This document discusses supraglottic airway devices. It begins by defining supraglottic airway devices as those that maintain airway patency by sitting just above the glottic opening without entering the trachea. It then classifies these devices based on generation, sealing mechanism, number of lumens, and other characteristics. Key devices discussed include the LMA Classic, Flexible LMA, ProSeal LMA, and Intubating LMA. Advantages and disadvantages of supraglottic airway devices are provided. Insertion techniques and signs of correct placement are also summarized.

1. SUPRA GLOTTIC
AIRWAY DEVICE
DR. DEBOJYOTI DUTTA
MODERATOR- DR.SUSHILBHAT
I
S.M.S. MEDICAL COLLEGE

2. INTRODUCTION
▶ Devices that are used to maintain the airway patency and provide
ventilation by placing just above the glottic opening.
▶ They sit outside the trachea and provide a hands free means of gas
tight airway.
▶ Standard of airway management , filling the niche between
facemask and tracheal tubes.
▶ Dr
. Archie Brain developed LMA in 1982 as a modification of
Goldman dental mask with ETtube.
▶ The first commercially available supraglottic airway device was LMA-
Classic(1988).

3. CLASSIFICATION
▶ Based on Generation:-
LMA
First Generation
Simple airway device.
Low pressure
pharyngeal seal
May ormay not protect
from aspiration.
Have no specific design
to lessen the risk.
Eg.-
cLMA
Flexible LMA
All LMs
Laryngeal tube
Cobra perilaryngeal
airway
Second Generation
Specially designed for
safety.
High pressure pharyngeal
seal.
Reduce the risk of
aspiration.
May be more efficacious
in ventilation.
Eg.-
PLMA,
Supreme LMA,
Laryngeal tube suction 2,
Laryngeal tube suction D,
i-gel,
SLIPA.

4. CLASSIFICATION
▶ Based on sealing mechanism –
1.Cuffed perilaryngeal sealer:-
Non-directional non esophageal Sealers- cLMA, Flexible LMA, LMA
unique.
Directional Non-esophageal sealing- Fastrach LMA, ALMA.
Directional esophageal sealing- Proseal LMA, Suprem LMA.
2.Cuffed pharyngeal sealer:-
Without esophageal sealing:COPA, PAX.
With esophageal sealing:Combitube, L
T
,L
TS.
3.Cuff less preshaped sealer: -
With esophageal sealing- Baska mask, i-gel.
Without esophageal sealing- SLIPA , AirQ-SP
.

5. CLASSIFICATION
▶ BASED ON THE NUMBER OF LUMEN-
1.Single Lumen Devices:-
LMA-classic, LMA-unique, LMA-flexible, ILMA, C-trach, Soft seal,
Laryngeal Airway Device(LAD), Ambu Laryngeal Mask,
Pharyngeal airway express(PAX), Cobra Perilaryngeal
Airway(CPLA), Laryngeal Tube(LT), Cuffed oropharyngeal airway,
Stream Lined Liner of the Pharyngeal Airway(SLIPA), Glottic
Aperture Seal Device.
2.Double Lumen Devices:- Proseal LMA, Combitube, Laryngeal
Tube Suction(L
TS), Airway Management Device(AMD).
3.Tripple Lumen Devices:- Elisha Airway Device(EAD).

6. INDICATION
▶ Alternative airway during GA specially in short surgical
procedures and minor therapeutic or diagnostic procedures
like radiation therapy, diagnostic and interventional
radiology, endoscopy, ECTetc.
▶ Cardiopulmonary resuscitation to secure the airway.
▶ Essential part of difficult airway trolley.
▶ Primary airway device when urgent airway patency is
required in lateral position as lessertime required to place
LMA in the lateral position as against endotracheal intubation
in this position.
▶ Relative indication- in professional singers to avoid vocal cord
trauma.

