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Extraglottic device

Brian E Driver, David Plummer, William Heegaard, Robert F Reardon
BACKGROUND: The King LT airway (King Systems, Noblesville, IN) is a popular extraglottic device that is widely used in the prehospital setting. We report a case of tracheal malplacement of the King airway with a severe kink in the distal tube. CASE REPORT: A 51-year-old unhelmeted motorcyclist collided with a freeway median and was obtunded when paramedics arrived. After bag mask ventilation, a King airway was placed uneventfully and the patient was transported to the emergency department...
September 17, 2016: Journal of Emergency Medicine
Robert S Green, Dean A Fergusson, Alexis F Turgeon, Lauralyn A McIntyre, George J Kovacs, Donald E Griesdale, Ryan Zarychanski, Michael B Butler, Nelofar Kureshi, Mete Erdogan
OBJECTIVES: Various medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians. METHODS: A clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail...
August 30, 2016: CJEM
Marijana Karišik, Dušanka Janjević, Massimiliano Sorbello
The primary goal of pediatric airway management is to ensure oxygenation and ventilation. Routine airway management in healthy pediatric patients is normally easy in experienced hands. Really difficult pediatric airway is rare and usually is associated with anatomically and physiologically important findings such as congenital abnormalities and syndromes, trauma, infection, swelling and burns. Using predictors of difficult intubation should be mandatory preoperative assessment in pediatric patients. Difficult airway algorithm for pediatric patients has to consist of three parts: oxygenation (A), tracheal intubation (B), and rescue (C)...
March 2016: Acta Clinica Croatica
Tom C R V Van Zundert, Jan F A Hendrickx, Jan L De Witte, David T Wong, Davide Cattano, Joseph R Brimacombe
STUDY OBJECTIVE: The study objective is to determine whether extraglottic airway devices (EADs) with or without mask aperture bars (MABs) result in similar anatomical positions in patients undergoing surgery. DESIGN: Prospective, randomized, crossover comparison of four extraglottic airway devices. SETTING: Operating theatre at a large teaching hospital. PATIENTS: Eighty consenting patients scheduled to undergo surgery with general anesthesia...
June 2016: Journal of Clinical Anesthesia
Christoph Martin, Tobias Nefzger, Gösta Lotz
Airway management in the prehospital setting is a particular challenge. Even with numerous alternative devices, endotracheal intubation still represents the gold standard. Limited knowledge and experience of the user in addition to a critical patient's condition, special environmental conditions and limited material resources at the out of hospital emergency, are major causes of an increased incidence of difficult airways in the preclinical setting. For the management of the difficult airway emergency physicians can use alternatives to tracheal intubation such as extraglottic airway devices, videolaryngoscopy and cricothyroidotomy...
April 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Gösta Lotz
Due to its relevance to patient outcome, management of the difficult airway is a major topic in the training of anesthesiologists. Algorithms may serve as a plan for a difficult situation. Since 1993, many professional organizations have published guidelines for airway management. ASA and DGAI share common strategies in their guidelines, but also have significant differences. The DGAI provides different algorithms for both the anticipated and unanticipated difficult airway, while the ASA uses one universal algorithm...
April 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Helmut Trimmel, Janett Kreutziger, Robert Fitzka, Stephan Szüts, Christoph Derdak, Elisabeth Koch, Boris Erwied, Wolfgang G Voelckel
OBJECTIVES: We sought to assess whether the GlideScope Ranger video laryngoscope may be a reliable alternative to direct laryngoscopy in the prehospital setting. DESIGN: Multicenter, prospective, randomized, control trial with patient recruitment over 18 months. SETTING: Four study centers operating physician-staffed rescue helicopters or ground units in Austria and Norway. PATIENTS: Adult emergency patients requiring endotracheal intubation...
July 2016: Critical Care Medicine
Jigisha Prahladrai Badheka, Rashida Mohammedi Jadliwala, Vrajeshchandra Amrishbhi Chhaya, Vandana Surendrabhai Parmar, Amit Vasani, Ajay Maganlal Rajyaguru
BACKGROUND: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries...
October 2015: Journal of Minimal Access Surgery
Tristan C Dumbarton, Orlando R Hung, Blaine Kent
In this report, we describe the case of a young female with Down syndrome who presented to the anesthesia service after pulseless electrical activity arrest with a King LT(S)-D extraglottic airway device in situ. She had multiple predictors of difficult intubation, including what appeared to be a submental mass consistent with Ludwig's angina. She went on to receive an urgent tracheotomy because of those predictors but had full resolution of the submental mass on removal of the extraglottic airway device, which had been overinflated at the time of insertion...
February 15, 2016: A & A Case Reports
James R Miner, John Rubin, Jacob Clark, Robert F Reardon
BACKGROUND: The intubating laryngeal mask airway (ILMA) is an extraglottic device with a high rate of successful ventilation and oxygenation. Most modern airway algorithms suggest using an extraglottic device as the first-line rescue technique for a failed airway in emergency airway management. Eventually, a more secure airway is needed if the extraglottic temporizing device is working well. Retrograde intubation is a surgical airway management technique that is effective but relatively slow, making it most useful when ventilation can be maintained during the procedure...
December 2015: Journal of Emergency Medicine
James Kempema, Marc D Trust, Sadia Ali, Jose G Cabanas, Paul R Hinchey, Lawrence H Brown, Carlos V R Brown
OBJECTIVE: The objective of the study is to compare outcomes in blunt trauma patients managed with prehospital insertion of an extraglottic airway device (EGD) vs endotracheal intubation (ETI). The null hypothesis was that there would be no difference in mortality for the 2 groups. METHODS: This is a retrospective study of blunt trauma patients with Glasgow Coma Scale score less than or equal to 8 transported by ground emergency medical services directly from the scene of injury to a single urban level 1 trauma center...
