Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position: A randomized crossover manikin study. Issue 25 (June 2018)

• Record Type: Journal Article
• Authors: Oshika, Hiroyuki; Koyama, Yukihide; Taguri, Masataka; Maruyama, Koichi; Hirabayashi, Go; Yamada, Shoko Merrit; Kohno, Masashi; Andoh, Tomio
• Other Names: Ting. Chien-Kun section editor.
• Is Part Of: Medicine. Volume 97:Issue 25(2018)
• Publication Date: 2018-06
• Subjects: accidental extubation -- prone position -- supraglottic airway device -- videolaryngoscope; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000011190
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Background: It is very rare but challenging to perform emergency airway management for accidental extubation in a patient whose head and neck are fixed in the prone position when urgently turning the patient to the supine position would be unsafe. The authors hypothesized that tracheal intubation with a videolaryngoscope would allow effective airway rescue in this situation compared with a supraglottic airway device and designed a randomized crossover manikin study to test this hypothesis. Methods: The authors compared airway rescue performances of the 3 devices—the ProSeal laryngeal mask airway (PLMA; Teleflex Medical, Westmeath, Ireland) as a reference; the Pentax AWS (AWS; Nihon Kohden, Tokyo, Japan) as a channeled blade-type videolaryngoscope; and the McGRATH videolaryngoscope (McGRATH; Medtronic, Minneapolis, MN) as a nonchanneled blade type in a manikin fixed to the operating table in the prone position. Twenty-one anesthesiologists performed airway management on the prone manikin with the 3 devices, and the time required for intubation/ventilation and the success rates were recorded. Results: The median (range) intubation/ventilation times with the PLMA, AWS, and McGRATH were 24.5 (13.5–89.5) s, 29.9 (17.1–79.8) s, and 46.7 (21.9–211.7) s, respectively. There was no significant difference in intubation/ventilation times between the PLMA and AWS. The AWS permitted significantly faster tracheal intubation than did the McGRATH (P = 0.006). The success rates with the PLMA (100%) and AWS (100%) were significantly greater than that with the McGRATH (71.4%). Airway management performance of the PLMA and AWS was comparable between devices and better than that of the McGRATH in the prone position. Conclusions: Considering that tracheal intubation can provide a more secure airway and more stable ventilation than the PLMA, re-intubation with a channeled blade-type videolaryngoscope such as the AWS may be a useful method of airway rescue for accidental extubation in patients in the prone position.