7. CONTRAINDICATION
▶
▶
▶
▶
Limited mouth opening (<2 fingers)
Local pathology in pharynx , larynx or upperairway.
Trismus,facial or upper airway trauma
Increase risk of aspiration- Morbid obese, >14 week pregnant,
prior opiods medication, delayed gastric empting, acute
abdominal or thoracic injury, history of GERD, and hiatus hernia.
▶ Reduced lung compliance/increase work of breathing

8. ADVANTAGES
 Increased speed and ease of
placement.
 Less requirement of expertise.
 Improved hemodynamic stability at
induction and during emergence of
anesthesia.
 Minimal IOP and ICP changes during
insertion.
 Increase airway tolerance.
 Lowerfrequency of coughing during
emergence.
 Improved oxygen saturation during
emergence
DISADVANTAGE
Inadequate positive
pressure ventilation.
More chances of aspiration
of gastric content.
Sore throat.
Vascularcompression and
nerve damage.

9. LMA- Classic
 Comprised of three main components
– Airway T
ube
– Mask
– Inflation line
 Maskdesigned to conform to the
contours of the hypopharynx with its
lumen facing the laryngeal opening.
 Made of medical grade silicone, it
can be autoclaved and reused many
times.
 Seal pressure =25cmH2O

10. SIZESELECTION
Mask Size Patient size /Body Weight Maximum Cuff
Inflation Volume (Air)
1 Neonates/Infants up to 5 kg Up to 4 mL
1.5 Infants 5–10 kg Up to 7 mL
2 Infants/Children 10–20 kg Up to 10 mL
2.5 Children 20–30 kg Up to 14 mL
3 Children 30–50 kg Up to 20 mL
4 Adults 50–70 kg Up to 30 mL
5 Adults 70–100 kg Up to 40 mL
6 Large Adults over 100 kg Up to 50 mL

11. PREPARATION PRIOR TO
INSERTION
▶ Select the propersize of LMA.
▶ Inspect the LMA for any tear , blockage .
▶ Slowly deflate the cuff to form a smooth flat wedge shape .
▶ Over inflate: look for leak.
▶ Use a water soluble lubricant to lubricate the posterior surface of LMA
just prior to insertion.
▶ Avoid excessive amounts of lubricant
-on the anterior surface of the cuff or
-in the bowl of the mask.
Avoid lignocaine jelly for lubrication .

12. INSERTION TECHNIQUE
▶ Position: Neck flexed and head extended.
▶ Use non-inserting hand to stabilize occiput.
▶ Jaw should be pulled down by assistant.
▶ LMA tube be grasped like a pen with index
finger pressing the point where tube joins
mask.
▶ Place the tip of the LMA against the inner surface
of the patient’s upper teeth.
▶ Aperture facing forward, the tip pressed
upwards against the hard palate.
▶ Mask is advanced into pharynx to ensure
that tip remains flattened and avoids the
tongue.

13. Continue..
▶ Neck iskept flexed and head extended.
▶ Press the mask into the posterior pharyngeal wall
using the index finger.
▶ Continue pushing with your index finger and
guide the mask downward into position.
▶ Grasp the tube firmly with the other hand and
then withdraw your index finger from the
pharynx.
▶ Press gently downward with your other hand to
ensure the mask is fully inserted.

14. Continue..
▶ Inflate the mask with the
recommended volume of air
.
▶ Do not over-inflate the LMA.
▶ Normally the mask should be
allowed to rise up slightly out of the
hypo pharynx as it isinflated to find
itscorrect position.
▶ Inserta bite-block or roll of gauze to
prevent occlusion of the tube.
▶ Now the LMA can be secured
utilizing the same techniques as
those employed in the securing of
an endotracheal tube.

15. OTHER METHODS OF
INSERTION
▶ 1. Thumb index method.
▶ 2.Partial inflation method.
▶ 3.180 degree rotation method.
▶ 4.Laryngoscopy aided method.
▶ 5.Stylet aided method.
▶ 6.Insertion from the side of the mouth opening.