August 2015: American Journal of Emergency Medicine
Ajay Kumar Pajiyar, Zhiting Wen, Haiyun Wang, Lin Ma, Lumin Miao, Guolin Wang
BACKGROUND: The Guardian Laryngeal Mask Airway (G-LMA) is a new silicone-based single-use extraglottic device with the drainage port and a cuff pilot valve with pressure indicator. The aim of this study is to compare the clinical performance of this laryngeal mask airway with ProSeal laryngeal mask airway (P-LMA). METHODS: In this prospective randomized study, we included adult patients with ASA grading I and II scheduled for elective surgery requiring supine position under total intravenous anesthesia...
2015: BMC Anesthesiology
Jenna M B White, Darren A Braude, Gamaliel Lorenzo, Blaine L Hart
OBJECTIVES: Extraglottic airway devices (EADs) are now commonly placed for airway management of critically ill or injured patients, particularly by emergency medical services providers in the out-of-hospital setting. Recent literature has suggested that EADs may cause decreased cerebral blood flow due to compression of the arteries of the neck by the devices' inflated cuffs. METHODS: The authors identified a cohort of 17 patients presumed to be hemodynamically stable with EADs in place who underwent radiographic imaging of the neck...
May 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Moustafa Abdelaziz Moustafa, Mohamed Mahmoud Abdelhady
STUDY OBJECTIVES: To determine, by fiberoptic endoscope, malpositioning of the Laryngeal Mask Airway (LMA) and other extraglottic devices. DESIGN: Prospective study. SETTING: University-affiliated medical center. PATIENTS: 60 adult, ASA physical status 1 and 2 patients, aged 20 - 60 years, scheduled to undergo ophthalmic procedures with general anesthesia during controlled ventilation via LMA (Laryseal). MEASUREMENTS: Adequacy of ventilation was determined by the absence of audible leak and appropriate capnograph trace...
September 2014: Journal of Clinical Anesthesia
Ramesh Ramaiah, Debasmita Das, Sanjay M Bhananker, Aaron M Joffe
Extraglottic airway devices (EAD) have become an integral part of anesthetic care since their introduction into clinical practice 25 years ago and have been used safely hundreds of millions of times, worldwide. They are an important first option for difficult ventilation during both in-hospital and out-of-hospital difficult airway management and can be utilized as a conduit for tracheal intubation either blindly or assisted by another technology (fiberoptic endoscopy, lightwand). Thus, the EAD may be the most versatile single airway technique in the airway management toolbox...
January 2014: International Journal of Critical Illness and Injury Science
Sebastian G Russo, Hinnerk Wulf
The use of extraglottic airway devices (EGA) is well accepted for airway management for certain classic indications such as general anaesthesia during limb surgery in the supine position. Furthermore, EGA have been deemed a useful tool during the management of an unrecognized difficult airway. On the other hand, the use of EGA has been controversially discussed for advanced indications such as during general anaesthesia during laparoscopic surgery and in coexisting morbid obesity. This article provides an evidence based review of the role of EGA during a variety of indications and is designed to assist with the decision making process of whether an EGA may or may not be appropriate for a particular indication...
March 2014: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
M Dreher, S Kluge
This review presents the potential indications for different airway devices in the intensive care unit (ICU). Since the interface during noninvasive ventilation is located outside the body, sedation is not regularly needed. Therefore, selection of a fitting mask is essential to avoid mask intolerance which is one of the biggest problems during noninvasive ventilation. Full-face masks are the interfaces mostly used for noninvasive ventilation to treat acute respiratory failure; here, mouth breathing is possible which is often necessary during acute respiratory failure...
June 2014: Pneumologie
T Suhitharan, Wendy H L Teoh
BACKGROUND: Second generation extraglottic airway devices with gastric access and separate breathing channels have ushered in a new era where their use is increasingly prevalent in surgical patients who would have been traditionally intubated for general anesthesia. New innovations like the i-gel, which is constructed of a thermoplastic elastomer, provide an airtight seal around patient's perilaryngeal anatomy without the inflatable cuff mechanism found in the laryngeal mask airway supreme (LMAS)...
October 2013: Saudi Journal of Anaesthesia
T C Van Zundert, C A Hagberg, D Cattano
BACKGROUND: Extraglottic airway devices (EADs) are frequently used airway devices, yet often they seal poorly, resulting in a functionally unacceptable leak. Optimal size selection of the EAD is therefore critical to the safe and effective use of an EAD. This review is designed to delineate the sizing recommendations of EADs and indicate the differences in order to make the optimal choice for device effectiveness and patient safety. METHODS: We searched manufacturing' guidelines regarding size recommendations of EADs...
June 2014: Minerva Anestesiologica
William Wallace Tollefsen, Calvin A Brown, Kelly L Cox, Ron M Walls
BACKGROUND: Effective airway management is the cornerstone of resuscitative efforts for any critically ill or injured patient. The role and safety of pediatric prehospital intubation is controversial, particularly after prior research has shown varying degrees of intubation success. We report a series of consecutive prehospital pediatric intubations performed by air-transport providers. METHODS: We retrospectively reviewed intubation flight records from an 89-rotorcraft, multistate emergency flight service during the time period from January 1, 2007, to December 31, 2009...
September 2013: Pediatric Emergency Care
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