. Various devices can be used in airway management. This includes a robotic video endoscope that guides intubation based on real image recognition, a laryngeal mask with a non-inflatable cuff that tries to reduce local complications, video laryngeal masks that are able to confirm the correct position and facilitate intubation, Viescope™, a videolaryngoscope developed for combat medicine with a unique circular blade, a system that uses cervical transillumination for glottis identification in difficult airways and Vivasight SL™ tracheal tube, which has a high-resolution camera at its tip guaranteeing visual assurance of tube position as well as guiding bronchial blocker position.
To conclude, we detailed the challenges in airway management outside the operating room as well as described suction-assisted laryngoscopy and airway decontamination technique for contaminated airways.
Further research in the clinical setting is recommended to better support the use of these technologies
... These are inserted in oral cavity. They create a great revolution in the airway management 9 . The supraglottis airway devices are now becoming famous for airway management and they are also very effective in difficult airway management 10,11 . ...
Background: At the time of induction during general anaesthesia the different complication can occur with endotracheal tube. Supraglottic devices are alternative of endotracheal tube and it prevents such complications. Aim: To compare the frequency of ease of insertion with lma and i-gel® during general anaesthesia. Method: 270 patients of asa class p1 & p2 undergoing general anaesthesia for elective surgeries were included after taking informed consent. Patients were divided into two groups a (lma classic) & b (i-gel) by using random number table. Each group comprised of 135 patients. In both groups dose of propofol was 2.5mg /kg body weight was given intravenously within 30 sec along with nalbuphine 0.1 mg /kg body weight and midazolam 0.05mg / kg body weight. The study design was quasi experimental and sampling technique was purposive non probability convenience sampling. Chi square test was used and collected data was analysed with spss version 20. Result: The ease of insertion in the lma classic group was 82% while the ease of insertion in i-gel® was 84 %. Statistically there was no significant difference of ease of insertion between two groups (p value = 0.41). Conclusion: Both devices have same level of ease of insertion. Keywords: Lma (laryngeal mask airway classic), i-gel®, general anaesthesia, ease of insertion
... A máscara laríngea tem revolucionado o manejo das vias aéreas, pois é um dispositivo inserido por via oral, sua extremidade distal se acomoda na hipofaringe, promovendo a vedação ao redor da entrada glótica, estabelecendo uma via aérea avançada para o processo de ventilação e oxigenação (Sharma et al., 2017). Assim os profissionais enfermeiros devem ter conhecimento, habilidade e atitude para utilizar o recurso disponível nas situações que for necessário o manejo rápido da via aérea. ...
Objetivo: Avaliar a aplicabilidade do cenário de simulação clínica com estudantes de enfermagem no ensino da inserção da máscara laríngea através da escala do design da simulação. Método: Estudo transversal de abordagem quantitativa, desenvolvido com estudantes do curso de enfermagem de uma instituição publica de ensino superior. Resultados: Predomínio do sexo feminino, solteiros (93%). A análise referente as cinco dimensões da escala do design de simulação evidenciou nota 5 (5,8), considerando a avaliação concordo totalmente, seguida da nota 4 (5.3), concordo com a afirmação. Desta forma, os estudantes consideram que os objetivos e as informações fornecidas foram suficientes e, as informações, adequadas e direcionadas para promover seu processo de compreensão para tomada de decisão. Durante o debriefing, o feedback e a reflexão logo após o atendimento, foram considerados pelos estudantes, como uma oportunidade de analisar seu próprio comportamento nas ações realizadas, e por fim, o realismo dentro do cenário proposto se assemelha a uma situação real. Conclusão: ressalta-se a importância de se testar cenários previamente planejados e que a simulação é uma metodologia ativa que proporciona a melhoria na tomada de decisão e contribui para o pensamento crítico do estudante.
... The laryngeal mask airway (LMA) is one of the most used supraglottic devices and has revolutionized airway management (1,2) . Since its introduction into clinical practice, there has been a great expansion in its applications (3) . ...
... The LMA is orally inserted and its distal end accommodates in the hypopharynx, sealing around the glottic entrance and establishing an advanced airway for oxygenation and ventilation (2) . It can be classified into two generations; the first has a single channel, the breathing, while the second generation has two channels, breathing and gastric (5) . ...
