SGA

1. Supraglottic Airway Devices
Nap4
Dr Anil Patel
Royal National Throat Nose & Ear Hospital
and
University College Hospital, London

2. I have received an honorarium from the Laryngeal
Mask Company & I have helped design the A.P.
Advance Videolaryngoscope

3. Numerical Analysis
• SAD 56% of all UK general anaesthetics
• 90% cLMA or LM’s
• 10% i-gel or Proseal LMA
• 34 cases where SAD was primary airway
• Of these 17 were aspiration
• Of the Non-aspiration events
• 2 deaths
• 5 emergency surgical airways
• 13 ICU admissions

4. Non-Aspiration Events - Deaths
• loss of airway in the semi-prone position
during prolonged surgery in a patient with a
predicted difficult airway
• poor laryngeal mask positioning, loss of
airway and unrecognised oesophageal
intubation during response to this event

5. Anaesthesia Events - 16 cases
• generally young (10/16 < 40years)
• healthy (14/16 ASA 1-2)
• ‘urgent’ procedure (7/16 ‘urgent’)
• Obesity (11/15 73%)
• compared to 31% outside this group
• None of the patients who aspirated during
use of a SAD weighed >100kg

6. Outcome and quality of airway
management

7. Devices Used

8. SAD - Themes
• Patient selection
• Limitation of use to appropriate surgery
• Understand limits of chosen SAD
• Inexperience, insertion and fixation
• Use of second generation devices
• Problems during maintenance
• Problems at emergence, recovery or
removal

9. Patient Selection
• aspiration risk, predicted difficult airway,
urgent surgery, obesity

10. Limitation of use to appropriate surgery
• obese, lithotomy, head / down, very
prolonged, prone

11. Inexperience

12. Inexperience and Insertion

13. Maintenance

14. Emergence, Recovery or Removal

15. SAD - Themes
• Patient selection
• Limitation of use to appropriate surgery
• Understand limits of chosen SAD
• Inexperience, insertion and fixation
• Use of second generation devices
• Problems during maintenance
• Problems at emergence, recovery or
removal

16. Recommendations
• Laryngeal mask anaesthesia is a
fundamental skill
• Same attention to detail as intubation
– patient selection
– indications
– contraindications
– insertion
– confirmation correct position
– maintenance

17. Recommendations
• SAD use for difficult intubation, consider awake
FOI or FOI through SAD
• Difficult or failed SAD placement should raise the
possibility of complications during maintenance /
emergence / recovery
• Continuing anaesthesia with a suboptimal airway
after SAD insertion is not acceptable
• Recovery staff competent with SAD procedures
and timing of removal

18. Recommendation
• If tracheal intubation is not considered to be
indicated but there is some (small) increased
concern about regurgitation risk a second
generation SAD is a more logical choice than a
first generation one.
• Factors that mean use of SAD is at limits of
normality (prone, airway access, size) consider
second generation SAD
• All hospitals have second generation SAD’s
available for both routine use and rescue airway
management

19. Supraglottic Airway Devices
Nap4