16. SIGNS OF
CORRECT
PLACEMENT
 The slight outward movement of the tube
upon LMA inflation.
 The presence of a smooth oval swelling in
the neck around the thyroid and cricoid
area, or no cuff visible in oral cavity.
 Ventilate the patient while confirming equal
breath sounds over both lungs in all fields
and the absence of ventilatory sounds over
the epigastrium.
Part of LMA Position
Distal tip of
silicone cuff
Upper esophageal
sphinter
Sides of the cuff Pyriform fossa
Upper part of the cuff Tounge base

17. PROBLEMS
▶ Failure to press the deflated mask up against
the hard palate or inadequate lubrication or
deflation can cause the mask tip to fold back on
itself.
▶ Once the mask tip has started to fold over, this
may progress, pushing the epiglottis into its
down-folded position causing mechanical
obstruction .
▶ If the mask tip is deflated forward it can push
down the epiglottis causing obstruction
▶ If the mask is inadequately deflated it may
either
▶ push down the epiglottis
▶ enter the glottis.

18. INTUBATION WITHC-LMA
▶ 1.Blind intubation.
▶ 2.Fibrescope guided.
▶ 3.retrograde.
▶ 4.Lighted stylet guided.
▶ 5.Nasotracheal intubation.
DISADVANTAGES:-
1.Standard tube not long enough to insert.
2.Pilot tube may kincked.
3.Cricoid pressure make it difficult to pass the tube.
4.Paediatric-largest uncuffed tube too small to allow good seal for
PPV.
5.Removal of the LMA disturbs the ETtube
6. PPV not always possible due to moderate pharyngeal seal.
7.More riskof aspiration

19. Steps to reduce the chance
of aspiration
 Routinely test the cuff for defects before
use.
 Avoid lubricating the anterior surface of
the mask, since the lubricant may be
aspirated.
 Insert the LMA only when adequate
depth of anesthesia has been reached.
 Avoid disturbing the patient during
emergence from anesthesia.
 Keep the cuff inflated till the patient is
awake.
Action after aspiration
 Avoid in patients who are un-fasted, or
have factors predispose to regurgitation. 1. Do not attempt to remove
LMA.
2. Disconnect the circuit and
allow to drain the fluid while
head isdown & to the side.
3. Suction the LMA & give 100%
O2.
4. Ventilate manually with low
gas flow & small TV
.
5. Evaluate tracheobronchial
tree & suction the remaining
fluid with FOB.
6. Intubate when aspiration
below vocal cords.

20. LMA - UNIQUE
▶ Single use , PVC made ,
cheaper.
▶ Tube –stiffer , Cuff-less
compliant.
▶ Less rise of intracuff presuure
with N2O.
▶ More difficult to insert.
▶ Size same as cLMA.

21. FLEXIBLE LMA
▶ Flexometallic tube- narrower & longer.
▶ Has a rigid preformed angle at the cuff.
▶ Seal pressure=20cmH2O
▶ More difficult to insert.
▶ Introducer helps to stabilize the airway tube
during insertion & it is removed once mask is
in place.
▶ It has a less incidence of dislodgement once
placed.
▶ More useful in head & neck surgeries, ENT and
upper torso procedures where need to
reposition the airway is prevalent
▶ Problems-Disruption of spiral reinforce
wire, Increased airway resistance , limits
endoscope & tracheal tube passage ,
unsuitable forMRI.

22. AMBU AURA LARYNGEAL
MASK
▶ Ambu Auraonce- single-use LM with a
preformed curve.
▶ T
he Ambu Aura40 isthe reusable, silicone
version of the Ambu AuraOnce.
▶ The Ambu Aura-i designed to facilitate
intubation like ILMA.
▶ Three parts- an airway tube, a mount area,
and a bowl including the inflatable cuff..
▶ All these three areas are molded as single
unit for extra safety -no separation..
▶ Facilitate insertion without exerting force on
the upper jaw in neutral position.
▶ A reinforced tip reduces the risk of the
device folding back during insertion.
▶ integrated inflation line and no epiglottic
barsat the airway orifice.

