scholarly journals Second Generation Supraglottic Airway (SGA) Devices

2020 ◽  
Author(s):  
Kriti Singh
Keyword(s):  
Clinical Practice ◽  
Tracheal Intubation ◽  
Airway Management ◽  
First Generation ◽  
Second Generation ◽  
Supraglottic Airway ◽  
Difficult Airway Management ◽  
Anaesthetic Care ◽  
Gastric Aspiration ◽  
Difficult Ventilation

Supraglottic Airways (SGAs) are an integral part of anaesthetic care. Since their introduction, several modifications, additions, and variations have been developed and are currently in clinical practice since the last 25 years. Not only are they useful for difficult ventilation during both in-hospital and out-of-hospital difficult airway management, they also act as a conduit for tracheal intubation. The newer or second-generation SGAs have been designed to provide a better seal of the airway and are relatively safer since they allow gastric aspiration. Thus, the SGAs may be the most versatile component in the airway management cart. Existing literature on SGAs tends to focus on first generation SGAs and their use in OT only. However, the scope and use of these devices is vast. Knowledge regarding specific devices and supporting data for their use is of utmost importance to patient’s safety. This chapter addresses various types of commercially available novel SGAs and their use in and out of hospital settings.

Airway Management in Children

2019 ◽  
Author(s):  
James Peyton ◽  
Raymond Park
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Fiberoptic Bronchoscopy ◽  
Difficult Tracheal Intubation ◽  
Airway Device ◽  
Successful Outcome ◽  
Supraglottic Airway ◽  
Supraglottic Airway Device ◽  
Factors Associated ◽  
Life Threatening

Airway management in children is usually very straightforward. Unfortunately, when it is not straightforward complications associated with problems encountered while managing the airway can be life-threatening. Airway management can be considered to consist of several different techniques for oxygenating and ventilating an anesthetized patient, namely mask ventilation, supraglottic airway device ventilation, and tracheal intubation. This chapter discusses these techniques and the factors associated with difficulty in performing them. There are anatomic features associated with difficulty in all of these techniques that are caused by syndromes or abnormal airway anatomy in children, although around 20% of difficult intubations are unanticipated. The majority of complications occur when attempting a difficult tracheal intubation. Morbidity and mortality relating to tracheal intubation correlate to the number of attempts at tracheal intubation. Severe hypoxia is estimated to occur in around 9% of children who are difficult to intubate and hypoxic cardiac arrest in nearly 2%, so the key to successful airway management is to focus on maintaining oxygenation and choosing a technique with the best chance of a successful outcome during the first attempt at airway management. This review contains 6 figures, 7 tables, and 41 references.  Keywords: cricothyrotomy, difficult airway, direct laryngoscopy, fiberoptic bronchoscopy, front of neck access, intubation, pediatric, videolaryngoscopy

scholarly journals The retrograde tracheal intubation technique for difficult airway management

2019 ◽  
Vol 3 (2) ◽  
pp. e16 ◽  
Author(s):  
Vincenzo Marchello ◽  
Ruggero M. Corso ◽  
Emanuele Piraccini ◽  
Alfredo Del Gaudio ◽  
Giuseppe Mincolelli ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
Difficult Airway Management ◽  
Intubation Technique

scholarly journals Clinical Massively Parallel Sequencing

2019 ◽  
Vol 66 (1) ◽  
pp. 77-88
Author(s):  
Ge Gao ◽  
David I Smith
Keyword(s):  
Clinical Practice ◽  
Dna Sequencing ◽  
Genome Sequencing ◽  
First Generation ◽  
Second Generation ◽  
Massively Parallel Sequencing ◽  
Massively Parallel ◽  
Parallel Sequencing ◽  
Near Term ◽  
Gene Panels