... The insertion of LMA in airway management and its algorithms has changed nurses' clinical practice. It is an alternative device that reduces the gap between the face mask and the endotracheal tube (2) . The emphasis given to LMA is related to aspects such as insertion speed, ease of learning and use, among others (2) . ...
Objective: To identify evidence-based literature on the laryngeal mask airway insertion by nurses. Results: Eight out of the 1,156 studies identified m et the inclusion c riteria. Studies were categorized into fi rst an d second-generation de vices. Conclusion: The use of a fi rst and second-generation laryngeal mask airway by nurses is a re commended alternative for its speed, success and effectiveness in ensuring the advanced airway, especially in situations of cardiopulmonary arrest in adults. However, adverse effects of its use should be evaluated.
... Second generation SGAs, such as ProSeal™ (Teleflex Inc., Wayne, Pennsylvania, USA) laryngeal mask airway (LMA), include an additional gastric channel that aims to reduce risk of gastric aspiration. A recent controversial new term, third generation, was introduced for commercial purposes to indicate the presence of self-energizing sealing cuffs such as Baska [5]. Other methods of classification can be whether it is cuffed such as cLMA and ProSeal™ LMA or uncuffed such as i-gel, Baska, and streamlined liner of the pharynx airway (SLIPA). ...
Introduction
The advancement of supraglottic airways (SGAs) has eased airway management, especially for anesthetists. There were functional improvements implemented to the newer SGA. We aim to assess the clinical performance of laryngeal mask airway (LMA) Protector™ Cuff Pilot™ (Teleflex Inc., Wayne, Pennsylvania, USA) against LMA Supreme™ (Teleflex Inc., Wayne, Pennsylvania, USA), in terms of oropharyngeal leak pressure (OLP), successful insertion attempts, mean insertion time, ease of gastric tube insertion, laryngeal view, and incidence of sore throat among anesthetized, non-paralyzed patients undergoing general anesthesia.
Methods
In this prospective single-blinded study, 60 patients were randomized to use either LMA Protector™ Cuff Pilot™ or LMA Supreme™. Both groups received standard monitoring and induction regimes. Post-insertion, a bronchoscope was used to verify its position. A gastric tube was inserted and OLP was measured. Patients were assessed during the post-operative period for sore throats.
Results
LMA Protector™ Cuff Pilot™ was comparable to LMA Supreme™ in terms of mean OLP (30.72±8.60 vs 27.23±8.09 cmH2O, P = 0.114), first successful attempt (P = 0.312), mean insertion time (27.72±9.45 vs 24.37±6.46 seconds, P = 0.116), and grade 1 laryngeal view (51.7% vs 36.7%, P = 0.244). At first attempt, LMA Protector™ Cuff Pilot™ had a lower success rate of gastric tube insertion than LMA Supreme™ (55.17% vs 96.67%, P <0.001). The incidence of the blood-stained device and sore throat post-operatively were comparable between the two groups.
Conclusion
LMA Protector™ Cuff Pilot™ was comparable to LMA Supreme™ in terms of overall clinical performance, except for the first successful gastric tube insertion. Improvements should be made to the gastric channel for easier gastric tube insertion in the LMA Protector™ Cuff Pilot™.
... In modern era, supraglottic airway devices (SADs) have brought revolution in airway management filling a niche between the facemask and endotracheal tube in terms of both anatomical position and degree of invasiveness. 1 The American Standards for Testing Materials (ASTM) Committee F29 on Anesthetic and Respiratory Equipment has defined SADs as "Airways that are intended to open, secure, and seal the supraglottic area to provide an unobstructed airway in spontaneously breathing or ventilated patients, typically during anesthetic procedures". 2 Endotracheal intubation (ETI) has been considered the conventional gold standard technique for securing the airway during general anesthesia. However, laryngoscopy and endotracheal intubation may be associated with considerable morbidities, ranging from minor side effects such as sore throat to more serious complications such as autonomic stimulation and difficult or failed intubation. ...