23. SOFT SEAL LARYNGEAL MASK
▶ similar to the single-use LMA.
▶ The ventilation orifice iswider and it is
characterized by the absence of mask
aperture bars.
▶ Cuff ismore elliptical.
▶ insertion with the cuff partially inflated is
recommended.
▶ A maximum intracuff pressure of 60 cm
H2O isrecommended.
▶ may be used as an intubation conduit.
▶ The large bowl of the device and itsPVC
Construction inhibit easy insertion.

24. PERILARYNGEAL AIRWAY
⚫ single use, PVC made, latex free .
⚫ Ithas a breathing tube with a large inner
diameter to increase air flow.
⚫ Inthe proximal end it has a standard 15 mm
connection
⚫ Novel head design- Grill of soft bar with Cobra
head shape.
▶ Lies infront of laryngeal inlet.
▶ T
ip deflects epiglottis.
▶ Bars allow ventilation & instrumentation.
▶ Internal ramp to guide ETTto wards glottis
Proximal high volume low pressure cuff- seals
hypopharynx.
PLA offers a more effective seal, and a better
fiberoptic score as the c-LMA.

25. ADVANTAGES
1. Easy to insert.
2. Large lumen allows larger ETT&
fibrescope.
3. Sealing pressure higherthan C-
LMA.
4. Can be used forparcutaneous
dilatational cricothyroidotomy.
DISADVANTAGES
1. Less airway protection –
as tip liesabove the
oesophageal inlet.
2. Airway obstruction.

26. INTUBATING
LARYNGEAL
AIRWAY
▶ medical-grade silicon and latexfree.
▶ airway tube iscurved similar to the
anatomical curve of the upperairway
to eliminate the need to bend the tube
furtherduring use, which can lead to
kinking.
▶ Mask-keyhole outlet to direct ETTto
laryngeal inlet.
▶ 3 ridges –on inflation of mask, these
ridges move against the posterior
pharynx and improve anteriormask
seal.
▶ After intubation , ILA can be removed
without dislodging the ETTusing a
reusable "ILARemoval Stylet”.
▶ Low airway seal, high risk of aspiration.

27. INTUBATING LMA
▶ A modification of the c-LMA.
▶ A rigid (stainless steel) anatomically
curved,short & wide bored shaft that
followsthe anatomical curve of the palate
and the post pharyngeal wall.
▶ An epiglottic elevator bar at the mask
aperture
▶ Armoured flexible ETtube with a
longitudinal and a horizontal black line-
coincides with the epiglottic elevating bar.
▶ T
he StabilizerRod of 25cm.
▶ Seal pressure=60cmof H2O max.
Body
weight
ILMA size Air
volume
Tracheal
Tube
30-50kg 3 20ml 7mm
50-70kg 4 30ml 7.5mm
70-100kg 5 40ml 8mm

28. INSERTION
▶ Position: Neutral
▶ Hold rigid handle parallel to patient’s chest.
▶ Glide the mask along the palate till the straight part of the rigid tube is
parallel to the chin.
▶ Rotate the rigid handle directing towards patient’s nose till it can not
be advanced.
▶ Inflate the cuff & check ventilation.
▶ Introduce FETTwith black line faceing rigid handle till 15 cm mark.
▶ Now grip ILMA handle firmly and lift it forward by few mms without
levering.
▶ Advance the tube using clinical judgment.
▶ Inflate the cuff and check for tracheal intubation.

29. Continue..
▶ After confirmation of tracheal intubation deflate the ILMA cuff.
▶ Remove FETTconnector
▶ Insert the stabilizing rod in the FETTto keep it in place.
▶ Remove the ILMA gently over the stabilizing rod until it is clear of the
oral cavity.
▶ Stablize the FETTto prevent accidental extubation.
▶ Remove ILMA and the stabilizing rod.
▶ Reconnect FETTconnector and the breathing circuit and
▶ confirm position again

30. CHANDY’S MANEUVER
▶ They increases the seal pressure and aligns the axes of trachea and
FETT
.
▶ First step :Rotating ILMA in coronal & sagittal plane in an attempt to
find least resistant ventilation position.
▶ Second step :is to grasp the handle and use it to draw LMA forward
2-5 mm in a lifting action without levering teeth.