Abstract BACKGROUND The newest advances in DNA sequencing are based on technologies that perform massively parallel sequencing (MPS). Since 2006, the output from MPS platforms has increased from 20 Mb to >7 Tb. First-generation MPS platforms amplify individual DNA molecules to multiple copies and then interrogate the sequence of those molecules. Second-generation MPS analyzes single unamplified molecules to generate much longer sequence reads but with less output than first-generation MPS and lower first-pass accuracy. With MPS technologies, it is now possible to analyze genomes, exomes, a defined subset of genes, transcriptomes, and even methylation across the genome. These technologies have and will continue to completely transform the clinical practice. CONTENT The major first- and second-generation MPS platforms and how they are used in clinical practice are discussed. SUMMARY The ability to sequence terabases of DNA per run on an MPS platform will dramatically change how DNA sequencing is used in clinical practice. Currently, MPS of targeted gene panels is the most common use of this technology clinically, but as the cost for genome sequencing inches downward to $100, this may soon become the method of choice (with the caveat that, at least in the near term, clinical-grade genome sequencing with interpretation may cost much more than $100). Other uses of this technology include sequencing of a mixture of bacterial and viral species (metagenomics), as well as the characterization of methylation across the genome.

Unanticipated Difficult Airway in Anesthetized Patients

2004 ◽  
Vol 100 (5) ◽  
pp. 1146-1150 ◽  
Author(s):  
Xavier Combes ◽  
Bertrand Le Roux ◽  
Powen Suen ◽  
Marc Dumerat ◽  
Cyrus Motamed ◽  
...  
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Improve Patient Safety ◽  
Management Strategies ◽  
Adherence Rate ◽  
Difficult Airway Management ◽  
Intubation Technique ◽  
Management Processes ◽  
Intubating Laryngeal Mask Airway ◽  
Difficult Ventilation

Background Management strategies conceived to improve patient safety in anesthesia have rarely been assessed prospectively. The authors undertook a prospective evaluation of a predefined algorithm for unanticipated difficult airway management. Methods After a 2-month period of training in airway management, 41 anesthesiologists were asked to follow a predefined algorithm for management in the case of an unanticipated difficult airway. Two different scenarios were distinguished: "cannot intubate" and "cannot ventilate." The gum elastic bougie and the Intubating Laryngeal Mask Airway (ILMA) were proposed as the first and second steps in the case of impossible laryngoscope-assisted tracheal intubation, respectively. In the case of impossible ventilation or difficult ventilation, the IMLA was recommended, followed by percutaneous transtracheal jet ventilation. The patient's details, adherence rate to the algorithm, efficacy, and complications of airway management processes were recorded. Results Impossible ventilation never occurred during the 18-month study. One hundred cases of unexpected difficult airway were recorded (0.9%) among 11,257 intubations. Deviation from the algorithm was recorded in three cases, and two patients were wakened before any alternative intubation technique attempt. All remaining patients were successfully ventilated with either the facemask (89 of 95) or the ILMA (6 of 95). Six difficult-ventilation patients required the ILMA before completion of the first intubation step. Eighty patients were intubated with the gum elastic bougie, and 13 required a blind intubation through the ILMA. Two patients ventilated with the ILMA were never intubated. Conclusion When applied in accordance with a predefined algorithm, the gum elastic bougie and the ILMA are effective to solve most problems occurring during unexpected difficult airway management.

scholarly journals Tracheal Intubation with Aura-i and aScope-2: How to Minimize Apnea Time in an Unpredicted Difficult Airway

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Vittorio Pavoni ◽  
Valentina Froio ◽  
Alessandra Nella ◽  
Martina Simonelli ◽  
Lara Gianesello ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Tracheal Intubation ◽  
Airway Management ◽  
Difficult Airway ◽  
Laryngeal Mask ◽  
Difficult Airway Management ◽  
Ventilation Technique ◽  
The Subject ◽  
Airway Devices ◽  
Entire Procedure

The supraglottic airway’s usefulness as a dedicated airway is the subject of continuing development. We report the case of an obese patient with unpredicted difficult airway management in which a new “continuous ventilation technique” was used with the Aura-i laryngeal mask and the aScope-2 devices. The aScope-2/Aura-i system implemented airway devices for the management of predictable/unpredictable difficult airway. The original technique required the disconnection of the mount catheter from Aura-i, the introduction of the aScope-2 into the laryngeal mask used as a conduit for video assisted intubation and then towards the trachea, followed by a railroading of the tracheal tube over the aScope-2. This variation in the technique guarantees mechanical ventilation during the entire procedure and could prevent the risk of hypoventilation and/or hypoxia.

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