Supraglottic Masked Airways have been in the U.S. market since the early 1990s.
- They are used as an alternative to the combination of face masks and other airway devices.
- Intubating Laryngeal Airways are inserted into the pharynx and create a low pressure seal around the laryngeal inlet in the pharynx.
- All alternative airways share the same basic principle – a tube delivers oxygen and/or gas without penetrating the vocal cords (glottis) hence the generic name supraglottic airways.
- These airways generally have one or two cuffs that inflate in the lower pharynx to create a seal enabling oxygen (gas) delivery.
- These devices are alternatives to ET tubes that penetrate the glottis and to mask ventilation.
- Supraglottic Airways provide an effective method of forming an airway during anesthesia in patients.
- These airways are more secure than a face mask while less invasive than intubation with an ET tube.
- They are used when tracheal intubation is not necessary or during an unexpected difficult airway situation.
- Patients requiring controlled or assisted-ventilation receive fresh gas through the airway connector.
- The growing popularity of these devices stem from their ease-of-use, their role in the difficult airway and the advantages they offer over the face mask and more invasive tracheal intubation.
ADVANTAGES OF Supraglottic airways over tracheal intubation with an ET tube
- Clinicians find they are quicker and easier to insert.
- Less resistance to breathing.
- Less incidence of sore throat.
- Smaller hemodynamic and respiratory response to insertion, maintenance and removal. This allows use of lighter levels of anesthesia agents than what might otherwise be necessary.
- Lower drug costs.
- Less trauma to the vocal tract than an ET tube.
- May be used in delivery of anesthesia, resuscitation, intensive care and management of the difficult airway.
- Color-Coded – 6 disposable air-Q sizes available (1.0, 1.5, 2.0, 2.5, 3.5, 4.5).
- Can be used for most adults, pediatric and infant patients.
- Generally the 3.5 is used on small adults or female patients and the 4.5 is used on large adults or male patients.
- They are available in ½ sizes since these fit a broader range of patients.
- Reusable air-Q is available in 4 sizes (2.0, 2.5, 3.5, 4.5) but sizes 1.0 and 1.5 will be available soon.
- Designed by an anesthesiologist following 8 years of clinical research.
- Infant sizes were designed specifically for the pediatric anatomy – not just miniature versions of adult airways.
- The air-Q should be used routinely as a classic passive airway.
- The air-Q is user-friendly, placement in patients is easy and air movement is outstanding.
- It has the added benefit of allowing for intubation using standard ET tubes.
- In addition to delivering oxygen and/or gas to the patient, the patented air-Q allows clinicians to intubate through it using a standard oral endotracheal tube (OETT sizes 4.0 8.5).
- Allows for air-Q removal after intubation. The user can easily remove the air-Q without dislodging the ET tube with the air-Q Removal Stylet.
- Alternatively, clinicians can choose to remove the ET tube and maintain the air-Q in place as the patient emerges from anesthesia with less bucking and straining with this exit strategy method.
- Single-patient-use availability offers the convenience of a disposable product while reducing concerns over cross-contamination issues.
QUICK TIP REFERENCE GUIDE
- Generally use size 3.5 for women and 4.5 for most men.
- Lubricate the back of air-Q and front ridges of mask cavity.
- Leave red tag on pilot balloon when inserting. After insertion, remove the red tag and add 3 5 cm air until firm bounce on pilot balloon is achieved.
- Use tongue depressor to lift tongue and get air-Q started.
- If the air-Q gets stuck during placement, put the left index finger behind the mask and use finger by pushing forward, to assist the mask around the corner.
- Do mandibular lift while passing air-Q into the pharynx.
- Check position of air-Q . . . patients incisors should be between 2 horizontal insertion marks indicated on air-Q.
- Place patients head in neutral position after placement.
Intubation through air-Q
Intubation through air-Q
- Tape air-Q into center of maxilla prior to intubation.
- Lubricate OETT liberally and lubricate inner portion of air-Q airway tube by sliding OETT up and down within tube several times.
- Pre-load OETT to 18 cm mark for 3.5 and 20 cm mark for 4.5.
- Pass a Fiber Optic scope through OETT – should see straight shot to glottis.
- If you do not immediately see the opening to the trachea and the cords, epiglottis most likely down-folded.
- Should epiglottic down-fold occur, deflate air-Q, back out about 2 – 3 inches, perform jaw lift and reinsert.
- Before first attempting blind intubation, look through air-Q a few times with Fiber Optic scope to see how air-Q lines up.
- On blind intubations, expect success on first pass about 60% – 70% of the time.
- If not successful, miss is usually low.
- Apply a little pressure over cricoid-thyroid area to lower inlet further into mask.
- Make sure the patients head is in neutral position.
- Make certain jaw lift is used during insertion.
- Make certain cuff is not over-inflated – check pilot balloon, if mushy, add a little air; if hard, remove air.
- Check position of air-Q . . . patients incisors should be between 2 horizontal insertion marks located on the air-Q.
- With air-Q inflated, pull back 1/4 to 1/2 inch.
- Consider using different size air-Q, depending on patient, go up or down 1 size.
- If small leak, check ETCO2 waveform and inspiratory pressure – may not be a problem if there is good ETCO2 and inspiratory pressure waveform.