31. ADVANTAGES
⚫ Useful in “can’t intubate, can’t
ventilate” scenarios.
⚫ Allows fast insertion into correct
position without moving patient’s
head or neck.
⚫ Can be used alone or as a guide to
intubation.
⚫ Facilitates ventilation between ILMA
insertion and ETT insertion
⚫ Good conduit for fibreoptic
intubation in presence of blood or
clot in oral cavity.
⚫ Difficult laryngoscopic view is
irrelevent to the success of ILMA
intubation.
DISADVANTAGES
More likely to dislodge in head or
neck manipulation.
Unsuitable forMRI.
Difficulty in insertion with limited
mouth opening.
On removal of ILMA , tracheal tube
can be displaced downwards.

32. PROSEAL LMA
▶ Reusable , silicon made , most
specialized modification of c-LMA.
▶ Modifications:-
(i)oesophageal drain tube
(ii)posteriorinflatable cuff
(iii)reinforced airway tube
(iv) integral bite block
(v)introducer
Higherleak pressure(35cm of H2O)
than c-LMA(25cm of H2O).
Size-in 7 sizes(1-5) like the C-LMA with
drainage tube of
8,10,10,14,16,16&18 Fr respectively.

33. INSERTION
▶ (i) Standard: identical to the cLMA, but demanding
careful attention to detail.
▶ (ii) Introducer: a metal introducer is attached to
the concave side of the device. It is then
introduced in the same manner as an intubating
LMA.
▶ (iii) Bougie-guided: a bougie is placed upside down
into the oesophagus and the PLMA is railroaded
into place via the drain tube (suction catheters or
orogastric tubes are alternatives).This technique
had a significantly higher success rate.
▶ Positioning:- The easy passage of an orogastric
tube into the stomach via the oesophageal
tube has been shown to correlate with optimal
anatomical airway positioning over the larynx.

34. ADVANTAGES
▶ Increased airway seal improves the PPV.
▶ Decreased chance of aspiration-
1.Oesophageal opening isisolated from the airway.
2.Drain tube vents gas leaked into the oesophagus.
3.On regurgitation drain tube vents the fluid & small solid particles
beyond the pharynx.
4.The large bulk of the PLMA reduces the space available for
regurgitated fluid to ‘pool’.
5. Increased oesophageal and pharyngeal seal decreases the risk
of any pooled fluid entering the laryngeal inlet.
▶ Simple tests enable correct positioning of the PLMA to be confirmed.
▶ The stomach may be accessed with an orogastric tube.

35. DISADVANTAGES
▶ 1. Less suitable as an intubating device as an ILMA b/c narrow
airway tube.
▶ 2.Slightly longer time required to insert than C-LMA.
▶ 3.Can cause airway obstruction by- compression of supraglottic
structure or cuff in folding.
▶ 4.Contraindicated for intraoral surgery .

36. LMA - SUPREME
▶ Single use, PVC made 2nd
generation LMA.
▶ Has features of P-LMA, I-LMA & LMA
unique.
(i) Single use , PVC- (cf.LMA unique).
(ii)Large inflatable plastic cuff, but
no posteriorcuff (cf. PLMA)
(iii)Oesophageal drain tube
(iv)Preformed semi-rigid tube
(v)Fins in the mask bowl to prevent
epiglottic obstruction(cf. PLMA,
cLMA)
▶ Pharyngeal seal isintermediate
between cLMA and PLMA( 26–30
cm H2O)
▶ Oesophageal seal not reported.