Background & objectives: The laryngeal mask airway Supreme™ (LMA-S) is a new, single-use, supraglottic device that combines the functionality of the ProSeal™ and Fastrach™ airways. Till now, there have been conflicting results regarding the oropharyngeal leak pressure (OLP) of the LMA Supreme™ vs. the LMA ProSeal™, which is the major determinant of effective ventilation and airway protection during LMA use. We compared the safety and efficacy of the LMA ProSeal™ vs. the LMA Supreme™ in ambulatory surgeries. Methodology: In this prospective, comparative trial, eighty adult patients undergoing elective surgery, were randomly allocated to one of the two groups: Group LMA–P (LMA ProSeal™ group) and Group LMA–S (LMA Supreme™ group) of 40 patients each. OLP, insertion times, number of insertion attempts, ease of insertion and pharyngolaryngeal morbidity were assessed. Statistical analysis was performed using SPSS version 21.0 software using Student’s t-test and Chi-square test. P < 0.05 was considered to be statistically significant. Results: Oropharyngeal leak pressure in Group LMA–P (26.65 ± 1.59 cmH2O) was comparable to Group LMA–S (26.08 ± 1.67 cmH2O) and both provided adequate seal and effective ventilation. The mean effective airway time was significantly less in Group LMA–S as compared to Group LMA–P (14.80 ± 1.24 sec and 17.80 ± 1.47 sec) respectively. Mean number of successful insertion attempts, hemodynamic response and pharyngolaryngeal morbidity were comparable in both the groups. Conclusion: Both LMA Supreme™ and LMA ProSeal™ are equally efficacious and safe for maintaining airway and ventilation in paralyzed patients. However, LMA Supreme™ is easier to insert with shorter effective airway time than LMA ProSeal™. Abbreviations: SAD - Supraglottic airway device; ETI - Endotracheal intubation; LMA - Laryngeal mask airways; PPV - Positive pressure ventilation; OLP - oropharyngeal leak pressure Key words: LMA ProSeal™, LMA Supreme™, Oropharyngeal leak pressure; Airway; Aieway management Citation: Singh A, Kaur J, Kaur S, Gupta KK. Safety and efficacy of LMA Supreme™ vs. LMA ProSeal™ for ambulatory surgeries in adult patients. Anaesth. pain intensive care 2021;26(1):63-68. DOI: 10.35975/apic.v26i1.1769 Received: June 02, 2021, Reviewed: December 13, 2021, Accepted: December 15, 2021
... Supraglottic airway devices are an integral part of airway management during general anaesthesia, 1 in fact over half of all procedures under general anaesthesia are managed with a supraglottic airway in the UK. 2 As a less invasive alternative to tracheal intubation, 3 supraglottic devices are commonly used in general anaesthesia of elective operations and are increasing in popularity across the world. The first supraglottic device, the laryngeal mask airway, was developed in the 1980s by Dr. Archibald Jeremy Brain 4 and was comprised of an elliptical inflatable cuff attached to an airway tube. ...
Protocol for a multicenter study evaluating a new supraglottic airway device - the i-gel Plus.
Available at: https://www.medrxiv.org/content/10.1101/2021.07.19.21260747v1
... The reason of the difference between the literature and our findings is the initial time of the procedure that mentioned in the material and method section. In studies among LM types; Baska Mask ® had a longer insertion time than classical LM variants (Sharma et al., 2017;Bindal et al., 2018). Silicone structure and shape of other LM prolong the insertion time compared to classical LM types. ...
Laryngeal mask (LM) types have been used as an airway device for an alternative to the standard endotracheal tube (ETT). One of the novel type of LM, the Baska Mask®, can be a safe alternative among the airway devices. The purpose of this study is to compare the effects of the new generation supraglottic airway device the Baska Mask® and the ETT on hemodynamic parameters (heart rate, mean arterial pressure), airway pressure and end tidal carbon dioxide (EtCO2) in patients undergoing general anesthesia. After the approval of the ethics committee, 70 patients who underwent septoplasty were included in the study. Written informed consent forms were taken from these patients. Demographic data of the patients were recorded. Hemodynamic data of patients were measured and recorded preoperative, during induction, at the time of intubation 1th, 3th and 5th minute and during extubation. Also, airway pressure and EtCO2 values of the patients were measured and recorded at the time of intubation, 1th, 3th and 5th minutes. Demographic data were similar in both groups. Mean arterial pressure, heart rate and airway pressure were lower in the group 2 (the Baska Mask® group) than in the group 1 (ETT group) and the difference was statistically significant (p<0.05). EtCO2 values were similar in both groups. No patients had tube leakage. In terms of hemodynamic and respiratory parameters the Baska Mask® is more advantageous than the ETT in short-term surgeries.
