Supraglottic Airways

Question 1

How do we classify SGAs

Answer 1

Sealing mechanism (cuffless, perilaryngeal, pharyngeal)
Generation

Question 2

What are the advantages of second generation SGAs

Answer 2

Reduced aspiration risk
Higher seal pressures so can ventilate airway at a higher pressure
Bite block to prevent airway occlusion

Question 3

Why is a good SGA seal needed

Answer 3

Contributes to the amount of negative pressure generated during decompression phase of CPR

Question 4

Describe the steps of LMA insertion

Answer 4

Position airway
Lubricate
Pull jaw and tongue forward
Insert the LMA pressing against the hard palate and advancing
Inflate cuff
Ventilate with PEEP
Confirm placement with ETCO2 and chest rise

Question 5

How are iGels sized

Answer 5

3 yellow for adults 30-60kg

4 green for adults 50-90kg

Question 6

How are laryngeal tubes sized

Answer 6

3 yellow - adult 4-5ft
4 red - adult 5-6ft
5 purple - adult >6ft

Question 7

What are the guidelines surrounding choice of airway

Answer 7

Intubation should be attempted if HCP is trained and regularly practiced
LMA, iGel or laryngeal tube are acceptable alternatives

Question 8

What was the outcome of Airways2 trial

Answer 8

In a non-traumatic OHCA SGA and tracheal intubation give similiar neurological outcomes

Question 9

Compare the advantages of SGA over ET

Answer 9

Easy insertion
Faster insetion
Less airway trauma
Less haemodynamic changes during insertion

Question 10

Compare the disadvantages of SGA over ET

Answer 10

Aspiration risk
Risk of dislodging
Inadequate positive pressure ventilation

Question 11

Compare the LMA classic and LMA supreme

Answer 11

They are both cuffed perilaryngeal sealers
Classic - 1st generation with no oesophageal seal (aspiration) and low seal pressure
Supreme - 2nd generation with oesophageal seal. Reinforced cuff to prevent folding. Narrow curve for easier insertion

Question 12

Describe the iGel and it’s advatnages

Answer 12

2nd generation cuffless perilaryngeal sealer
Oesophageal seal for aspiration risk
Preshaped and cuffless for easy insertion and less tissue compression
Channel to insert gastric tube
Conduit for intubation

Question 13

Describe the air-q-sp

Answer 13

3rd generation cuffed perilaryngeal sealer
Positive pressure ventilation that self pressurises the cuff ie seal is increased during upstroke of ventilation and the cuff self deflated to level of PEEP on expiration

Question 14

Describe the laryngeal tube

Answer 14

Cuffed pharyngeal sealer with oesophageal cuffs

One cuff to block oro/nasopharynx and 2nd cuff to block oesophagus. Opening between 2 cuffs allows for ventilation

Question 15

What is the role of the iGel gastric channel

Answer 15

Early warnings of regurgitation

NG tube can be passed to empty the stomach and facilitate venting

Question 16

What is the role of the bite block of an iGel

Answer 16

Reduces the possibility of airway occlusion

Question 17

What is the role of the iGels epiglottic rest

Answer 17

Reduced possibility of epiglottic downfolding and airway obstruction

Question 18

What are the advantages of tracheal intubation

Answer 18

Secure
Prevent gastric distension
Protection from pulmonary aspiration
Optimal control of airway pressure
Provide PEEP

Question 19

How can you tell a tracheal tube is correctly placed

Answer 19

Laryngoscopic observation of it passing through vocal cords
ETCO2
Symmetrical chest wall rise
Mist in the tube during expiration
No gastric distension
Air entry heard on auscultation of the axilla
No air entry heard on auscultation of abdomen