38. ADVANTAGES
The reinforced tip reduces the risk
of fold-over
, compared with the
PLMA.
Anatomic curve that facilitates
easy insertion.
A drain tube to allow gastric
which generates higher seal
pressure (36.1 vs 27.4cm H20 of
LMA unique).
▶ A built-in bite block and fixation
tab to help secure the airway
▶ 4- An oval airway crosssection
forimproved stability of the
airway
DISADVANTAGES
drain tube runs through the middle
of the airway tube (rather than
next to it in the PLMA) dividing it
into two narrow lumens.This limits
itsuse forairway inspection
aspiration. and foruse as a conduit for
▶ A high volume/ low pressure cuff intubation.
Being made of PVC, the SLMA
may cause more trauma than
silicone devices

39. LMA C Trach
• The LMA CTrach system is a new system for
airway management and endotracheal
intubation.
• It is based on the ILMA (LMA Fastrach)
system with two in-built fiberoptic channels,
one to convey light from and the other to
convey the image to the viewer.
• This fiberoptic system is sealed and robust,
and the Ctrach can be autoclaved.
• The CTrach has an epiglottis elevating bar,
which elevates the epiglottis during passage
of the ETT through the Ctrach into the
larynx.
• A rechargeable battery is provided for up to
30 minutes of continuous use. A charger
cradle for recharging the viewer is included
in the system

40. LMA C-Trach
▶ Enables combined ventilation,
visualization, and intubation.
⚫ High first attempt intubation success rate
of 91%
.
⚫ Fiberoptic technology allows real time
visualization of the glottic opening and
of the ETtube passing through the vocal
cords.
⚫ Ideal in rescue/difficult airway situations
⚫ Completely portable and wirelesssystem
weighs less than eight ounces.
⚫ Easy to learn and very effective

41. INSERTION
▶ Inserted exactly the same as the LMA Fastrach.
▶ Once the airway is secured and patient is being ventilated
▶ The viewer is switched on, placed in the magnetic connector and a clear
image of the larynx is displayed in real time.
▶ The ET tube can be viewed as it enters the trachea. Once the patient is
intubated, the viewer is removed and the mask is removed leaving the ET
tube in place.
▶ Problems:-
1. Ithas a poorer image quality than a flexible fiberoptic endoscope.
2.Itcannot be used easily in the patient with a limited mouth
opening.
3. The view may be obstructed by secretions, lubricant, or blood.

42. i-GEL
▶ Novel SAD designed by UK anaesthetist,
Muhammed Nasir
.
▶ (i) Single use.
▶ (ii) Cuffless:the mask ismade of a soft
polymer and isshaped similarly to an
inflated LMA posteriorly with itsanterior
shape designed to ‘fit the perilaryngeal
structures’.
▶ (iii) Narrow-bore oesophageal drain
tube.
▶ (iv) Short, wide-bore airway tube.
▶ (v) Integral bite block
▶ (vi) Contains an epiglottic rest at the
anteriorpart of the cuff which reduces
the possibility of epiglottis ‘down folding’
and airway obstruction.

44. Continue…
▶ Mask ismade of a thermoplastic elastomer (SEBS-StyreneEthylene
Butadiene Styrene) that has the flexibility and feel of human tissue. .
After placement, body heat from the patient activates the gel component of
this airway which expands to fill the void in the hypopharynx where the
device rests.
Advantages:-
▶ 1. easy to insert: due to a combination of a very,very low coefficient
of friction when lubricated & absence of cuff.
▶ 2. truncated tip, with the aim of reducing post-use dysphagia.
▶ 3. wide lumen make it well worth for both airway rescue and as a
conduit forassisted intubation.
▶ 4. A gastric channel allows for suctioning and placement of a
nasogastric tube.
▶ 5.Though oesophageal seal islow but enough (according to the
manufacturer).

45. LARYNGEAL TUBE
multiuse, latex-free, single-
lumen silicon tube
two low pressure cuffs
(proximal and distal).
▶ The distal balloon
(esophageal balloon) seals
the airway distally
▶ The proximal balloon
(oropharyngeal balloon)
sealsboth the oral and nasal
cavity.
▶ Two anterior,oval ventilating
ventsbetween the cuffs.
▶ Cough pressure 60cmH2O
▶ 4 types-L
T
,L
T
-D, L
TS-II, L
T
s-D

47. INSERTION
▶ Open the mouth app. 3 cm using
the thumb and index finger
technique in neutral position of
head.
▶ Hold like a pen in the area of the
teeth marks(three black marks).
▶ Insert centrally along the hard
palate into the hypopharynx.
▶ Advance until a slight resistance is
felt. The center black line should n
be level with the upper front teeth.
▶ Inflate the cuffs considering the
respective colour code.
▶ Connect bag to the 15 mm
standard connector.
▶ place the tube deeper, inflate the
cuffsand withdraw until ventilation
isoptimized results in the best depth
of insertion because tissue is
retracted away from the laryngeal
inlet.

48. SIZE VOLUME(ml)
0 10
1 20
2 35
2.5 45
3 60
4 80
5 90

49. ADVANTAGES
1. Easy insertion.
2. 2.High ventilation pressure can
be used.
3. Better protection from
aspiration.
4. Can be used to intubate the
trachea.
DISADVANTAGES
1.Airway obstruction.
2.Displacement on head &
neck movement.
3. Cuff rupture
4. T
rauma to pharynx.

50. ESOPAHGEAL- TRACHEAL
COMBITUBE
▶ PVC double lumen supraglottic
airway device with two inflatable
balloons
▶ 2 Lumens:tracheal and pharyngeal
▶ Ventilation -eithertracheal or
esophageal intubation
▶ 95%of casestube enters the
esophagus
▶ Proximal balloon-seals the oral and
the nasal cavity
▶ Distal balloon - sealseitherthe
esophagus or the trachea,
depending on which of these the
ETC has been sited.
▶ Size-37 Fr for height up to 5 ft.
▶ 41 Fr for height above 5.5 ft.
▶ Between 5-5.5ft – either of these.

51. INSERTION
▶ Neutral position. Lift the tongue and
lower jaw upward to open the
oropharynx .
▶ Lubricate the tube with sterile, water
soluble lubricant.
▶ Insert the Combitube so that it curves in
the same direction as the natural
curvature of the pharynx .
▶ If resistance ismet, withdraw tube and
attempt to reinsert.
▶ Advance tube until the patient’s teeth
are between the two black lines.
▶ Inflate the blue pilot cuff with 100ml of
airfrom the large syringe.
▶ Inflate the white pilot cuff with 15ml of
airfrom the small syringe.
▶ Begin ventilation through the longer
tube . If auscultation of breath sounds is
good and gastric inflation isnegative,
continue and vice versa.

53. INDICATION
1. Patientsin irreversible
respiratory arrest (i.e.
narcotic overdose,
hypoglycemia).
2. Patientsin cardiac arrest.
3. Ventilation in
normal/abnormal airways
4. Failed intubation
5. Unconscious patientswithout
a gag reflex, and in need of
ventilatory support
CONTRAINDICATION
1. Intact gag reflex
2. Under 4 feet tall & Under 16
years of age
3. Conscious –arouseable
patient
4. Known esophageal disease
(cancer, varices)
5. Ingestion of caustic
substances
6. Stoma or functional surgical
airway
7. Partial or complete FBAO
8. CONS
IDER:Latex Allergy

54. ADVANTAGES
1. Requires minimal training
2. May be more useful in non-
fasted patients
3. Successful passage and
ventilation in many patients via
esophageal route
4. Portable, useful in remote
setting
5. Functions in eitherthe trachea
or esophagus
DISADVANTAGES
1. Only adult and small adult
sizes
2. Potential foresophageal
trauma
3. Problems maintaining
seal in some patients

55. EASY TUBE
▶ The Easy Tube isnew disposable,
polyvinyl -chloride, double-lumen,
latex-free, supra-glottic airway
device.
▶ It has a close design to the
Combitube, intended to be more
friendly to use.
▶ Allows ventilation in either
esophageal or tracheal position,
however it isexpected to enter the
esophagus in most cases.
▶ However, the Easy Tube had a better
fiberoptic view and a shorter time to
achieve an effective airway, with
similar ventilatory performanceswith
the ETC

56. STREAMLINED LINEROF
THE PHARYNGEAL
AIRWAY
.
▶ Plastic made, uncuffed, disposable ,2nd
generation SAD.
▶ Anatomically pre-shaped to line the
pharynx.
▶ Hollow & boot shaped distal part-
1
. T
oe- rest in the oesophageal entrance
2. Bridge- fits to the pyriform fossa.
3. Heel- anchor in correct position &
connect the airway tube.
4
. T
wo lateral bulges- relieve pressure on
Hypoglossal& recurrent laryngeal NV.
5. Large capacity chamber-store
regurgited fluid.
Available in 6 sizes- relate to dimension
across the bridge: 47, 49, 51, 53, 55, and
57 mm.

57. ADVANTAGES
1. Easy to insert.
2. Greater airway sealing pressure.
3. N2O has no effect on sealing
pressure-as no cuff.
4. Effective protection against
aspiration during PPV
CONTRAINDICATED
Upperairway
abnormality.

58. CUFFED OROPHARYNGEAL
AIRWAY
⚫ PVC made , single use ,1st generation.
▶ The distal cuff inflate below the soft
palate, behind the tongue,above the
epiglottis, and within the oropharynx.
▶ Available in five sizes: 7, 8, 9, 10, and 11
cm length with cuff inflation volume of 20,
25, 30, 35, and 40 ml respectively.
▶ Insertion like Gudel’s oropharyngeal
airway.
▶ COPA isrecommended foruse in
spontaneously breathing patients with no
risk factorsforaspiration.
⚫ It isquick and easy to place.
⚫ Easy size selection & low cost.
⚫ Less airway protection

59. ELISHA AIRWAY DEVICE
▶ Silicon made , latex free, latest.
▶ three separate channelsforventilation,
intubation, and gastric tube insertion.
▶ Ventilation channel (VC) and
Intubation channel (IC) are side-by-side
but join at the ventilation outlet situated
in front of the laryngeal inlet.
▶ The VC has a standard 15 mm
connector at th proximal end.
▶ The IC allows passage of an 8.0 mm ET
tube forblind orfiberoptic-guided
intubation.
▶ Gastric tube channel (GTC) has an
outlet located in the distal end of the
device.

60. ▶ Two high-volume, low-pressure cuffs.
▶ Proximal cuff seals the oropharynx and nasopharynx & distal
cuff sealsesophagus.
▶ Both are inflated through a single pilot port with 50 cc of air
resulting in an intra-balloon pressure of approximately 70 cm
H2O.
▶ Provide combination of 3 functions in a single device:
ventilation, intubation (blind and/or fiberoptic-aided) without
interruption of ventilation, and gastric tube insertion.

61. OTHER NEWER SAD
▶ EldorLaryngeal Airway.
▶ Glottic Aperture Seal Airway.
▶ Glossopalatine Tube. Etc.

62. EFFICACY VS SAFETY
▶ For the evaluation of efficacy (absolute & relative ) small clinical
trialscan be used.
▶ Contrary, evaluations of safety (like ventilation failure rates , more
pertinently the risk of aspiration ) may need studies in larger scale
with larger populations.
▶ Therefore the risk profile of a new device (unless it is particularly
unsafe) isunlikely to be established for several years after
introduction.

63. SUMMARY
▶ There is no solid evidence of any device performing better than
the classic LMA among the first generation SADs.
▶ In the second-generation SADs-The PLMA proved top be very
efficacious and safe in both routine and advanced uses
▶ SAD with a drain tube has become the first choice as the
standard of care.
▶ OthernewerSADs like i-gel, SLMA, and L
TS-IIhave increasing
positive evidence of their superiority.
▶ All these developments in the field of SAD paved the way to take
an ever larger role in modern airway management.